Invited discussant of the phase III EPOCH trial, Thomas Gruenberger, MD, a surgical oncologist at the Clinic Favoriten, Health Network Vienna, noted that the trial’s “intention was fulfilled,” thus making it the “first positive phase III trial that prolonged both progression-free and hepatic progression–free survival.”1
Thomas Gruenberger, MD
According to Dr. Gruenberger, an important message emerged from the subgroup analysis: The best candidates for transarterial embolization with yttrium Y-90 plus chemotherapy are patients with limited liver disease who are unresponsive to first-line treatment.
Unresolved Issues
However, Dr. Gruenberger added, the study left unresolved issues:
- Does adding transarterial embolization to second-line chemotherapy create the potential for secondary resectability?
- Is a second dose of transarterial embolization reasonable and advisable?
- Can progression-free and overall survival be prolonged by increasing the use of biologics?
- What are the quality-of-life findings for transarterial embolization plus chemotherapy?
“Keep in mind, there were severe side effects in the transarterial embolization arm, including several deaths related to treatment,” Dr. Gruenberger said, noting there are “other less expensive and less morbid” approaches to delivering chemotherapy to the liver. Although small trials suggest these alternatives are also beneficial, a comparison of such approaches to Y-90 transarterial embolization could be important.
DISCLOSURE: Dr. Gruenberger reported financial relationships with Roche, Merck-Serono, Bayer, Sanofi-Aventis, Amgen, Eli Lilly, Servier, Humedics, BMS, Olympus, MSD, and Incyte.
REFERENCE
1. Mulcahy MJ, Salem R, Mahvash A, et al: Radioembolization with chemotherapy for colorectal liver metastases: A randomized, open-label, international, multicenter, phase III trial (EPOCH study). ESMO Congress 2021. Abstract LBA21. Presented September 20, 2021.
