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Updated: Jun 3, 2025
Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma
Published on: May 24, 2024
Safety and Effectiveness of Yttrium-90 Radioembolization in People Living with Human Immunodeficiency Virus
Kartikeya M Menon1, Ricki A Gottlieb1, Thomas Marron2
1Division of Vascular and Interventional Radiology, Mount Sinai Hospital, New York, New York.
Purpose:
To investigate whether yttrium-90 (90Y) transarterial radioembolization (TARE) is a safe and effective treatment in people living with human immunodeficiency virus (PLWH) with hepatocellular carcinoma (HCC) across the Barcelona Clinic Liver Cancer stage spectrum.
Materials And Methods:
A retrospective review was conducted of all patients with HCC presented at a multidisciplinary institutional liver tumor board who underwent 90Y TARE between January 2014 and June 2023. Thirty-nine patients with documented human immunodeficiency virus (HIV) seropositivity prior to 90Y TARE and adherence to highly active antiretroviral therapy were included. For 19 patients (48.7%), cluster of differentiation 4 (CD4) and total lymphocyte counts and HIV viral load polymerase chain reaction data were collected before and after 90Y TARE within 12 weeks of therapy. The Kaplan-Meier analysis was used to compute median overall survival (OS) and the Fine-Gray subdistribution hazard model was used to estimate progression-free survival (PFS). Imaging response was assessed by the modified Response Evaluation Criteria in Solid Tumours (mRECIST), and adverse events (AEs) were analyzed per Common Terminology Criteria for Adverse Events (CTCAE) version 5.0.
Results:
For the 19 patients with HIV laboratory data available, the mean CD4 lymphocyte count dropped from 374.3 cells/mm3 (SD ± 238.9) to 180.3 cells/mm3 (SD ± 144.3) (P < .001) after 90Y TARE but rebounded to 320.9 cells/mm3 (SD ± 234.3) at 12-month follow-up (P = .013). The overall response rate was 87.2% and disease control rate was 97.4%. The median OS was 35.8 months (95% confidence interval [CI], 17.0 months to no estimate), and median PFS was 14.7 months (95% CI, 10.7-28.9 months). No Grade 3 clinical toxicities, 3 Grade 3 biochemical toxicities, and 1 opportunistic infection 18 months following 90Y TARE were reported.
Conclusions:
Yttrium-90 TARE is safe and effective in PLWH with HCC. No significant HIV-related AEs were attributable to radioembolization.
