Polyethylene glycol microspheres loaded with irinotecan for arterially directed embolic therapy of metastatic liver cancer

Abstract

AIMTo study tumor response, and tolerability of arterially directed embolic therapy (ADET) with polyethylene glycol embolics loaded with irinotecan for the treatment of colorectal cancer liver metastases (CRC-LM). Secondary objectives were to monitor quality of life, time to progression and survival of patients.METHODSPatients were included in the study if they were affected by CRC-LM, refractory to systemic chemotherapy, treated with ADET using polyethylene glycol embolics, and had liver involvement < 50%. Tumor response, performance status (PS), tumor marker antigens, and quality of life (QoL) were monitored at 1, 3 and 6 mo after ADET. QoL was assessed with the Palliative Performance Scale (PPS).RESULTSWe treated 50 consecutive CRC-LM patients with ADET using polyethylene glycol embolics. Their tumor response one month after ADET was: 28% of complete response (CR), 48% of partial response (PR), 8% stable disease (SD), and 16% of progression. Tumor response 3 mo after ADET was CR 24%, PR 38%, SD 19% and progression disease (PD) 19%. Tumor response 6 mo after ADET was CR 18%, PR 44%, SD 21% and PD 18%. QoL was 90% PPS at each time point. Median time to progression for patients who progressed was 2.5 mo (range 0.8-6). Median follow-up was 14 mo (0.8-25 range). ADETs were performed with no complications. Observed side effects (mild or moderate intensity) were: Pain in 32% of patients, increase of transaminase levels in 20% and fever in 14%, whereas 30% of patients did not complain any adverse event.CONCLUSIONThe treatment of unresectable CRC-LM with ADET using polyethylene glycol microspheres loaded with irinotecan was effective in tumor response and resulted in mild toxicity, and good QoL.

Updates of colorectal cancer liver metastases therapy: review on DEBIRI

“…Type & size of the embolics There are several types of embolics for the irinotecan delivery. Recent improvements of TACE, including the introduction of new types of embolics (PEG microspheres), have increased tumor response in CRC-LM patients [23,24]. Some type of beads (LUMI) incorporate an imaging agent and can be loaded with a chemotherapeutic drug and can be visualized during TACE and in follow-up imaging [25][26][27].…”

“…In the past decade, several efforts have been made to improve TACE tolerability, including drug dosage adjustments, incremental experience of interventional radiologist, introduction of new type of drugs and microspheres to obtain a more precise and selective treatment [23][24][25][26][27].…”

The CIREL Cohort: A Prospective Controlled Registry Studying the Real-Life Use of Irinotecan-Loaded Chemoembolisation in Colorectal Cancer Liver Metastases: Interim Analysis

“…However, correlating different periprocedural medications and treatment strategies with adverse events is beyond the scope of this interim analysis. Another important aspect of palliative treatment is the maintenance of health-related quality of life (HRQOL), yet there are only few studies dedicated to studying HRQOL in TACE in CRLM [44][45][46][47]. Our data suggest improvement or maintenance of global health in 62%, of functionality in 74% and of symptom score in 82% of patients.…”

“…Deterioration in HRQOL global health score was observed especially for salvage therapy patients. While reporting maintenance or improvement of HRQOL, most studies have a limited number of participants [46,47] or are not using patient-reported performance scales [45] and there is currently no comparable study describing the effect on irinotecan TACE on global health and functionality score. Previous findings using the Edmonton SAS questionnaire which correlates with the symptom score of the EORTC QLQ 30 in a comparable cohort to CIREL report improvement in 91% of patients [44] which is in line with our results regarding the symptom score.…”

New frontiers in endovascular therapies for locally advanced hepatocellular carcinoma

“…However, this combined treatment has yet to be standardised, and there is still no consensus as to whether the thermal ablation should be performed before or after TACE, as well as whether both treatments should be performed in a single-step fashion or in a sequential manner (with an interval between the two from 24 h to several days) to achieve the optimal synergistic effect ( 8 ) . The other advantage of combined treatment is its usefulness in treating lesions in unfavourable locations, such as peri-cholecystic and sub-capsular lesions, as well as hypovascular lesions due to the hyperaemic effect of thermal ablation, although it is also of great help in treating post-thermal ablation complications, such as bleeding (especially in patients with low platelet counts), with the same TACE micro-spheres ( 9 , 10 ) .…”