16 May 2024
People with neuroendocrine tumours (NETs) in the liver could benefit from a therapy that targets tumours with radiation while limiting exposure to healthy surrounding tissue, according to new guidance from the National Institute for Health and Care Excellence (NICE).1 NETs are cancers of neuroendocrine cells commonly spread from organs such as the gastrointestinal tract or pancreas to the liver. The guidance is significant as it offers another option for healthcare professionals to treat patients within the National Health Service in England and Wales.
Selective Internal Radiation Therapy (SIRT), a procedure which takes one to two hours, involves injecting tiny radioactive spheres into the artery that takes blood to the liver. These microspheres deliver targeted radiation that kills the cancer cells.
Expanding treatment options
Figure 1: Centres of Excellence for Neuroendocrine Tumours
NICE reviewed the evidence on the safety and efficacy of SIRT, which included TheraSphere™ Y90 Microspheres2. NICE found that SIRT may result in fewer side effects, faster recovery times, and better quality of life for patients compared with surgery or chemotherapy. NICE recommended that a multidisciplinary team experienced in managing NETs (see Figure 1) should select the patient and carry out the procedure in specialist centres by clinicians trained and experienced in delivering SIRT. If there are cases where SIRT cannot completely eradicate the cancer, it can still be used to reduce the tumour size and control symptoms of the disease.
“SIRT may be better tolerated and more suitable for elderly or frail patients or those having comorbidities,” said Dr Sachin Modi, consultant Interventional Radiologist/Oncologist at University of Southampton. “Research shows that NETs, as a collective group, is the tenth most prevalent cancer in England.3 With the increasing incidence of NETs diagnoses, it is critical that there are a variety of treatment options that enable clinicians to improve patient care.”
Until now, treatment options for NETs in the liver include surgical resection, percutaneous ablation, and systemic chemotherapy. Some of these tumours may release hormones which cause severe symptoms such as diarrhoea, fast heart rate and breathlessness which are clinically referred to as carcinoid syndrome.
Medtech innovation
About 6,000 people are diagnosed with NETs in the UK every year, while others face long delays in getting diagnosed.4 Patients with NETs in the liver tend to have less favourable outcomes compared with those experiencing NETs that has not spread to the liver as their tumours are more challenging to treat.5 For Layla Stephen, a NETs survivor for 15 years and chief executive officer of PLANETS, a charity focused on funding patient support groups and innovative research for NETs, SIRT offers hope. “We are so pleased NICE has issued this new guideline on SIRT as it will help ensure that more cancer patients can access this invaluable treatment option if funding is made available by NHS England,” she said. “I have had a multitude of different treatments for my liver tumours, some of which have been incredibly invasive with numerous side effects and, disappointingly, SIRT has always been a treatment that has been out of reach for me as it had not been offered within the NHS. All patients with NETs in the liver deserve equal access to this innovative treatment and, following this decision by NICE, I am hopeful the treatment will now be an additional option my interventional radiologist can consider when looking at what is next for my disease management.”
Recent advances in SIRT have come from efforts to optimise the therapy by customising a high dose of radiation to target a patient’s tumour and delivering that dose in an extremely precise way while sparing healthy tissue. This highly personalised dosing, known as dosimetry, has been shown to improve outcomes for patients with liver cancer.5
A multidisciplinary team, comprising interventional and vascular radiologists and nuclear medicine specialists, collaborate using specialised software to share radiological images and dosimetry data to achieve effective dosing and treatment plans tailored to individual patients.
“Targeted, minimally invasive cancer treatment can improve patient outcomes and reduce pressure on healthcare systems where staff shortages are compounding the challenge of timely diagnosis and care,” said Xavier Bertrand, vice president of Peripheral Interventions for Boston Scientific in EMEA. “We’re excited that this guidance means more patients could benefit from this therapy and more broadly that it addresses disparities in access to healthcare.”
References
2. TheraSphere is a Boston Scientific SIRT that was considered in NICE’s Interventional Procedure 1314 to treat neuroendocrine tumours in the liver
3. Spotlight on Neuroendocrine Cancer: Supporting Healthcare Professionals - Neuroendocrine Cancer UK (2024)
4. R. Basuroy et al, “Delays and routes to diagnosis of neuroendocrine tumours,” BNC Cancer 18: 1122, May 2018.
5. E. Garin, et al, “Personalised versus standard dosimetry approach of selective internal radiation therapy in patients with locally advanced hepatocellular carcinoma (DOSISPHERE-01): a randomised, multicentre, open-label phase 2 trial,” The Lancet Gastroenterology & Hepatology 6:1, January 2021.