SARAH and SIRveNIB
Two large trials found radioactive beads were gentler than sorafenib but did not help patients live longer.
Overview
SARAH and SIRveNIB, led by trial NCT01482442 and sponsored by AP-HP and the National Cancer Centre Singapore, were two large trials reported in 2017 that found yttrium-90 radioembolisation was gentler than sorafenib in locally advanced hepatocellular carcinoma but did not help patients live longer. SARAH randomised 459 patients and SIRveNIB 360, and neither improved overall survival, although the radioactive beads gave better quality of life and more responses. Nuclide links them to hepatocellular carcinoma, radioembolisation and sorafenib. The results were interpreted as showing the need for personalised dosimetry and earlier-stage use rather than the failure of the modality, and whether dosimetry-guided radioembolisation can succeed where fixed dosing did not is the open question.
- Median 8 vs 9.9 months with Y-90 SIRT compared with Sorafenib; about 1.9 months shorter for half the group.
- A median is a midpoint: half the people did better than this and half did worse, so it is not a prediction for any one person.
- Put another way, the treated group had about 15 percent higher chance of the event at any given time (hazard ratio 1.15).
- Overall survival counts deaths from any cause, so it is the most direct measure of whether a treatment helps people live longer.
- These results apply to the people the trial enrolled: Locally advanced HCC: yttrium-90 radioembolisation vs sorafenib. People in a different situation may not see the same effect.
Numbers are from the trial as recorded here; see the source links in the table below. This is orientation, not medical advice: ask your team how closely the trial population matches you.
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