April 2024 | Educational Supplement
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Efficacy and flexibility of SIRT with SIRSpheres® for treatment of HCC and liver metastases from mCRC raised at SUMM90YT conference In a dynamic two-day scientific programme, the SUMM90YT conference (23 February, Frankfurt, Germany), hosted by Sirtex, brought together key opinion leaders in selective internal radiation therapy (SIRT) using SIR-Spheres Y-90 resin microspheres (Sirtex Medical), for a multidisciplinary discussion and debate on patient selection in hepatocellular carcinoma (HCC) and metastatic liver tumours from primary colorectal cancer (mCRC) refractory to or intolerant of chemotherapy, and technical advancements to date.
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he SUMM90YT programme was sectioned into three distinct sessions— SIRT in HCC, SIRT in mCRC and key technical aspects of the procedure. Aiming for a rounded scientific exchange set against the backdrop of a simulated multidisciplinary tumour board, sessions were chaired by medical oncologist Elena Elez (Vall d’Hebron University Hospital, Barcelona, Spain), surgeon Giuseppe Maria Ettorre (San Camillo-Forlanini Hospital, Rome, Italy), interventional radiologist Peter Reimer (Städtisches Klinikum Karlsruhe, Karlsruhe, Germany), nuclear medicine physician Macarena Rodríguez-Fraile (Clínica Universidad de Navarra, Pamplona, Spain), and hepatologist Chris Verslype (UZ Leuven, Leuven, Belgium).
SIRT for HCC
First to present was liver surgeon Claire Goumard (University Hospital Pitié Salpêtrière, Paris, France), who spoke on the curative potential of SIRT in early HCC. Primarily, Goumard drew the audience’s awareness to the current guidelines, detailing the 2022 update of the Barcelona Clinic Liver Cancer (BCLC) staging system, which recommended SIRT—or TARE (transarterial radioembolization)—for patients with a single lesion of less than 8cm who are not suitable for resection or transplantation. The main aim of this recommendation was to achieve successful downstaging to surgery. Looking closely at SIRT and its benefits prior to resection, Goumard then addressed challenges that can arise typically in a neoadjuvant setting, where patients are borderline surgical candidates with large tumours, portal vein thrombus, and/or small future liver remnant (FLR). “The goal of SIRT in this setting is to lower tumour load”, she added, “to diminish tumoral thrombus extent,
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and/or induce FLR hypertrophy to reduce surgical risk”. “The specificity of SIRT is you have to wait,” Goumard said, noting that three months must be met as a minimum to see treatment response and preferably six months to obtain liver hypertrophy—“the more you wait, the less mortalities you have”, the speaker asserted. But, she added that oncological selection in these borderline patients has the “test of time” on its side so that futile major resections can be avoided. Then, considering the advantages of SIRT prior to transplantation, Goumard first noted that radioembolization is often in competition with other locoregional therapies, such as transarterial chemoembolization (TACE), as a bridging treatment. Finally, Goumard presented SIRT as a method of downstaging patients to transplantation. She referenced a small study carried out by her team led by Amel Mejait (University Hospital Pitié Salpêtrière, Paris, France), in which 27 patients underwent SIRT, and eight received SIRT combined with atezolizumab-bevacizumab in a downstaging setting. Their findings show that eight patients (23%) were successfully downstaged—four of whom underwent liver transplantation and four subtotal hepatectomy—which Goumard
believes places SIRT firmly within the armoury of bridging treatments. “We really believe that the association of SIRT and successful downstaging/resection may be quite powerful, but of course this needs to be confirmed,” Goumard said. Following Goumard, interventional radiologist Irene Bargellini (Cuneo Hospital, Cuneo, Italy) assessed the applicability of SIRT for intermediate to advanced stage HCC. Recent research has shifted from stage classifications to a ‘therapeutic hierarchy’ in HCC treatment. “This is a big evolution,” Bargellini stated, “this reflects what we do in practice and promotes the consideration of every treatment at each stage of disease”. Bargellini noted a proposal published in The Lancet Oncology in 2023 by Alessandro Vitale et al (University of Padova, Padova, Italy), which outlines a multidisciplinary multiparametric approach which can provide greater granularity over inclusion criteria to enable better selection of patients for SIRT. The proposal detailed that patients’ fitness, comorbidities, critical tumour location, liver functional parameters, specific technical constraints, and resource availability are central factors to consider in the Continued on page 2
This educational supplement has been sponsored by Sirtex