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Radiation therapy improves tumour response in liver cancer patients
Multi-disciplinary team discovers radiation therapy known as Yttrium-90 radioembolisation (Y90-RE) increases anti-cancer immunity and improves tumour response in liver cancer patients.

Yttrium-90 radioembolisation (Y90-RE), a form of radiation therapy, was discovered by scientists in Singapore, to boost patients’ immune systems to fight hepatocellular carcinoma (HCC), or primary liver cancer. This is in addition to the expected effects of radiotherapy, which is to kill cancer cells directly. Y90-RE enhances the activation of immune cells with anti-tumour activity in patients with HCC.

The research team comprised members from the National Cancer Centre Singapore (NCCS), Translational Immunology Institute (TII), SingHealth Duke-NUS Academic Medical Centre and the Singapore General Hospital (SGH).

Y90-RE is a minimally-invasive radiation treatment that delivers high-energy beta radiation directly to cancer tumours. It is currently being used as treatment for patients with tumours that are too advanced for surgery, liver transplant, or radiofrequency ablation (RFA). Findings of the impact of Y90-RE on the immune system were published in scientific journal Gut in February 2018.

The team looked at 34 patients with intermediate and advanced HCC over two years. They studied specific T-cells populations (immune cells with anti-tumour activity) in the patients’ blood and within the liver cancer after Y90-RE treatment, and found that they significantly increased and remained elevated specifically in patients with sustained response.

Of these 34 patients, 16 patients showed no further tumour progression and seven patients’ cancer tumours shrank sufficiently (downstaged) for subsequent liver resection. These seven patients were compared to another seven patients who had surgery for HCC without being downstaged with Y90-RE.

In another recent publication, the team reported the conclusion of a six-year long, 11-country Asia-Pacific phase-III clinical trial led by NCCS comparing Y90-RE with anti-cancer drug sorafenib in 364 patients. This clinical trial showed that while average survival rates were similar with the two treatment methods, patients treated with Y90-RE had significantly fewer side-effects and better tumour response.

Prof Pierce Chow, Protocol Chair of the phase III trial and also corresponding author of translational research study said, “The combined findings of these two landmark studies suggests the potential combination of immunotherapy with Y90-RE, so as to enhance the efficacy of immunotherapy treatment for patients with liver cancer.” Prof Chow is Senior Consultant, Division of Surgical Oncology at NCCS and Course Director at Duke-NUS Medical School.

In addition to the clinical study, the team will next be looking at developing a prediction tool to determine which patients will benefit most from Y90-RE.

These studies were made possible with funding from the National Medical Research Council Singapore. Sirtex Medical also contributed with a research grant in the phase III clinical trial.

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