Yttrium Radioembolization with Second-Line Chemotherapy in CRC

Transarterial Yttrium-90 radioembolization (TARE) is a treatment option for patients with refractory colorectal cancer and unresectable liver-confined metastases. In a recent randomized trial, combining regional radioembolization with chemotherapy in the first-line treatment of metastatic colorectal cancer failed to improve survival over chemotherapy alone (NEJM JW Oncol Hematol Nov 2017 and Lancet Oncol 2017; 18:1159)

Investigators now report results of an industry-sponsored, multicenter, open-label randomized phase 3 trial evaluating the addition of TARE to second-line chemotherapy in metastatic colorectal cancer with liver-dominant metastatic disease. Of 428 patients randomized, median age was 61, 36% had the primary tumor in place, 26% had right-sided primaries, 64% had extrahepatic metastases, 47% had KRAS mutant status, and 59% received irinotecan-based chemotherapy.

Progression-free survival (PFS), a coprimary endpoint, favored TARE/chemotherapy over chemotherapy alone (median, 8.0 vs. 7.2 months; hazard ratio, 0.69; 1-sided P=0.0013). The second coprimary endpoint, hepatic PFS, also favored combination therapy (median, 9.1 vs. 7.2 months; HR, 0.59; 1-sided P< 0.0001). Overall survival, however, did not differ with TARE or chemotherapy alone (median, 15.2 and 14.3 months; HR 0.96; P=0.3841). Incidence of grade 3/4 adverse events was higher with TARE (68.4% vs. 49.3%) and there were more grade 5 events in the TARE arm (8 vs. 4). No cost analysis or quality-of-life data were presented.