Author information

¹Radiation Oncology, Sarah Cannon Research Institute, Nashville, TN, USA. Electronic address: andrew.kennedy@sarahcannon.com.

²Interventional Radiology, Vanderbilt University Medical Center, Nashville, TN, USA.

³Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center Duarte, Duarte, California, USA.

⁴TCU Burnett School of Medicine, Fort Worth, TX, USA.

⁵Drug Development, Sarah Cannon Research Institute, Nashville, TN, USA.

⁶University of British Columbia, Faculty of Medicine, School of Biomedical Engineering, Vancouver, BC, Canada.

⁷Department of Surgery & Cancer, Imperial College London, Hammersmith Hospital, London, UK; Division of Oncology, Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy.

⁸Liver Unit, Clinica Universidad de Navarra and CIBEREHD, Pamplona-Madrid, Spain.

⁹Department of Radiation Oncology, WellSpan Cancer Center, York, PA.

¹⁰Interventional Radiology, Stanford University, Palo Alto, CA, USA.

¹¹Digestive Oncology, University Hospitals Leuven and KU Leuven, Leuven, Belgium.

¹²Department of Cancer Medicine, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, UK.

Abstract

Purpose: To provide guidance, via multidisciplinary consensus statements, on the safety interactions between systemic anticancer agents (such as radiosensitizing chemotherapy, immunotherapy, targeted therapy and peptide receptor radionuclide therapy) and transarterial radioembolization (TARE) with yttrium-90 (⁹⁰Y) labeled microspheres in the treatment of primary and metastatic liver malignancies.

Materials and methods: A literature search identified 59 references that informed 26 statements on the safety of ⁹⁰Y TARE combined with systemic therapies. Modified Delphi method was used to develop consensus on statements through online anonymous surveys of the 12 panel members representing the fields of interventional radiology, medical oncology, surgical oncology, hepatology, and pharmacy, focusing on hepatocellular carcinoma (HCC), metastatic colorectal cancer (mCRC), neuroendocrine tumors, metastatic breast cancer and intrahepatic cholangiocarcinoma.

Results: High level evidence was limited. Level 1 data in patients with mCRC suggest that some radiosensitizing chemotherapies (e.g., oxaliplatin) require temporary dose reduction when used concomitantly with ⁹⁰Y TARE and some targeted therapies (e.g., vascular endothelial growth factor inhibitors and anti-angiogenic tyrosine kinase inhibitors) should be avoided for at least 4 weeks before ⁹⁰Y TARE. In patients with HCC, the feasibility of ⁹⁰Y TARE and immunotherapy has been demonstrated with Level 4 evidence. Data are more limited for other primary and secondary liver malignancies, and consensus statements were driven by expert opinion (Level 5).

Conclusion: Given the absence of evidence-based guidelines on the safety of ⁹⁰Y TARE in combination with systemic anticancer therapy, these consensus statements provide expert guidance on the potential risks when considering specific combinations.