Top Line: Does trans-arterial radioembolization (TARE) of colorectal cancer liver metastases improve survival after progression on first-line chemo?
The Study: A combined analysis of 3 randomized trials (FOXFIRE, SIRFLOX, and FOXFIRE-Global) showed that the addition of TARE using Yttrium-90 to first-line FOLFOX chemo did not improve overall survival in patients with liver-only or liver-dominant metastatic disease. The EPOCH trial was a phase 3 study that randomized 428 patients with colorectal cancer liver-only metastases who progressed on first-line chemotherapy to second line chemo with or without trans-arterial radioembolization (TARE) using Yttrium-90 (TheraSphere). While confirmed extrahepatic disease wasn’t allowed, 49% had indeterminate extrahepatic lesions. In the TARE arm, TARE was delivered prior to 2nd line chemo, although 1 cycle was allowed during treatment planning. Most patients (82%) had bilobar disease and 76% of those received treatment to both lobes on the same day. The majority of patients with unilobar disease (74%) received unilobar treatment. The addition of TARE to 2nd line chemo significantly improved median PFS from 7.2→ 8 months and median hepatic PFS from 7.2→ 9.1 months. Response rate was also improved with TARE from 21→ 34%. This benefit was mainly seen in patients with KRAS mutation, left sided tumors, small volume of disease, and resected primary disease. There was no improvement in overall survival. In addition, the rate of grade 3 toxicity was higher with TARE (68%) than with chemo alone (49%).
TBL: The addition of TARE to 2nd line chemotherapy modestly improves PFS by < 1 month (and doesn’t improve OS) in patients with colorectal cancer liver metastases who progress on 1st line chemotherapy. | Mulcahy, J Clin Oncol 2021