Inside access JVIR spotlight
Multidisciplinary Delphi consensus on safety of combining transarterial radioembolization with yttrium-90 microspheres with systemic anticancer agents for the treatment of liver malignancy
Andrew Kennedy, MD, et al. JVIR. 2024;35(9):1253–1267.e1 This is an open access article.
Tell us about you, your research team and your institution. Andrew Kennedy, MD: I have the privilege of working in a busy radiation oncology clinic serving adults and pediatric patients with a variety of cancer diagnoses. Over the years it has been a distinct honor to collaborate with these well-known and outstanding physician researchers who also share an interest in liver-directed therapies for malignancies. Our coauthors represent the complement of specialists that most hepatobiliary cancer multidisciplinary teams contain, with the addition of a pharmacist who is a senior leader of an extensive first-in-man and phase I/II clinical trialist network. The institutions of our investigators range from community practice to high-level urban academic centers in the U.S. and EU.
Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) diagram for literature review.
What was the focus of your study? AK: Our intent was to provide a consensus of expert opinions regarding the most common clinical scenarios facing practitioners today to deliver effective and safe ways of combining systemic agents and Y-90 transarterial radioembolization (TARE).
"Inside access" provides interviews and background on open access and featured articles from the Journal of Vascular and Interventional Radiology. This issue brings you two articles from fall 2024. Read the full articles on
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Why did you set out to research this topic? AK: Despite the hundreds of published papers related to utilizing Y-90 TARE for hepatic malignancies, there is not adequate, high-level medical evidence to inform us on the optimal way to use hepatic radioembolization with concurrent systemic therapies. It is exciting to gain new and effective systemic agents for liver cancers, and an obvious next step to consider is how we can combine the best-known approaches for unresectable hepatic cancers with these new drugs. Often the oncology community codevelops best practices in lieu of high-level medical evidence; we share what experience we have with each other broadly and learn from this collective
experience to avoid complications and improve therapeutic outcomes.
What were the key takeaways? AK: It was our intent to highlight safety recommendations. This includes not just a sequence of agents with Y-90, but the exclusion of untested classes of drugs that might reasonably be considered by teams (but could lead to unintended and severe toxicities).
In metastatic colorectal cancer patients, we believed it is important to emphasize the medical evidence supporting multiagent chemotherapy with Y-90. But also, these data include a dose reduction or omission of a key agent—oxaliplatin— and proper washout of epidermal growth factor agents (cetuximab and panitumumab) and vascular endothelial growth factor inhibitor (bevacizumab) before exposing liver to radiotherapy.
In hepatocellular carcinoma, improved outcomes with use of anti-PD-1 and anti-CTLA-4 agents plus tyrosine kinase inhibitor along with Y-90 TARE is a common clinical inquiry. Encouraging medical evidence supports using
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