Article

The psoriasis clinical trials listed below are all phase 3 and recruiting participants as of July 19, 2022. For additional information on the study design, eligibility criteria, and contacts/locations, visit ClinicalTrials.gov.

GENERALIZED PUSTULAR PSORIASIS

Long-Term Safety and Efficacy of Imsidolimab (ANB019) in Subjects With Generalized Pustular Psoriasis (GEMINI2)

ClinicalTrials.gov Identifier: NCT05366855

An Expanded Access Trial in Japan to Provide Spesolimab to People With a Flare-up in Generalized Pustular Psoriasis Who Have no Other Treatment Options

ClinicalTrials.gov Identifier: NCT05200247

An Expanded Access Program in China to Provide Spesolimab to People With a Flare-up in Generalized Pustular Psoriasis Who Have No Other Treatment Options

ClinicalTrials.gov Identifier: NCT05239039

Study to Evaluate the Efficacy and Safety of Imsidolimab (ANB019) in the Treatment of Subjects With GPP (GEMINI1)

ClinicalTrials.gov Identifier: NCT05352893

NAIL PSORIASIS

Efficacy and Safety Study of Tildrakizumab in the Treatment of Nail Psoriasis

ClinicalTrials.gov Identifier: NCT03897075

PALMOPLANTAR PUSTULOSIS

Phase 3, Randomized Study of Apremilast in Japanese Participants With Palmoplantar Pustulosis (PPP)

ClinicalTrials.gov Identifier: NCT05174065

PLAQUE PSORIASIS

A Long-term Extension Study of Apremilast (CC-10004) in Pediatric Subjects From 6 Through 17 Years of Age With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04175613

A Phase III Efficacy and Safety Study of Hemay005 in Subjects With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04839328

A Study of Subcutaneous Risankizumab Injection for Pediatric Participants With Moderate to Severe Plaque Psoriasis to Assess Change in Disease Symptoms

ClinicalTrials.gov Identifier: NCT04435600

A Study to Evaluate the Drug Levels, Efficacy and Safety of Deucravacitinib in Adolescent Participants With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04772079

Investigator Initiated Trial to Study Duobrii® Lotion in the Treatment of Mild Plaque Psoriasis in Adults

ClinicalTrials.gov Identifier: NCT05203315

Comparative Study of BAT2206 With Stelara® in Patients With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04728360

A Study to Evaluate the Efficacy and Safety of Bimekizumab in Adult Korean Study Participants With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT05020249

Comparing Efficacy and Safety of Bmab 1200 and Stelara in Patients With Moderate to Severe Chronic Plaque Psoriasis (STELLAR-2)

ClinicalTrials.gov Identifier: NCT05335356

A Study to Evaluate the Efficacy, Safety, and Drug Concentration of Certolizumab Pegol (CZP) in Children and Adolescent Study Participants With Moderate to Severe Chronic Plaque Psoriasis (PSO)(CIMcare)

ClinicalTrials.gov Identifier: NCT04123795

A Study of Tildrakizumab in Pediatric Subjects With Chronic Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT03997786

Tapinarof for the Treatment of Plaque Psoriasis in Pediatric Subjects

ClinicalTrials.gov Identifier: NCT05172726

A Study to Evaluate the Efficacy, Safety, and Pharmacokinetics of Subcutaneously Administered Guselkumab for the Treatment of Chronic Plaque Psoriasis in Pediatric Participants (PROTOSTAR)

ClinicalTrials.gov Identifier: NCT03451851

PSORIATIC ARTHRITIS

Efficacy of Secukinumab Compared to Ustekinumab in Adults With Active Psoriatic Arthritis and Failure of TNFα-Inhibitor Treatment (AgAIN)

ClinicalTrials.gov Identifier: NCT04632927

A Long-term Extension Study of Ustekinumab in Pediatric Participants (UNITED)

ClinicalTrials.gov Identifier: NCT05092269

A Study of Ustekinumab or Guselkumab in Pediatric Participants With Active Juvenile Psoriatic Arthritis (PSUMMIT-Jr)

ClinicalTrials.gov Identifier: NCT05083182

Comparative Study of BAT2506 With Simponi® in Participants With Active Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT05046431

Long Term Evaluation of Safety and Efficacy of Tildrakizumab in Patients With Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04991116

To Evaluate the Efficacy and Safety of SHR0302 Tablet in Subjects of Active Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04957550

PSORIATIC ARTHRITIS (continued)

Guselkumab in Active Psoriatic Arthritis Participants With Inadequate Response/Intolerance to One Prior Anti-TNF Alpha Agent (SOLSTICE)

ClinicalTrials.gov Identifier: NCT04936308

A Study to Determine the Efficacy and Safety of Deucravacitinib Compared With Placebo in Participants With Active Psoriatic Arthritis (PsA) Who Are Naïve to Biologic Disease-modifying Anti-rheumatic Drugs

ClinicalTrials.gov Identifier: NCT04908202

A Study to Determine the Efficacy and Safety of Deucravacitinib Compared With Placebo in Participants With Active Psoriatic Arthritis (PsA) Who Are Naïve to Biologic Disease Modifying Anti-rheumatic Drugs or Had Previously Received TNFα Inhibitor Treatment

ClinicalTrials.gov Identifier: NCT04908189

A Study of Guselkumab in Participants With Active Psoriatic Arthritis (APEX) ClinicalTrials.gov Identifier: NCT04882098 Apremilast Pediatric Study in Children With Active Juvenile Psoriatic Arthritis (PEAPOD)

ClinicalTrials.gov Identifier: NCT04804553

Impact of Tapering Immunosuppressants on Maintaining Minimal Disease Activity in Adult Subjects With Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04610476

A Study of Ixekizumab (LY2439821) in Children With Juvenile Idiopathic Arthritis Categories of Enthesitis-related Arthritis (Including Juvenile Onset Ankylosing Spondylitis) and Juvenile Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04527380

Efficacy and Safety of Tildrakizumab Compared to Placebo in Subjects With Active Psoriatic Arthritis I (INSPIRE 1)

ClinicalTrials.gov Identifier: NCT04314544

Efficacy and Safety of Tildrakizumab Compared to Placebo in Anti- TNF naïve Subjects With Active Psoriatic Arthritis II (INSPIRE 2)

ClinicalTrials.gov Identifier: NCT04314531

The psoriasis clinical trials listed below are all phase 3 and recruiting participants as of July 19, 2022. For additional information on the study design, eligibility criteria, and contacts/locations, visit ClinicalTrials.gov.

GENERALIZED PUSTULAR PSORIASIS

Long-Term Safety and Efficacy of Imsidolimab (ANB019) in Subjects With Generalized Pustular Psoriasis (GEMINI2)

ClinicalTrials.gov Identifier: NCT05366855

An Expanded Access Trial in Japan to Provide Spesolimab to People With a Flare-up in Generalized Pustular Psoriasis Who Have no Other Treatment Options

ClinicalTrials.gov Identifier: NCT05200247

An Expanded Access Program in China to Provide Spesolimab to People With a Flare-up in Generalized Pustular Psoriasis Who Have No Other Treatment Options

ClinicalTrials.gov Identifier: NCT05239039

Study to Evaluate the Efficacy and Safety of Imsidolimab (ANB019) in the Treatment of Subjects With GPP (GEMINI1)

ClinicalTrials.gov Identifier: NCT05352893

NAIL PSORIASIS

Efficacy and Safety Study of Tildrakizumab in the Treatment of Nail Psoriasis

ClinicalTrials.gov Identifier: NCT03897075

PALMOPLANTAR PUSTULOSIS

Phase 3, Randomized Study of Apremilast in Japanese Participants With Palmoplantar Pustulosis (PPP)

ClinicalTrials.gov Identifier: NCT05174065

PLAQUE PSORIASIS

A Long-term Extension Study of Apremilast (CC-10004) in Pediatric Subjects From 6 Through 17 Years of Age With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04175613

A Phase III Efficacy and Safety Study of Hemay005 in Subjects With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04839328

A Study of Subcutaneous Risankizumab Injection for Pediatric Participants With Moderate to Severe Plaque Psoriasis to Assess Change in Disease Symptoms

ClinicalTrials.gov Identifier: NCT04435600

A Study to Evaluate the Drug Levels, Efficacy and Safety of Deucravacitinib in Adolescent Participants With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04772079

Investigator Initiated Trial to Study Duobrii® Lotion in the Treatment of Mild Plaque Psoriasis in Adults

ClinicalTrials.gov Identifier: NCT05203315

Comparative Study of BAT2206 With Stelara® in Patients With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04728360

A Study to Evaluate the Efficacy and Safety of Bimekizumab in Adult Korean Study Participants With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT05020249

Comparing Efficacy and Safety of Bmab 1200 and Stelara in Patients With Moderate to Severe Chronic Plaque Psoriasis (STELLAR-2)

ClinicalTrials.gov Identifier: NCT05335356

A Study to Evaluate the Efficacy, Safety, and Drug Concentration of Certolizumab Pegol (CZP) in Children and Adolescent Study Participants With Moderate to Severe Chronic Plaque Psoriasis (PSO)(CIMcare)

ClinicalTrials.gov Identifier: NCT04123795

A Study of Tildrakizumab in Pediatric Subjects With Chronic Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT03997786

Tapinarof for the Treatment of Plaque Psoriasis in Pediatric Subjects

ClinicalTrials.gov Identifier: NCT05172726

A Study to Evaluate the Efficacy, Safety, and Pharmacokinetics of Subcutaneously Administered Guselkumab for the Treatment of Chronic Plaque Psoriasis in Pediatric Participants (PROTOSTAR)

ClinicalTrials.gov Identifier: NCT03451851

PSORIATIC ARTHRITIS

Efficacy of Secukinumab Compared to Ustekinumab in Adults With Active Psoriatic Arthritis and Failure of TNFα-Inhibitor Treatment (AgAIN)

ClinicalTrials.gov Identifier: NCT04632927

A Long-term Extension Study of Ustekinumab in Pediatric Participants (UNITED)

ClinicalTrials.gov Identifier: NCT05092269

A Study of Ustekinumab or Guselkumab in Pediatric Participants With Active Juvenile Psoriatic Arthritis (PSUMMIT-Jr)

ClinicalTrials.gov Identifier: NCT05083182

Comparative Study of BAT2506 With Simponi® in Participants With Active Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT05046431

Long Term Evaluation of Safety and Efficacy of Tildrakizumab in Patients With Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04991116

To Evaluate the Efficacy and Safety of SHR0302 Tablet in Subjects of Active Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04957550

PSORIATIC ARTHRITIS (continued)

Guselkumab in Active Psoriatic Arthritis Participants With Inadequate Response/Intolerance to One Prior Anti-TNF Alpha Agent (SOLSTICE)

ClinicalTrials.gov Identifier: NCT04936308

A Study to Determine the Efficacy and Safety of Deucravacitinib Compared With Placebo in Participants With Active Psoriatic Arthritis (PsA) Who Are Naïve to Biologic Disease-modifying Anti-rheumatic Drugs

ClinicalTrials.gov Identifier: NCT04908202

A Study to Determine the Efficacy and Safety of Deucravacitinib Compared With Placebo in Participants With Active Psoriatic Arthritis (PsA) Who Are Naïve to Biologic Disease Modifying Anti-rheumatic Drugs or Had Previously Received TNFα Inhibitor Treatment

ClinicalTrials.gov Identifier: NCT04908189

A Study of Guselkumab in Participants With Active Psoriatic Arthritis (APEX) ClinicalTrials.gov Identifier: NCT04882098 Apremilast Pediatric Study in Children With Active Juvenile Psoriatic Arthritis (PEAPOD)

ClinicalTrials.gov Identifier: NCT04804553

Impact of Tapering Immunosuppressants on Maintaining Minimal Disease Activity in Adult Subjects With Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04610476

A Study of Ixekizumab (LY2439821) in Children With Juvenile Idiopathic Arthritis Categories of Enthesitis-related Arthritis (Including Juvenile Onset Ankylosing Spondylitis) and Juvenile Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04527380

Efficacy and Safety of Tildrakizumab Compared to Placebo in Subjects With Active Psoriatic Arthritis I (INSPIRE 1)

ClinicalTrials.gov Identifier: NCT04314544

Efficacy and Safety of Tildrakizumab Compared to Placebo in Anti- TNF naïve Subjects With Active Psoriatic Arthritis II (INSPIRE 2)

ClinicalTrials.gov Identifier: NCT04314531

The psoriasis clinical trials listed below are all phase 3 and recruiting participants as of July 19, 2022. For additional information on the study design, eligibility criteria, and contacts/locations, visit ClinicalTrials.gov.

GENERALIZED PUSTULAR PSORIASIS

Long-Term Safety and Efficacy of Imsidolimab (ANB019) in Subjects With Generalized Pustular Psoriasis (GEMINI2)

ClinicalTrials.gov Identifier: NCT05366855

An Expanded Access Trial in Japan to Provide Spesolimab to People With a Flare-up in Generalized Pustular Psoriasis Who Have no Other Treatment Options

ClinicalTrials.gov Identifier: NCT05200247

An Expanded Access Program in China to Provide Spesolimab to People With a Flare-up in Generalized Pustular Psoriasis Who Have No Other Treatment Options

ClinicalTrials.gov Identifier: NCT05239039

Study to Evaluate the Efficacy and Safety of Imsidolimab (ANB019) in the Treatment of Subjects With GPP (GEMINI1)

ClinicalTrials.gov Identifier: NCT05352893

NAIL PSORIASIS

Efficacy and Safety Study of Tildrakizumab in the Treatment of Nail Psoriasis

ClinicalTrials.gov Identifier: NCT03897075

PALMOPLANTAR PUSTULOSIS

Phase 3, Randomized Study of Apremilast in Japanese Participants With Palmoplantar Pustulosis (PPP)

ClinicalTrials.gov Identifier: NCT05174065

PLAQUE PSORIASIS

A Long-term Extension Study of Apremilast (CC-10004) in Pediatric Subjects From 6 Through 17 Years of Age With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04175613

A Phase III Efficacy and Safety Study of Hemay005 in Subjects With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04839328

A Study of Subcutaneous Risankizumab Injection for Pediatric Participants With Moderate to Severe Plaque Psoriasis to Assess Change in Disease Symptoms

ClinicalTrials.gov Identifier: NCT04435600

A Study to Evaluate the Drug Levels, Efficacy and Safety of Deucravacitinib in Adolescent Participants With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04772079

Investigator Initiated Trial to Study Duobrii® Lotion in the Treatment of Mild Plaque Psoriasis in Adults

ClinicalTrials.gov Identifier: NCT05203315

Comparative Study of BAT2206 With Stelara® in Patients With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT04728360

A Study to Evaluate the Efficacy and Safety of Bimekizumab in Adult Korean Study Participants With Moderate to Severe Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT05020249

Comparing Efficacy and Safety of Bmab 1200 and Stelara in Patients With Moderate to Severe Chronic Plaque Psoriasis (STELLAR-2)

ClinicalTrials.gov Identifier: NCT05335356

A Study to Evaluate the Efficacy, Safety, and Drug Concentration of Certolizumab Pegol (CZP) in Children and Adolescent Study Participants With Moderate to Severe Chronic Plaque Psoriasis (PSO)(CIMcare)

ClinicalTrials.gov Identifier: NCT04123795

A Study of Tildrakizumab in Pediatric Subjects With Chronic Plaque Psoriasis

ClinicalTrials.gov Identifier: NCT03997786

Tapinarof for the Treatment of Plaque Psoriasis in Pediatric Subjects

ClinicalTrials.gov Identifier: NCT05172726

A Study to Evaluate the Efficacy, Safety, and Pharmacokinetics of Subcutaneously Administered Guselkumab for the Treatment of Chronic Plaque Psoriasis in Pediatric Participants (PROTOSTAR)

ClinicalTrials.gov Identifier: NCT03451851

PSORIATIC ARTHRITIS

Efficacy of Secukinumab Compared to Ustekinumab in Adults With Active Psoriatic Arthritis and Failure of TNFα-Inhibitor Treatment (AgAIN)

ClinicalTrials.gov Identifier: NCT04632927

A Long-term Extension Study of Ustekinumab in Pediatric Participants (UNITED)

ClinicalTrials.gov Identifier: NCT05092269

A Study of Ustekinumab or Guselkumab in Pediatric Participants With Active Juvenile Psoriatic Arthritis (PSUMMIT-Jr)

ClinicalTrials.gov Identifier: NCT05083182

Comparative Study of BAT2506 With Simponi® in Participants With Active Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT05046431

Long Term Evaluation of Safety and Efficacy of Tildrakizumab in Patients With Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04991116

To Evaluate the Efficacy and Safety of SHR0302 Tablet in Subjects of Active Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04957550

PSORIATIC ARTHRITIS (continued)

Guselkumab in Active Psoriatic Arthritis Participants With Inadequate Response/Intolerance to One Prior Anti-TNF Alpha Agent (SOLSTICE)

ClinicalTrials.gov Identifier: NCT04936308

A Study to Determine the Efficacy and Safety of Deucravacitinib Compared With Placebo in Participants With Active Psoriatic Arthritis (PsA) Who Are Naïve to Biologic Disease-modifying Anti-rheumatic Drugs

ClinicalTrials.gov Identifier: NCT04908202

A Study to Determine the Efficacy and Safety of Deucravacitinib Compared With Placebo in Participants With Active Psoriatic Arthritis (PsA) Who Are Naïve to Biologic Disease Modifying Anti-rheumatic Drugs or Had Previously Received TNFα Inhibitor Treatment

ClinicalTrials.gov Identifier: NCT04908189

A Study of Guselkumab in Participants With Active Psoriatic Arthritis (APEX) ClinicalTrials.gov Identifier: NCT04882098 Apremilast Pediatric Study in Children With Active Juvenile Psoriatic Arthritis (PEAPOD)

ClinicalTrials.gov Identifier: NCT04804553

Impact of Tapering Immunosuppressants on Maintaining Minimal Disease Activity in Adult Subjects With Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04610476

A Study of Ixekizumab (LY2439821) in Children With Juvenile Idiopathic Arthritis Categories of Enthesitis-related Arthritis (Including Juvenile Onset Ankylosing Spondylitis) and Juvenile Psoriatic Arthritis

ClinicalTrials.gov Identifier: NCT04527380

Efficacy and Safety of Tildrakizumab Compared to Placebo in Subjects With Active Psoriatic Arthritis I (INSPIRE 1)

ClinicalTrials.gov Identifier: NCT04314544

Efficacy and Safety of Tildrakizumab Compared to Placebo in Anti- TNF naïve Subjects With Active Psoriatic Arthritis II (INSPIRE 2)

ClinicalTrials.gov Identifier: NCT04314531

On the basis of this presentation, and the findings from the chest x-ray (as shown), the likely diagnosis is non–small cell lung cancer (NSCLC), Pancoast tumor, also known as superior sulcus tumor. Pancoast tumors are rare, representing about 3%-5% of all lung cancers, and invade the structures in the apex of the chest, including the first thoracic ribs or periosteum, the lower nerve roots of the bronchial plexus, the sympathetic chain and stellate ganglion, or the subclavian vessels. The majority of Pancoast tumors are non–small cell carcinomas.

Because of their pulmonary location, Pancoast tumors are characterized by several distinct symptoms. As seen in this case, patients often present with shoulder pain that worsens over time, especially with invasion of the chest wall and brachial plexus. The pain may radiate to the neck; axilla; anterior chest wall; and medial aspect of the arm, forearm, and wrist. If Pancoast tumors infiltrate the ulnar nerve, patients may present with weakness and muscle atrophy of the intrinsic muscles of the hand. In addition, invasion of the sympathetic chain and of the inferior cervical ganglion can cause Horner syndrome (ptosis, miosis, enophthalmos, and anhidrosis). Lastly, upper-arm edema may develop, signaling invasion and potentially occlusion of the subclavian vein.

During workup, CT-guided core biopsy is the first-line diagnostic test for Pancoast tumors. CT of the chest can confirm the presence of an apical mass and its position in relation to other structures of the thoracic inlet. MRI can further assess suspected brachial plexus, subclavian vessels, spine, and neural foramina invasion, specifying the extent of the disease and of the amount of nerve-root involvement.

For resectable Pancoast tumors, the National Comprehensive Cancer Network recommends chemoradiation, followed by surgical resection and chemotherapy. Preoperative chemoradiation together with surgical resection has shown a 2-year survival between 50% and 70%. Depending on biomarker status (certain EGFR mutations or programmed death ligand 1 levels ≥ 1%), the addition of either atezolizumab or osimertinib is advised. However, the positioning of Pancoast tumors can pose a surgical challenge, and if the lesion remains unresectable after preoperative concurrent chemoradiation, then consolidation immunotherapy with durvalumab is recommended.

Karl J. D'Silva, MD, Clinical Assistant Professor, Department of Medicine, Tufts University School of Medicine, Boston; Medical Director, Department of Oncology and Hematology, Lahey Hospital and Medical Center, Peabody, Massachusetts.

Karl J. D'Silva, MD, has disclosed no relevant financial relationships.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

On the basis of this presentation, and the findings from the chest x-ray (as shown), the likely diagnosis is non–small cell lung cancer (NSCLC), Pancoast tumor, also known as superior sulcus tumor. Pancoast tumors are rare, representing about 3%-5% of all lung cancers, and invade the structures in the apex of the chest, including the first thoracic ribs or periosteum, the lower nerve roots of the bronchial plexus, the sympathetic chain and stellate ganglion, or the subclavian vessels. The majority of Pancoast tumors are non–small cell carcinomas.

Because of their pulmonary location, Pancoast tumors are characterized by several distinct symptoms. As seen in this case, patients often present with shoulder pain that worsens over time, especially with invasion of the chest wall and brachial plexus. The pain may radiate to the neck; axilla; anterior chest wall; and medial aspect of the arm, forearm, and wrist. If Pancoast tumors infiltrate the ulnar nerve, patients may present with weakness and muscle atrophy of the intrinsic muscles of the hand. In addition, invasion of the sympathetic chain and of the inferior cervical ganglion can cause Horner syndrome (ptosis, miosis, enophthalmos, and anhidrosis). Lastly, upper-arm edema may develop, signaling invasion and potentially occlusion of the subclavian vein.

During workup, CT-guided core biopsy is the first-line diagnostic test for Pancoast tumors. CT of the chest can confirm the presence of an apical mass and its position in relation to other structures of the thoracic inlet. MRI can further assess suspected brachial plexus, subclavian vessels, spine, and neural foramina invasion, specifying the extent of the disease and of the amount of nerve-root involvement.

For resectable Pancoast tumors, the National Comprehensive Cancer Network recommends chemoradiation, followed by surgical resection and chemotherapy. Preoperative chemoradiation together with surgical resection has shown a 2-year survival between 50% and 70%. Depending on biomarker status (certain EGFR mutations or programmed death ligand 1 levels ≥ 1%), the addition of either atezolizumab or osimertinib is advised. However, the positioning of Pancoast tumors can pose a surgical challenge, and if the lesion remains unresectable after preoperative concurrent chemoradiation, then consolidation immunotherapy with durvalumab is recommended.

Karl J. D'Silva, MD, Clinical Assistant Professor, Department of Medicine, Tufts University School of Medicine, Boston; Medical Director, Department of Oncology and Hematology, Lahey Hospital and Medical Center, Peabody, Massachusetts.

Karl J. D'Silva, MD, has disclosed no relevant financial relationships.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

On the basis of this presentation, and the findings from the chest x-ray (as shown), the likely diagnosis is non–small cell lung cancer (NSCLC), Pancoast tumor, also known as superior sulcus tumor. Pancoast tumors are rare, representing about 3%-5% of all lung cancers, and invade the structures in the apex of the chest, including the first thoracic ribs or periosteum, the lower nerve roots of the bronchial plexus, the sympathetic chain and stellate ganglion, or the subclavian vessels. The majority of Pancoast tumors are non–small cell carcinomas.

Because of their pulmonary location, Pancoast tumors are characterized by several distinct symptoms. As seen in this case, patients often present with shoulder pain that worsens over time, especially with invasion of the chest wall and brachial plexus. The pain may radiate to the neck; axilla; anterior chest wall; and medial aspect of the arm, forearm, and wrist. If Pancoast tumors infiltrate the ulnar nerve, patients may present with weakness and muscle atrophy of the intrinsic muscles of the hand. In addition, invasion of the sympathetic chain and of the inferior cervical ganglion can cause Horner syndrome (ptosis, miosis, enophthalmos, and anhidrosis). Lastly, upper-arm edema may develop, signaling invasion and potentially occlusion of the subclavian vein.

During workup, CT-guided core biopsy is the first-line diagnostic test for Pancoast tumors. CT of the chest can confirm the presence of an apical mass and its position in relation to other structures of the thoracic inlet. MRI can further assess suspected brachial plexus, subclavian vessels, spine, and neural foramina invasion, specifying the extent of the disease and of the amount of nerve-root involvement.

For resectable Pancoast tumors, the National Comprehensive Cancer Network recommends chemoradiation, followed by surgical resection and chemotherapy. Preoperative chemoradiation together with surgical resection has shown a 2-year survival between 50% and 70%. Depending on biomarker status (certain EGFR mutations or programmed death ligand 1 levels ≥ 1%), the addition of either atezolizumab or osimertinib is advised. However, the positioning of Pancoast tumors can pose a surgical challenge, and if the lesion remains unresectable after preoperative concurrent chemoradiation, then consolidation immunotherapy with durvalumab is recommended.

Karl J. D'Silva, MD, Clinical Assistant Professor, Department of Medicine, Tufts University School of Medicine, Boston; Medical Director, Department of Oncology and Hematology, Lahey Hospital and Medical Center, Peabody, Massachusetts.

Karl J. D'Silva, MD, has disclosed no relevant financial relationships.

Image Quizzes are fictional or fictionalized clinical scenarios intended to provide evidence-based educational takeaways.

Key clinical point: In patients with hepatocellular carcinoma (HCC), transarterial radioembolization (TARE) provides significantly longer time to progression (TTP) than transarterial chemoembolization (TACE), but does not significantly prolong overall survival.

Major finding: TARE vs TACE significantly prolonged the mean TTP (17.5 vs 9.8 months; 95% CI 1.3-8.3 months) but resulted in comparable overall survival (absolute difference −0.55 months; 95% CI −1.95 to 3.05 months).

Study details: This was a meta-analysis of 17 studies involving 2465 unique patients that directly compared TACE and TARE for treating HCC.

Disclosures: This study was supported by the US National Institutes of Health. Some authors declared serving as consultants or advisory board members of or receiving grants from various sources.

Source: Brown AM et al. TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta-analysis. Cancer Med. 2022 (Aug 9). Doi: 10.1002/cam4.5125

Key clinical point: In patients with hepatocellular carcinoma (HCC), transarterial radioembolization (TARE) provides significantly longer time to progression (TTP) than transarterial chemoembolization (TACE), but does not significantly prolong overall survival.

Major finding: TARE vs TACE significantly prolonged the mean TTP (17.5 vs 9.8 months; 95% CI 1.3-8.3 months) but resulted in comparable overall survival (absolute difference −0.55 months; 95% CI −1.95 to 3.05 months).

Study details: This was a meta-analysis of 17 studies involving 2465 unique patients that directly compared TACE and TARE for treating HCC.

Disclosures: This study was supported by the US National Institutes of Health. Some authors declared serving as consultants or advisory board members of or receiving grants from various sources.

Source: Brown AM et al. TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta-analysis. Cancer Med. 2022 (Aug 9). Doi: 10.1002/cam4.5125

Key clinical point: In patients with hepatocellular carcinoma (HCC), transarterial radioembolization (TARE) provides significantly longer time to progression (TTP) than transarterial chemoembolization (TACE), but does not significantly prolong overall survival.

Major finding: TARE vs TACE significantly prolonged the mean TTP (17.5 vs 9.8 months; 95% CI 1.3-8.3 months) but resulted in comparable overall survival (absolute difference −0.55 months; 95% CI −1.95 to 3.05 months).

Study details: This was a meta-analysis of 17 studies involving 2465 unique patients that directly compared TACE and TARE for treating HCC.

Disclosures: This study was supported by the US National Institutes of Health. Some authors declared serving as consultants or advisory board members of or receiving grants from various sources.

Source: Brown AM et al. TACE versus TARE for patients with hepatocellular carcinoma: Overall and individual patient level meta-analysis. Cancer Med. 2022 (Aug 9). Doi: 10.1002/cam4.5125

Key clinical point: Baseline des-gamma-carboxy prothrombin (DCP) levels and neutrophil-to-lymphocyte ratio (NLR) may serve as predictive biomarkers of survival in patients with advanced hepatocellular carcinoma (HCC) receiving atezolizumab plus bevacizumab (ATE+BEV) therapy.

Major finding: Multivariate analysis revealed that a DCP level of ≥186 mAU/mL and an NLR of ≥2.5 independently predict overall survival (adjusted hazard ratio [aHR] 5.102; P < .001; and aHR 3.584; P  =  .001, respectively) and progression-free survival (aHR 2.311; P  =  .002; and aHR 1.938; P  =  .012, respectively).

Study details: The data come from a real-world observational study that included 121 patients with advanced HCC who received ≥1 cycle of ATE+BEV treatment.

Disclosures: This study was sponsored by a National Research Foundation of Korea grant funded by the Korea government. Some authors declared receiving honoraria or research grants from various sources.

Source: Chon YE, Cheon J, et al. Predictive biomarkers of survival in patients with advanced hepatocellular carcinoma receiving atezolizumab plus bevacizumab treatment. Cancer Med. 2022 (Aug 23). Doi: 10.1002/cam4.5161

Key clinical point: Baseline des-gamma-carboxy prothrombin (DCP) levels and neutrophil-to-lymphocyte ratio (NLR) may serve as predictive biomarkers of survival in patients with advanced hepatocellular carcinoma (HCC) receiving atezolizumab plus bevacizumab (ATE+BEV) therapy.

Major finding: Multivariate analysis revealed that a DCP level of ≥186 mAU/mL and an NLR of ≥2.5 independently predict overall survival (adjusted hazard ratio [aHR] 5.102; P < .001; and aHR 3.584; P  =  .001, respectively) and progression-free survival (aHR 2.311; P  =  .002; and aHR 1.938; P  =  .012, respectively).

Study details: The data come from a real-world observational study that included 121 patients with advanced HCC who received ≥1 cycle of ATE+BEV treatment.

Disclosures: This study was sponsored by a National Research Foundation of Korea grant funded by the Korea government. Some authors declared receiving honoraria or research grants from various sources.

Source: Chon YE, Cheon J, et al. Predictive biomarkers of survival in patients with advanced hepatocellular carcinoma receiving atezolizumab plus bevacizumab treatment. Cancer Med. 2022 (Aug 23). Doi: 10.1002/cam4.5161

Key clinical point: Baseline des-gamma-carboxy prothrombin (DCP) levels and neutrophil-to-lymphocyte ratio (NLR) may serve as predictive biomarkers of survival in patients with advanced hepatocellular carcinoma (HCC) receiving atezolizumab plus bevacizumab (ATE+BEV) therapy.

Major finding: Multivariate analysis revealed that a DCP level of ≥186 mAU/mL and an NLR of ≥2.5 independently predict overall survival (adjusted hazard ratio [aHR] 5.102; P < .001; and aHR 3.584; P  =  .001, respectively) and progression-free survival (aHR 2.311; P  =  .002; and aHR 1.938; P  =  .012, respectively).

Study details: The data come from a real-world observational study that included 121 patients with advanced HCC who received ≥1 cycle of ATE+BEV treatment.

Disclosures: This study was sponsored by a National Research Foundation of Korea grant funded by the Korea government. Some authors declared receiving honoraria or research grants from various sources.

Source: Chon YE, Cheon J, et al. Predictive biomarkers of survival in patients with advanced hepatocellular carcinoma receiving atezolizumab plus bevacizumab treatment. Cancer Med. 2022 (Aug 23). Doi: 10.1002/cam4.5161

Key clinical point: First-line lenvatinib, toripalimab, and hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX) is a well-tolerated and effective treatment for patients with high-risk advanced hepatocellular carcinoma (HCC).

Major finding: The progression-free survival (PFS) of 80.6% (95% CI 64.0%-91.8%) of patients was >6 months, and the median PFS was 10.4 months (95% CI 5.8-15.0 months). The median overall survival was not reached at the prespecified final analysis. The objective response rate was 63.9%. Serious treatment-related adverse events occurred in 38.9% of patients.

Study details: This single-center, phase 2 trial included 36 adult treatment-naive patients with advanced HCC (86.1% with high-risk features) who received lenvatinib, toripalimab, and FOLFOX-HAIC.

Disclosures: This study was supported by the National Natural Science Foundation of China, Development Planned Project in Key Areas of Guangdong Province, and the China Postdoctoral Science Foundation. The authors declared no conflicts of interest.

Source: Lai ZC, He MK, Bu XY, Xu YJ, et al. Lenvatinib, toripalimab plus hepatic arterial infusion chemotherapy in patients with high-risk advanced hepatocellular carcinoma: A biomolecular exploratory, phase II trial. Eur J Cancer. 2022;174:68-77 (Aug 15). Doi: 10.1016/j.ejca.2022.07.005

Key clinical point: First-line lenvatinib, toripalimab, and hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX) is a well-tolerated and effective treatment for patients with high-risk advanced hepatocellular carcinoma (HCC).

Major finding: The progression-free survival (PFS) of 80.6% (95% CI 64.0%-91.8%) of patients was >6 months, and the median PFS was 10.4 months (95% CI 5.8-15.0 months). The median overall survival was not reached at the prespecified final analysis. The objective response rate was 63.9%. Serious treatment-related adverse events occurred in 38.9% of patients.

Study details: This single-center, phase 2 trial included 36 adult treatment-naive patients with advanced HCC (86.1% with high-risk features) who received lenvatinib, toripalimab, and FOLFOX-HAIC.

Disclosures: This study was supported by the National Natural Science Foundation of China, Development Planned Project in Key Areas of Guangdong Province, and the China Postdoctoral Science Foundation. The authors declared no conflicts of interest.

Source: Lai ZC, He MK, Bu XY, Xu YJ, et al. Lenvatinib, toripalimab plus hepatic arterial infusion chemotherapy in patients with high-risk advanced hepatocellular carcinoma: A biomolecular exploratory, phase II trial. Eur J Cancer. 2022;174:68-77 (Aug 15). Doi: 10.1016/j.ejca.2022.07.005

Key clinical point: First-line lenvatinib, toripalimab, and hepatic arterial infusion chemotherapy (HAIC) with oxaliplatin, leucovorin, and 5-fluorouracil (FOLFOX) is a well-tolerated and effective treatment for patients with high-risk advanced hepatocellular carcinoma (HCC).

Major finding: The progression-free survival (PFS) of 80.6% (95% CI 64.0%-91.8%) of patients was >6 months, and the median PFS was 10.4 months (95% CI 5.8-15.0 months). The median overall survival was not reached at the prespecified final analysis. The objective response rate was 63.9%. Serious treatment-related adverse events occurred in 38.9% of patients.

Study details: This single-center, phase 2 trial included 36 adult treatment-naive patients with advanced HCC (86.1% with high-risk features) who received lenvatinib, toripalimab, and FOLFOX-HAIC.

Disclosures: This study was supported by the National Natural Science Foundation of China, Development Planned Project in Key Areas of Guangdong Province, and the China Postdoctoral Science Foundation. The authors declared no conflicts of interest.

Source: Lai ZC, He MK, Bu XY, Xu YJ, et al. Lenvatinib, toripalimab plus hepatic arterial infusion chemotherapy in patients with high-risk advanced hepatocellular carcinoma: A biomolecular exploratory, phase II trial. Eur J Cancer. 2022;174:68-77 (Aug 15). Doi: 10.1016/j.ejca.2022.07.005

Key clinical point: Pretreatment albumin-bilirubin (ALBI) score and radiation dose on the nontumor section of the liver are independent predictive factors for post-transarterial radioembolization (TARE) hepatic decompensation in patients with hepatocellular carcinoma (HCC).

Major finding: Multivariate analysis revealed ALBI score at baseline (adjusted odds ratio [aOR] 6.425; P  =  .005) and radiation dose on the nontumor section of the liver (aOR 1.072; P  =  .011) to be independent risk factors for the development of hepatic decompensation after TARE.

Study details: Findings are from a single-center retrospective observational study that included 61 patients with HCC who underwent TARE and thereafter did (n = 17) or did not (n = 44) develop hepatic decompensation.

Disclosures: This study was conducted with no specific funding. Some authors declared serving as consultants, advisors, or speakers for various organizations.

Source: Reincke M et al. Hepatic decompensation after transarterial radioembolization: A retrospective analysis of risk factors and outcome in patients with hepatocellular carcinoma. Hepatol Commun. 2022 (Sep 5). Doi: 10.1002/hep4.2072

Key clinical point: Pretreatment albumin-bilirubin (ALBI) score and radiation dose on the nontumor section of the liver are independent predictive factors for post-transarterial radioembolization (TARE) hepatic decompensation in patients with hepatocellular carcinoma (HCC).

Major finding: Multivariate analysis revealed ALBI score at baseline (adjusted odds ratio [aOR] 6.425; P  =  .005) and radiation dose on the nontumor section of the liver (aOR 1.072; P  =  .011) to be independent risk factors for the development of hepatic decompensation after TARE.

Study details: Findings are from a single-center retrospective observational study that included 61 patients with HCC who underwent TARE and thereafter did (n = 17) or did not (n = 44) develop hepatic decompensation.

Disclosures: This study was conducted with no specific funding. Some authors declared serving as consultants, advisors, or speakers for various organizations.

Source: Reincke M et al. Hepatic decompensation after transarterial radioembolization: A retrospective analysis of risk factors and outcome in patients with hepatocellular carcinoma. Hepatol Commun. 2022 (Sep 5). Doi: 10.1002/hep4.2072

Key clinical point: Pretreatment albumin-bilirubin (ALBI) score and radiation dose on the nontumor section of the liver are independent predictive factors for post-transarterial radioembolization (TARE) hepatic decompensation in patients with hepatocellular carcinoma (HCC).

Major finding: Multivariate analysis revealed ALBI score at baseline (adjusted odds ratio [aOR] 6.425; P  =  .005) and radiation dose on the nontumor section of the liver (aOR 1.072; P  =  .011) to be independent risk factors for the development of hepatic decompensation after TARE.

Study details: Findings are from a single-center retrospective observational study that included 61 patients with HCC who underwent TARE and thereafter did (n = 17) or did not (n = 44) develop hepatic decompensation.

Disclosures: This study was conducted with no specific funding. Some authors declared serving as consultants, advisors, or speakers for various organizations.

Source: Reincke M et al. Hepatic decompensation after transarterial radioembolization: A retrospective analysis of risk factors and outcome in patients with hepatocellular carcinoma. Hepatol Commun. 2022 (Sep 5). Doi: 10.1002/hep4.2072

Key clinical point: Postoperative adjuvant transcatheter arterial chemoembolization (TACE) offers a favorable prognosis in hepatocellular carcinoma (HCC) with micronecrosis but limited efficacy against HCC without micronecrosis.

Major finding: Adjuvant TACE significantly improved the overall survival (OS; P  =  .004) and disease-free survival (DFS; P  =  .034) of patients with micronecrosis but led to a nonsignificant difference in the OS (P  =  .430) and DFS (P  =  .131) of patients without micronecrosis.

Study details: This retrospective study propensity score-matched patients who underwent curative liver resection for HCC with (n = 328) or without (n = 438) micronecrosis, with each group comprising patients who did or did not (1:1) receive adjuvant TACE after liver resection.

Disclosures: This study was supported by the National Key Research & Development Program of China and others. No information on conflicts of interest was available.

Source: Wang Y, Ge H, Hu M, et al. Histological tumor micronecrosis in resected specimens after R0 hepatectomy for hepatocellular carcinomas is a factor in determining adjuvant TACE: A retrospective propensity score-matched study. Int J Surg. 2022;105:106852 (Aug 24). Doi: 10.1016/j.ijsu.2022.106852.

Key clinical point: Postoperative adjuvant transcatheter arterial chemoembolization (TACE) offers a favorable prognosis in hepatocellular carcinoma (HCC) with micronecrosis but limited efficacy against HCC without micronecrosis.

Major finding: Adjuvant TACE significantly improved the overall survival (OS; P  =  .004) and disease-free survival (DFS; P  =  .034) of patients with micronecrosis but led to a nonsignificant difference in the OS (P  =  .430) and DFS (P  =  .131) of patients without micronecrosis.

Study details: This retrospective study propensity score-matched patients who underwent curative liver resection for HCC with (n = 328) or without (n = 438) micronecrosis, with each group comprising patients who did or did not (1:1) receive adjuvant TACE after liver resection.

Disclosures: This study was supported by the National Key Research & Development Program of China and others. No information on conflicts of interest was available.

Source: Wang Y, Ge H, Hu M, et al. Histological tumor micronecrosis in resected specimens after R0 hepatectomy for hepatocellular carcinomas is a factor in determining adjuvant TACE: A retrospective propensity score-matched study. Int J Surg. 2022;105:106852 (Aug 24). Doi: 10.1016/j.ijsu.2022.106852.

Key clinical point: Postoperative adjuvant transcatheter arterial chemoembolization (TACE) offers a favorable prognosis in hepatocellular carcinoma (HCC) with micronecrosis but limited efficacy against HCC without micronecrosis.

Major finding: Adjuvant TACE significantly improved the overall survival (OS; P  =  .004) and disease-free survival (DFS; P  =  .034) of patients with micronecrosis but led to a nonsignificant difference in the OS (P  =  .430) and DFS (P  =  .131) of patients without micronecrosis.

Study details: This retrospective study propensity score-matched patients who underwent curative liver resection for HCC with (n = 328) or without (n = 438) micronecrosis, with each group comprising patients who did or did not (1:1) receive adjuvant TACE after liver resection.

Disclosures: This study was supported by the National Key Research & Development Program of China and others. No information on conflicts of interest was available.

Source: Wang Y, Ge H, Hu M, et al. Histological tumor micronecrosis in resected specimens after R0 hepatectomy for hepatocellular carcinomas is a factor in determining adjuvant TACE: A retrospective propensity score-matched study. Int J Surg. 2022;105:106852 (Aug 24). Doi: 10.1016/j.ijsu.2022.106852.

Key clinical point: Patients with unresectable hepatocellular carcinoma (uHCC) and modified albumin-bilirubin (mALBI) grade 1 or 2a show better therapeutic response to atezolizumab plus bevacizumab (ATE+BEV) treatment than those with uHCC and mALBI grade 2b or 3.

Major finding: Patients with mALBI grade 1+2a vs mALBI grade 2b+3 had a significantly higher objective response rate (26.2% vs 3.4%; P  =  .02) and longer median progression-free survival (10.5 vs 3.0 months; hazard ratio 2.086; P < .01) with ATE+BEV.

Study details: This retrospective observational study included 71 patients who received ATE+BEV for uHCC and had an mALBI grade of 1+2a (n = 42) or 2b+3 (n = 29).

Disclosures: No source of funding was reported. The authors declared no conflicts of interest.

Source: Tomonari T et al. Initial therapeutic results of atezolizumab plus bevacizumab for unresectable advanced hepatocellular carcinoma and the importance of hepatic functional reserve. Cancer Med. 2022 (Aug 14). Doi: 10.1002/cam4.5145

Key clinical point: Patients with unresectable hepatocellular carcinoma (uHCC) and modified albumin-bilirubin (mALBI) grade 1 or 2a show better therapeutic response to atezolizumab plus bevacizumab (ATE+BEV) treatment than those with uHCC and mALBI grade 2b or 3.

Major finding: Patients with mALBI grade 1+2a vs mALBI grade 2b+3 had a significantly higher objective response rate (26.2% vs 3.4%; P  =  .02) and longer median progression-free survival (10.5 vs 3.0 months; hazard ratio 2.086; P < .01) with ATE+BEV.

Study details: This retrospective observational study included 71 patients who received ATE+BEV for uHCC and had an mALBI grade of 1+2a (n = 42) or 2b+3 (n = 29).

Disclosures: No source of funding was reported. The authors declared no conflicts of interest.

Source: Tomonari T et al. Initial therapeutic results of atezolizumab plus bevacizumab for unresectable advanced hepatocellular carcinoma and the importance of hepatic functional reserve. Cancer Med. 2022 (Aug 14). Doi: 10.1002/cam4.5145

Key clinical point: Patients with unresectable hepatocellular carcinoma (uHCC) and modified albumin-bilirubin (mALBI) grade 1 or 2a show better therapeutic response to atezolizumab plus bevacizumab (ATE+BEV) treatment than those with uHCC and mALBI grade 2b or 3.

Major finding: Patients with mALBI grade 1+2a vs mALBI grade 2b+3 had a significantly higher objective response rate (26.2% vs 3.4%; P  =  .02) and longer median progression-free survival (10.5 vs 3.0 months; hazard ratio 2.086; P < .01) with ATE+BEV.

Study details: This retrospective observational study included 71 patients who received ATE+BEV for uHCC and had an mALBI grade of 1+2a (n = 42) or 2b+3 (n = 29).

Disclosures: No source of funding was reported. The authors declared no conflicts of interest.

Source: Tomonari T et al. Initial therapeutic results of atezolizumab plus bevacizumab for unresectable advanced hepatocellular carcinoma and the importance of hepatic functional reserve. Cancer Med. 2022 (Aug 14). Doi: 10.1002/cam4.5145

Key clinical point: Hepatectomy offers greater survival benefits than sorafenib therapy in patients with advanced hepatocellular carcinoma (HCC) and macroscopic portal vein tumor thrombus (PVTT).

Major finding: Patients who underwent hepatectomy vs received sorafenib had a significantly longer median survival time (15.1 vs 4.5 months; hazard ratio 1.704; P  =  .0446).

Study details: This study propensity score-matched patients with advanced HCC and macroscopic PVTT invaded into an ipsilateral first-order portal branch or main trunk/contralateral portal vein who underwent hepatectomy (n = 36) with those who received sorafenib (n = 36).

Disclosures: No source of funding was reported. Some authors reported receiving grants or personal fees from various sources.

Source: Komatsu S et al. Hepatectomy versus sorafenib for advanced hepatocellular carcinoma with macroscopic portal vein tumor thrombus: A bi-institutional propensity-matched cohort study. J Hepatobiliary Pancreat Sci. 2022 (Sep 1). Doi: 10.1002/jhbp.1236

Key clinical point: Hepatectomy offers greater survival benefits than sorafenib therapy in patients with advanced hepatocellular carcinoma (HCC) and macroscopic portal vein tumor thrombus (PVTT).

Major finding: Patients who underwent hepatectomy vs received sorafenib had a significantly longer median survival time (15.1 vs 4.5 months; hazard ratio 1.704; P  =  .0446).

Study details: This study propensity score-matched patients with advanced HCC and macroscopic PVTT invaded into an ipsilateral first-order portal branch or main trunk/contralateral portal vein who underwent hepatectomy (n = 36) with those who received sorafenib (n = 36).

Disclosures: No source of funding was reported. Some authors reported receiving grants or personal fees from various sources.

Source: Komatsu S et al. Hepatectomy versus sorafenib for advanced hepatocellular carcinoma with macroscopic portal vein tumor thrombus: A bi-institutional propensity-matched cohort study. J Hepatobiliary Pancreat Sci. 2022 (Sep 1). Doi: 10.1002/jhbp.1236

Key clinical point: Hepatectomy offers greater survival benefits than sorafenib therapy in patients with advanced hepatocellular carcinoma (HCC) and macroscopic portal vein tumor thrombus (PVTT).

Major finding: Patients who underwent hepatectomy vs received sorafenib had a significantly longer median survival time (15.1 vs 4.5 months; hazard ratio 1.704; P  =  .0446).

Study details: This study propensity score-matched patients with advanced HCC and macroscopic PVTT invaded into an ipsilateral first-order portal branch or main trunk/contralateral portal vein who underwent hepatectomy (n = 36) with those who received sorafenib (n = 36).

Disclosures: No source of funding was reported. Some authors reported receiving grants or personal fees from various sources.

Source: Komatsu S et al. Hepatectomy versus sorafenib for advanced hepatocellular carcinoma with macroscopic portal vein tumor thrombus: A bi-institutional propensity-matched cohort study. J Hepatobiliary Pancreat Sci. 2022 (Sep 1). Doi: 10.1002/jhbp.1236

Key clinical point: Transarterial chemoembolization (TACE) via transradial access (TRA) leads to improved patient satisfaction along with similar procedural variables and safety compared with TACE via transfemoral access (TFA) in patients with hepatocellular carcinoma (HCC).

Major finding: In the TACE-TRA vs TACE-TFA group a significantly higher proportion of patients preferred the current access for their next procedure (90.8% vs 24.6%; P < .001), although between-group procedural variables (such as procedure time and length of hospital stay; all P > .05) and the incidence and severity of adverse events (all P > .05) were similar.

Study details: This single-center prospective randomized controlled trial included 130 patients with HCC who underwent TACE for the first time either via TRA (n = 65) or TFA (n = 65).

Disclosures: This study was sponsored by the Beijing Hope Run Special Fund of the Cancer Foundation of China. The authors declared no conflicts of interest.

Source: Zhang X et al. Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized trial. Eur Radiol. 2022 (Aug 26). Doi: 10.1007/s00330-022-09038-1

Key clinical point: Transarterial chemoembolization (TACE) via transradial access (TRA) leads to improved patient satisfaction along with similar procedural variables and safety compared with TACE via transfemoral access (TFA) in patients with hepatocellular carcinoma (HCC).

Major finding: In the TACE-TRA vs TACE-TFA group a significantly higher proportion of patients preferred the current access for their next procedure (90.8% vs 24.6%; P < .001), although between-group procedural variables (such as procedure time and length of hospital stay; all P > .05) and the incidence and severity of adverse events (all P > .05) were similar.

Study details: This single-center prospective randomized controlled trial included 130 patients with HCC who underwent TACE for the first time either via TRA (n = 65) or TFA (n = 65).

Disclosures: This study was sponsored by the Beijing Hope Run Special Fund of the Cancer Foundation of China. The authors declared no conflicts of interest.

Source: Zhang X et al. Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized trial. Eur Radiol. 2022 (Aug 26). Doi: 10.1007/s00330-022-09038-1

Key clinical point: Transarterial chemoembolization (TACE) via transradial access (TRA) leads to improved patient satisfaction along with similar procedural variables and safety compared with TACE via transfemoral access (TFA) in patients with hepatocellular carcinoma (HCC).

Major finding: In the TACE-TRA vs TACE-TFA group a significantly higher proportion of patients preferred the current access for their next procedure (90.8% vs 24.6%; P < .001), although between-group procedural variables (such as procedure time and length of hospital stay; all P > .05) and the incidence and severity of adverse events (all P > .05) were similar.

Study details: This single-center prospective randomized controlled trial included 130 patients with HCC who underwent TACE for the first time either via TRA (n = 65) or TFA (n = 65).

Disclosures: This study was sponsored by the Beijing Hope Run Special Fund of the Cancer Foundation of China. The authors declared no conflicts of interest.

Source: Zhang X et al. Transradial versus transfemoral access without closure device for transarterial chemoembolization in patients with hepatocellular carcinoma: A randomized trial. Eur Radiol. 2022 (Aug 26). Doi: 10.1007/s00330-022-09038-1