Intra-Arterial Chemotherapy for Stage-lll/IV Pancreatic Cancer

Abstract

Objective: The very limited efficacy of current chemotherapeutic strategies in advanced pancreatic cancer (APC) and the pattern of metastastic spread, largely confined to the upper abdominal organs within the arterial supply of celiac axis, induced us to design this phase-II study of locoregional intra-arterial chemotherapy. The aim of the present study was to evaluate the feasibility, the toxicity, the response rate and survival of a new combination of drugs administered intra-arterially in the treatment of APC. Methods: From January 1994 to August 1995, thirty-six consecutive patients with APC were given intra-arterial cycles of chemotherapy every 3 weeks through a catheter in the celiac axis introduced via the femoral artery. Seventeen patients were classified as UICC stage III and 19 as stage IV. Nineteen had liver metastases and 1 patient also had lung metastases. The schedule was: 5-fluorouracil 1,000 mg/m²; folinic acid 100mg/m²; epirubicin 60 mg/m² and carboplatin 300 mg/m². Each drug was infused over a period of 10 min and only 1 day of hospitalization was necessary for each cycle. After 3 cycles, when a response or stable disease had been obtained, another 2 cycles were planned, health conditions permitting. Results: A total of 114 courses of chemotherapy were administered with a mean of 3 for each patient (range 1-5). 33 patients were evaluable for response by CT scan: 7 of 33 (21%) had a partial response; 16 of 33 (49%) had stable disease; 10 of 33 (30%) had a progressive disease, and 23 of 36 (64%) had a decrease in Ca 19-9. A reduction in pain was reached in 16 of 26 patients (62%) and particularly 9 of 26 patients (35%) showed complete regression for 8 weeks or more. Weight increase was obtained in 13 of 28 patients (46%). Grade-3-4 hematological toxicity was observed in 9 of 36 (25%), and ematemesis in 2 of 36 patients (6%). Grade-3 gastrointestinal toxicity was observed in 4 of 36 (11%); alopecia in 3 of 36 (8%). One sudden death was observed in a patient on day 23 after the third cycle. No complication related to the angiographic procedure was noted. At a median follow-up of 7 months (range 1-17), the median survival was 6.2 months and, according to stage, 4.9 and 13.4 months for stages IV and III, respectively. The median time to progression was 4 months (range 2-11). Conclusions: This study shows that this drug combination, given through a celiac axis infusion, is well tolerated and active, requires only 1 day of hospitalization and might become an interesting form of integrated strategy in a palliative setting. Stage-111 patients are probably the group that might profit most with prolonged survival.

Combined Gemcitabine and α-Interferon Therapy for Pancreatic Cancer: Report of a Case

“…However, liver tumors metastatic from pancreatic cancers hardly respond to transarterial chemotherapy. Moreover, although arterial infusion chemotherapy has been attempted to increase the local concentration of anticancer agents in pancreatic tumors, the treatment results (mean survival times) have been unsatisfactory (16)(17)(18). Conventional chemotherapy is ineffective because of the high malignant potentiality of pancreatic cancers.…”

Advanced pancreatic carcinoma showing a complete response to arterial infusion chemotherapy

“…1,5 This principle was not fully put into practice with conventional arterial infusion chemotherapy, as the catheter tip was placed in the abdominal aorta or celiac artery, regardless of whether it was intended to treat the primary lesion or the liver metastasis, resulting in both dilution of the infused drug due to swift arterial flow and decreased drug delivery to the target organ. 6,7 This deficiency was overcome by TPPAE and HSAIC, and resulted in almost triple the response rate in advanced pancreatic cancer, compared with the conventional arterial infusion chemotherapy. 1-3 While TPPAE is arterial embolization for the treatment of the primary lesion of pancreatic cancer, HSAIC is arterial infusion chemotherapy for the residual tumor after TPPAE.…”

A novel arterial infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma after vascular supply distribution via superselective embolization

“…31,32 However, we produced a biliary endoprosthesis in which an H-PSD tube was connected with the implanted port, 16 which enabled us to easily resolve jaundice and thus appeared to contribute to the increase of the survival rate. 7,24 Even in patients with advanced pancreatic carcinoma who were able to receive SAIC or HSAIC, the 3-year survival rate was no greater than 18.3%. We thus consider this biliary endoprosthesis system to be useful for advanced pancreatic carcinoma complicated by obstructive jaundice.…”