Surgical downstaging and neo-adjuvant therapy in metastatic colorectal carcinoma with irinotecan drug-eluting beads: a multi-institutional study

Abstract

Hepatic arterial infusion irinotecan drug-eluting beads is safe and effective in pre-surgical therapy and helpful in evaluating the biology of metastatic colorectal cancer to the liver prior to planned hepatic resection.

Historical perspective: Two decades of progress in treating metastatic colorectal cancer

“…Currently, this is the most standard and accepted of the TACE technologies . DEB‐TACE can be used in patients with adequate liver function in tumors without vascular invasion and has been studied in non‐resectable colorectal liver metastases and as a neo‐adjuvant therapy to downstage patients for surgical resection or ablation with objective response rates of 42% to 78% and progression‐free survival of 11 to 19 months . A phase III randomized controlled trial found improved survival in patients with unresectable liver metastases receiving DEB‐TACE compared with systemic treatment with FOLFIRI with no significant difference in extra‐hepatic progression .…”

“…DEB-TACE combines the two methods: permanent embolic agents are coated with cytotoxic therapies allowing for a controlled release of the drug into the tissues over hours or days. Current recruiting or active/not recruiting phase III or IV clinical trials for metastatic colorectal cancer in the United States survival of 11 to 19 months 163,164. A phase III randomized controlled trial found improved survival in patients with unresectable liver metastases receiving DEB-TACE compared with systemic treatment with FOLFIRI with no significant difference in extra-hepatic progression 165.…”

Locoregional drug delivery using image-guided intra-arterial drug eluting bead therapy

“…Early clinical data are very encouraging, with local disease control rates of >60% (by modified RECIST criteria) [62–64] with one study reporting a statistically significant improvement in median overall survival compared to chemotherapy (FOLFIRI) of 23 versus 15 months [65]. Some patients treated with DEBIRI have been subsequently down-staged to surgery, which demonstrates the feasibility of this treatment in a neoadjuvant setting [66]. …”

Safety and Efficacy Compared between Irinotecan-Loaded Microspheres HepaSphere and DC Bead in a Model of VX2 Liver Metastases in the Rabbit

“…Several observational studies have used embolic agents loaded with IRI in different therapeutic settings (6)(7)(8)(9)(10). One phase III randomized controlled trial reported promising results: Overall survival, progression-free survival, and quality of life were significantly improved for IRI-loaded beads compared with systemic chemotherapy with 5-fluorouracil and IRI (11).…”