1 Recommendations

1.1 The selective internal radiation therapy (SIRT) SIR‑Spheres is recommended as an option for treating unresectable advanced hepatocellular carcinoma (HCC) in adults, only if:

used for people with Child–Pugh grade A liver impairment when conventional transarterial therapies are inappropriate, and
the company provides SIR‑Spheres according to the commercial arrangement.

1.2 The SIRT TheraSphere is recommended as an option for treating unresectable advanced HCC in adults, only if:

used for people with Child–Pugh grade A liver impairment when conventional transarterial therapies are inappropriate, and
the company provides TheraSphere according to the commercial arrangement.

1.3 The SIRT QuiremSpheres is not recommended for treating unresectable advanced HCC in adults.

1.4 These recommendations are not intended to affect treatment with SIR‑Spheres, TheraSphere and QuiremSpheres that was started in the NHS before this guidance was published. People having treatment outside these recommendations may continue without change to the funding arrangements in place for them before this guidance was published, until they and their NHS clinician consider it appropriate to stop.

Why the committee made these recommendations

Treatment for HCC depends on the stage of the disease and liver function. Treatment options include surgery, ablation, transarterial therapies, chemotherapy (such as sorafenib) and best supportive care. Treatment does not cure the disease for most people.

SIRTs are small radioactive beads that are injected into the liver's blood supply to treat liver cancer. QuiremSpheres, SIR-Spheres and TheraSphere are the 3 SIRTs considered in this appraisal. The clinical trial data for these SIRTs compared with other treatment options are limited. But, compared with sorafenib, SIRTs may have fewer and more manageable adverse effects, which can improve quality of life.

There is not enough evidence to consider SIRTs a cost-effective use of NHS resources for people with early and intermediate HCC.

For people with advanced HCC, QuiremSpheres is less clinically effective than sorafenib and costs more, so it is not recommended. SIR-Spheres and TheraSphere are slightly less clinically effective than sorafenib but cost less. The cost savings mean that SIR‑Spheres and TheraSphere can be recommended as options for people with Child–Pugh grade A liver impairment when conventional transarterial therapies are inappropriate.