Despite some limitations, the research by Yoon and colleagues provides “much-needed prospective data” suggesting that multimodality therapy may improve the dismal prognosis of patients with hepatocellular carcinoma (HCC) with portal venous invasion, according to authors of an editorial on the study.
“Existing treatments demonstrate poor efficacy for HCC with portal venous invasion, with subgroup analyses in early major prospective trials showing modest, if any, benefits of therapy beyond the natural history of the disease,” wrote editorial authors Khashayar Farsad, MD, PhD, Charlotte E. Costentin, MD, and Andrew X. Zhu, MD, PhD.
The data from Yoon et al. not only support a role for locoregional therapy in this challenging patient subgroup, but also suggest external beam radiotherapy is an “asset in the locoregional therapy toolbox,” they wrote.
In the study, use of transarterial chemoembolization (TACE) plus external beam radiotherapy improved the primary endpoint of 12-week progression-free survival versus sorafenib (86.7% versus 34.3%, respectively; P less than .001), among other improved outcomes, they noted.
That is “impressive” but certain caveats must be considered if extrapolating the data from this small study to clinical practice, they added. For example, most of the patients had liver disease related to hepatitis B virus; compared with patients with liver disease related to hepatitis C virus, that subset of patients may have worse outcomes on sorafenib, the authors wrote.
The TACE protocol used in the study included cisplatin, which is not universally used because of availability or practice patterns, they added. Moreover, a median of four treatments were delivered, while many centers use repeat TACE only when needed (e.g., due to residual disease).
Limitations aside, the study results provide prospective evidence that more effective treatment strategies for HCC with portal venous invasion may be established, according to the authors.
“For those of us managing these patients daily in our clinics and procedure suites, it is encouraging to know there is hope ahead,” they said. “Work in this realm is just beginning, highlighting the need for additional prospective studies to validate and optimize these findings in other patient populations.”
Dr. Farsad is with the Charles T. Dotter Department of Interventional Radiology, Oregon Health & Science University, Portland. Dr. Costentin and Dr. Zhu are with Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston. These comments are derived from their editorial (JAMA Oncol. 2018 Mar 15. doi: 10.1001/jamaoncol.2018.0007). The authors reported no conflict of interest disclosures related to their editorial.
