The National Institute for Health and Care Excellence (NICE) has today recommended that selective internal radiation therapy (SIRT) can be used as an option for some people with hepatocellular carcinoma (HCC).
The British Liver Trust attended meetings and made several submissions to NICE on behalf of patients. The Trust is delighted that these views have now been listened to and this new treatment can now be made available on the NHS in England and Wales. We will do the same for patients in Scotland when the Scottish Medicine Consortium considers the treatment.
SIRT is an innovative way of giving radiotherapy treatment for cancer via tiny radioactive beads (called microspheres) that are injected into the artery supplying blood to the tumour via a catheter from the femoral artery. This helps to minimise the risk of radiation damage to healthy surrounding tissues.
Vanessa Hebditch Director of Policy, at the British Liver Trust, said “There are currently very few treatment options for patients with HCC and every day we hear heart-breaking stories from people who have been diagnosed and and feel a sense of hopelessness because of the limited options for treatment. In our submission to NICE, we made sure that the patient voice was heard. By collating information, evidence and patient stories from those who have been affected by liver cancer we were able to make clear the unmet need, reduced quality of life and poor outcomes these patients receive. I would particularly like to thank the patients who had experienced SIRT in clinical trials who came forward to help as their stories made a compelling case.”
The draft guidance recommends the use of SIR-Spheres (made by SIRTEX) and TheraSphere (made by Boston Scientific) for treating advanced liver cancer that can’t be surgically removed and when a procedure to cut off the blood supply to the tumour (transarterial therapy) isn’t appropriate. The draft guidance specifies that SIR-Spheres and TheraSphere should only be considered for people with Child-Pugh grade A liver impairment. The Child-Pugh grading system classifies how well the liver is working to establish the most suitable type of treatment. Child-Pugh grade A means the liver is working normally.
Although the clinical trial data for these SIRTs compared with other treatment options are limited, the committee concluded that, compared with systemic therapy sorafenib, SIRT may have fewer and more manageable side-effects, which can improve quality of life.
SIR-Spheres and TheraSphere are slightly less clinically effective than sorafenib but cost less. The cost savings mean that SIR‑Spheres and TheraSphere can be recommended as cost-effective options for people with Child-Pugh grade A liver impairment when conventional transarterial therapies are inappropriate.
Meindert Boysen, deputy chief executive and director of the Centre for Health Technology Assessment at NICE, said: “Unlike current systemic therapy for advanced liver cancer, which is given over a long time period and can have persistent side effects, SIRT is a locally targeted one-off treatment option. This draft guidance will provide people with advanced liver cancer the opportunity to benefit from an effective treatment which, importantly in terms of quality of life, is likely to have fewer and less severe side effects than standard systemic therapy.”
Pamela Healy OBE, Chief Executive of the British Liver Trust, said: “The British Liver Trust is delighted that NICE has now approved the use of SIRT as an option for treating unresectable advanced hepatocellular carcinoma in adults. Hepatocellular carcinoma is the most common form of liver cancer. It is particularly aggressive and a diagnosis is devastating for patients, carers and their families. Treatment options for patients with advanced liver cancer have been very limited and this decision will make this innovative treatment more easily available and improve options for patients. Evidence shows that outcomes for people with advanced liver cancer are particularly poor so this is a really important step.”
Hepatocellular carcinoma is a cancer that originates in the liver, not as the result of tumours spreading to the liver from other parts of the body. There were 4,975 people diagnosed with HCC in England in 2017 of whom around 1,780 would be eligible for treatment with SIRTs.
Treatment for hepatocellular carcinoma (HCC) depends on the stage of the disease and liver function. Treatment options include surgery, ablation, transarterial therapies, systemic therapies (such as lenvatinib and sorafenib) and best supportive care.