Updates of colorectal cancer liver metastases therapy: review on DEBIRI

Fiorentini, Giammaria; Sarti, Donatella; Nani, Roberto; Aliberti, Camillo; Fiorentini, Caterina; Guadagni, Stefano

doi:10.2217/hep-2019-0010

Cited by 31 publications

(34 citation statements)

References 63 publications

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“…In contrast to doxycycline-TACE in intermediate HCC, there is no standardisation of peri-procedural management for irinotecan TACE. As expected, this has resulted in vast differences in procedural medications being reported in CIREL, which has been already reported in the literature [40]. In response to the need for treatment standardisation, Iezzi et al recently published recommendations, suggesting the continuous infusion of opioid and non-steroidal anti-inflammatory medication to reduce peri-procedural pain.…”

Section: Discussionmentioning

confidence: 90%

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

Pereira

Iezzi

Manfredi

et al. 2020

Cardiovasc Intervent Radiol

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Purpose Transarterial chemoembolisation (TACE) using irinotecan-eluting beads is an additional treatment option for colorectal cancer liver metastases (CRLM) patients that are not eligible for curative treatment approaches. This interim analysis focuses on feasibility of the planned statistical analysis regarding data distribution and completeness, treatment intention, safety and health-related quality of life (HRQOL) of the first 50 patients prospectively enrolled in the CIrse REgistry for LifePearl™ microspheres (CIREL), an observational multicentre study conducted across Europe. Methods In total, 50 patients ≥ 18 years diagnosed with CRLM and decided to be treated with irinotecan-eluting LifePearl™ microspheres TACE (LP-irinotecan TACE) by a multidisciplinary tumour board. There were no further inclusion or exclusion criteria. The primary endpoint is the categorisation of treatment intention, and secondary endpoints presented in this interim analysis are safety, treatment considerations and HRQOL. Results LP-irinotecan TACE was conducted in 42% of patients as salvage therapy, 20% as an intensification treatment, 16% as a first-line treatment, 14% a consolidation treatment and 8% combination treatment with ablation with curative intent. Grade 3 and 4 adverse events were reported by 4% of patients during procedure and by 10% within 30 days. While 38% reported a worse, 62% reported a stable or better global health score, and 54% of patients with worse global health score were treated as salvage therapy patients. Conclusion This interim analysis confirms in a prospective analysis the feasibility of the study, with an acceptable toxicity profile. More patients reported a stable or improved HRQOL than deterioration. Deterioration of HRQOL was seen especially in salvage therapy patients. Trial Registration NCT03086096.

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Section: Discussionmentioning

confidence: 90%

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

Pereira

Iezzi

Manfredi

et al. 2020

Cardiovasc Intervent Radiol

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“…Studies using DEB-TACE chemoembolization show a risk of serious complications estimated at 1.6–11% [ 11 ] and a 30-day mortality of up to 1% [ 12 ]. The most common serious complications include liver failure and cholecystitis.…”

Section: Discussionmentioning

confidence: 99%

Side Effect/Complication Risk Related to Injection Branch Level of Chemoembolization in Treatment of Metastatic Liver Lesions from Colorectal Cancer

Szemitko

Golubinska-Szemitko

Wilk-Milczarek

et al. 2020

JCM

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Purpose: Transarterial chemoembolization with drug eluting beads (DEB-TACE) loaded with irinotecan despite having proven efficacy in the treatment of unresectable liver metastases in the course of colorectal cancer (CRC) does not have an established consistent method. In particular, there are discrepancies in the branch level at which microspheres are administered. Lobar embolization supplies microspheres to all vessels supplying a metastatic lesion but exposes the entire liver parenchyma to negative effects from microsphere irinotecan. Superselective chemoembolization compromises healthy liver parenchyma less but may omit small vessels supplying metastatic lesions. Objective: Assessment of the risk of complications and the severity of postembolization syndromes with CRC metastatic liver lesion chemoembolization with irinotecan-loaded microspheres, according to branch level of chemoembolization. Patients and methods: The analysis included 49 patients (27 female/22 male) with liver metastases in the course of CRC, who underwent 192 chemoembolization treatments (mean 3.62 per patient) with microspheres loaded with 100 mg irinotecan. The procedures were performed according to an adopted schema: alternating the right and left lobe of the liver at 3-week intervals. The severity of postembolization syndrome (PES) and the presence of complications were assessed according to the branch level of chemoembolization; microspheres were administered at the branch level of lobar, segmental, or subsegmental arteries. Assessment of adverse events was performed according to the standards of the Cancer Therapy Evaluation Program Common Terminology Criteria for Adverse Events, Version 5.0. Results: The median survival of all patients from the start of chemoembolization was 13 months. With 192 chemoembolization sessions, 14 (7.3%) serious complications were found. The study showed no significant relationship between the branch level of embolizate administration and the presence of complications (p = 0.2307). Postembolization syndrome was diagnosed after 102 chemoembolization treatments, i.e., 53.1% of treatments. A significant correlation was found between the severity of the postembolization syndrome and the branch level of embolization treatment (p = 0.00303). The mean PES severity increased from subsegmental through segmental to lobar administration. Conclusion: Chemoembolization using Irinotecan-loaded microspheres was relatively well tolerated by patients and gave a low risk of significant complications, which did not change with the branch level of microsphere administration. However, an association was found between the branch level of chemoembolization and the severity of postembolization syndrome. Further research is needed to determine the most effective DEB-TACE chemoembolization technique.

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“…renal cell carcinoma (NCC), cholangiocellular carcinoma (CCC) and hepatocellular carcinoma (HCC) and even newer drugs are only effective in defined subgroups – for example immunotherapy has proven effectiveness in the subgroup of pretreated mismatch-repair-deficient/microsatellite instable (MSI) CRC in stage IV – this makes up just 3-20% of the CRC patients ( 8 , 9 ). Unresectable CRC liver metastases that are refractory to SCT benefit from liver-directed transarterial therapies ( 8 , 10 ). Compared to classical surgery, the main advantages of MIT are the lower invasiveness, the lack of anesthesia, less pain and shorter hospital stays.…”

Section: Interventional Oncologymentioning

confidence: 99%

“…EVT are preferable to ablation and SBRT if in a liver lobe several LM are present, which can be treated simultaneously. In comparison, transarterial chemoembolization (TACE) of colorectal liver metastases (DEBIRI) showed not only a survival benefit but also better tolerability compared to intravenous systemic therapy (FOLFIRI) ( 10 , 11 ).…”

Section: Evidencementioning

confidence: 99%

Personalized Image-Guided Therapies for Local Malignencies: Interdisciplinary Options for Interventional Radiology and Interventional Radiotherapy

Kovács¹,

Bischoff²,

Haddad³

et al. 2021

Front. Oncol.

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Minimal-invasive interventions considerably extend the therapeutic spectrum in oncology and open new dimensions in terms of survival, tolerability and patient-friendliness. Through the influence of image-guided interventions, many interdisciplinary therapy concepts have significantly evolved, and this process is by far not yet over. The rapid progression of minimal-invasive technologies offers hope for new therapeutic concepts in the short, medium and long term. Image-guided hybrid-technologies complement and even replace in selected cases classic surgery. In this newly begun era of immune-oncology, interdisciplinary collaboration and the focus on individualized and patient-friendly therapies are crucial.

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Updates of colorectal cancer liver metastases therapy: review on DEBIRI

Cited by 31 publications

References 63 publications

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

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

Side Effect/Complication Risk Related to Injection Branch Level of Chemoembolization in Treatment of Metastatic Liver Lesions from Colorectal Cancer

Personalized Image-Guided Therapies for Local Malignencies: Interdisciplinary Options for Interventional Radiology and Interventional Radiotherapy

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