目的:提供指导,通过多学科共识声明,关于全身抗癌药物之间的安全性相互作用(如放射增敏化疗,免疫疗法,靶向治疗和肽受体放射性核素治疗)和使用钇90(90Y)标记的微球的经动脉放射性栓塞(TARE)治疗原发性和转移性肝脏恶性肿瘤。
方法:文献检索确定了59篇参考文献,提供了26篇关于90YTARE联合全身疗法安全性的陈述。通过对代表介入放射学领域的12个小组成员的在线匿名调查,使用改进的德尔菲法就声明达成共识,医学肿瘤学,肿瘤外科,肝病学,药房,关注肝细胞癌(HCC),转移性结直肠癌(mCRC),神经内分泌肿瘤,转移性乳腺癌和肝内胆管癌。
结果:高水平证据有限。mCRC患者的1级数据表明,一些放射增敏化疗(例如,奥沙利铂)与90YTARE和一些靶向疗法同时使用时需要暂时减少剂量(例如,在90YTARE之前,应避免使用血管内皮生长因子抑制剂和抗血管生成酪氨酸激酶抑制剂)至少4周。在HCC患者中,90YTARE和免疫治疗的可行性已得到4级证据的证明.其他原发性和继发性肝脏恶性肿瘤的数据更有限,共识声明由专家意见驱动(第5级)。
结论:鉴于缺乏关于90YTARE联合全身抗癌治疗安全性的循证指南,这些共识声明为考虑特定组合时的潜在风险提供了专家指导。
OBJECTIVE: 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.
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 (eg, oxaliplatin) require temporary dose reduction when used concomitantly with 90Y TARE, and some targeted therapies (eg, vascular endothelial growth factor inhibitors and antiangiogenic 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).
CONCLUSIONS: 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.