Preoperative Y-90 Radioembolization for Tumor Control and Future Liver Remnant Hypertrophy in Patients With Colorectal Liver Metastases

A prospective, interventional study evaluating the safety of Y-90 TARE for tumor control of the right side and induction of left liver hypertrophy as part of a planned single-stage or two-stage hepatectomy for patients with CLM and insufficient FLR at the time of presentation.

Study Overview

• Status: Recruiting
• Conditions: Metastases
• Intervention / Treatment: Drug: Yttrium-90 (Y-90) resin microspheres

Detailed Description

Primary Objective:

To examine the safety and feasibility of Y-90 TARE directed to the right hemi-liver for induction of left liver FLR hypertrophy as part of a planned hepatectomy for patients with CLM.

Secondary Objectives:

• To describe changes in liver volume after Y-90 TARE, including:

  • The kinetic growth rate (KGR) of the FLR
  • Degree of hypertrophy 6 weeks after TARE
  • Atrophy of targeted right hemi-liver from TARE date to date of surgery
• To describe additional interventional procedures needed to induce additional hypertrophy if insufficient hypertrophy from Y-90 TARE
• To assess the proportion of TARE patients who undergo attempted and complete curative-intent resection of CLM

• To assess measures of disease control, including:

  • Tumor marker trend
  • RECIST/mRECIST criteria
  • CT morphologic response
  • PET CT response
• To describe Patient Reported Outcomes using MDASI-GI
• To assess FLR liver quality, right-sided surgical adhesions from TARE intraoperatively
• To describe dosimetry of individual liver lesions - using SPECT/CT, CT, and pathology correlation
• To describe change in liver function measured by the pre- and post-TARE HIDA SPECT/CT scans and hepatic function blood tests

• Study Type: Interventional
• Enrollment (Estimated): 50
• Phase: Phase 1

Contacts and Locations

• Study Contact: Name: Ching-Wei Tzeng, MD; Phone Number: (713) 792-0386; Email: cdtzeng@mdanderson.org

Study Locations

• United States
  • Texas
    • Houston, Texas, United States, 77030
      • Recruiting
      • M D Anderson Cancer Center
      • Contact: Ching-Wei David Tzeng, MD
      • Principal Investigator: Ching-Wei David Tzeng, MD

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Borderline resectable unresectable (due to insufficient liver volume at presentation) colorectal liver metastases with potential curative intent, as determined by the surgeon and multidisciplinary team
• Anticipated standardized FLR (sFLR) that would require right portal vein embolization (PVE) to increase the sFLR prior to either a single major hepatectomy, or prior to the second stage hepatectomy as part of a two-stage hepatectomy strategy, all in the setting of curative-intent resection(s). This evaluation will be documented in the clinical chart
• Received at least four cycles (or two months) of chemotherapy
• Willing, able and mentally competent to provide written informed consent
• Medically and physically operable as determined by the surgeon

Exclusion Criteria:

• Extrahepatic disease that precludes intended curative intent treatment sequencing (treatable primary tumor and lung metastases allowed). "Treatable" is defined as having an intended future plan for local therapy (surgery, radiation, or ablation) as determined by the patient's medical oncologist and surgical oncologist
• Projected sFLR before Y-90 of <20% (starting with sFLR that is unrealistic for improvement to ≥30%)
• Performance status limitations (Karnofsky <80%, ECOG >1)
• Portal hypertension and/or cirrhosis
• Starting total bilirubin >1.3 mg/dL (except if patient has Gilbert's Disease)
• CEA >200 after 4 cycles of chemotherapy upon restaging visit
• Clinical progression of disease on imaging and/or tumor marker after 4 cycles of chemotherapy that is clinically judged by surgical oncology and medical oncology to preclude surgical resection
• Platelet count <100,000/µL
• Albumin <3.5 g/dl
• Symptomatic primary colon or rectal cancer (without pre-existing proximal diverting ostomy)
• Pregnant or breast-feeding patient
• Other medical or clinical contraindications to liver surgery
• Non-English-speaking participants

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: N/A
• Interventional Model: Single Group Assignment
• Masking: None (Open Label)

Number of Arms

1

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Yttrium-90; Help to control the tumor(s) on the right side of the liver while the remaining left side of the liver, which is clear of cancer, grows.	Drug: Yttrium-90 (Y-90) resin microspheres; Given by scan

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
The evaluation from using the feasibility of Y-90 TARE directed to the right hemi-liver for induction of left liver FLR hypertrophy as part of a planned hepatectomy for patients with CLM.	through study completion, an average of 1 year
The evaluation of using the safety of Y-90 TARE directed to the right hemi-liver for induction of left liver FLR hypertrophy as part of a planned hepatectomy for patients with CLM.	through study completion, an average of 1 year

Collaborators and Investigators

• Sponsor: M.D. Anderson Cancer Center
• Collaborators: Sirtex Medical
• Investigators: Principal Investigator: Ching-Wei Tzeng, MD, M.D. Anderson Cancer Center

Publications and helpful links

Helpful Links

• M D Anderson Cancer Center

Study record dates

Study Major Dates

• Study Start (Actual): November 16, 2022
• Primary Completion (Estimated): March 31, 2028
• Study Completion (Estimated): March 31, 2028

Study Registration Dates

• First Submitted: November 24, 2021
• First Submitted That Met QC Criteria: January 4, 2022
• First Posted (Actual): January 19, 2022

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 22, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Neoplasms; Neoplastic Processes; Pathological Conditions, Signs and Symptoms; Neoplasm Metastasis; Yttrium-90
• Other Study ID Numbers: 2021-0521; NCI-2021-13239 (Other Identifier: NCI-CTRP Clinical Trials Registry)

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No