LEGACY Trial of Radioembolization Shows Practice-Changing Data in HCC

Michael R. Charlton, MD, MBBS, professor of medicine, director of the Center for Liver Diseases, and codirector of the Transplant Institute at the University of Chicago Medicine, discusses the impact of the LEGACY trial investigating yttrium-90 radioembolization in patients with solitary, unresectable hepatocellular carcinoma (HCC).

Even though the pandemic has hindered many clinical trials, Charlton feels there have been tremendous steps forward in the HCC setting. The progress stems from the groundwork for the major studies that were already in place before the pandemic. One of these studies was the LEGACY trial conducted at Northwestern Feinberg School of Medicine in Chicago, Mount Sinai Health System in New York, among other institutions. This study looked at radioembolization of single lesions up to 8 cm in size that were not resectable.

Many patients with these lesions usually receive locoregional therapy and then transplantation if they are eligible. Charlton says that physicians for HCC should rethink that strategy because liver transplantation can be difficult on patients and not always available for those who need it. The 5-year survival rates in the LEGACY study were comparable with the survival of standard-of-care methods. There are likely groups of patients who are being over-treated in this setting with locoregional therapy and liver transplantation, according to Charlton. Patients with Child-Pugh A HCC after hepatitis C cure might do well with this radioembolization.