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Melancon MP, Yevich S, Avritscher R, Swigost A, Lu L, Tian L, Damasco JA, Dixon K, Cortes AC, Munoz NM, Liang D, Liu D, Tam AL. A novel irinotecan-lipiodol nanoemulsion for intravascular administration: pharmacokinetics and biodistribution in the normal and tumor bearing rat liver. Drug Deliv 2021; 28:240-251. [PMID: 33501859 PMCID: PMC8725905 DOI: 10.1080/10717544.2020.1869863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Colorectal cancer is one of the most common cancers in the United States and treatment options are limited for patients who develop liver metastases. Several chemotherapeutic regimens have been used for transvascular liver-directed therapy in the treatment of colorectal liver metastases without clear evidence of superiority of one therapy over another. We describe the development of a novel nanoemulsion through combining irinotecan (IRI), a first line systemic agent used for the treatment of colon cancer, with lipiodol, an oily contrast medium derived from poppy seed oil, and evaluated its pharmacokinetic and biodistribution profile as a function of portal venous chemoembolization (PVCE) versus transarterial chemoembolization (TACE) delivery. The Tessari technique was used to create a stable emulsion (20 mg IRI mixed with 2 mL lipiodol) with resultant particle size ranging from 28.9 nm to 56.4 nm. Pharmacokinetic profile established through venous sampling in Buffalo rats demonstrate that the area under the curve (AUC0−∞) of IRI was significantly less after PVCE with IRI-lipiodol as compared to IRI alone (131 vs. 316 µg*min/mL, p-value = .023), suggesting significantly higher amounts of IRI retention in the liver with the IRI-lipiodol nanoemulsion via first-pass extraction. Subseqent biodistribution studies in tumor-bearing WAG/Rjj rats revealed more IRI present in the tumor following TACE versus PVCE (29.19 ± 12.33 µg/g versus 3.42 ± 1.62; p-value = .0033) or IV (29.19 ± 12.33 µg/g versus 1.05 ± 0.47; p-value = .0035). The IRI-lipiodol nanoemulsion demonstrated an acceptable hepatotoxicity profile in all routes of administration. In conclusion, the IRI-lipiodol nanoemulsion via TACE showed promise and warrants further investigation as an option for the treatment of metastatic colorectal cancer.
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Affiliation(s)
- Marites P Melancon
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,The University of Texas MD Anderson Cancer Center UT Health Graduate School of Biomedical Sciences, Houston, TX, USA
| | - Steven Yevich
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rony Avritscher
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Adam Swigost
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Medstar Georgetown University Hospital, Washington Hospital Center, Washington, DC, USA
| | - Linfeng Lu
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.,Baylor College of Medicine, Houston, TX, USA
| | - Li Tian
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Jossana A Damasco
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Katherine Dixon
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Andrea C Cortes
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Nina M Munoz
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Dong Liang
- College of Pharmacy and Health Sciences, Texas Southern University, Houston, TX, USA
| | - David Liu
- The University of British Columbia, Vancouver, Canada
| | - Alda L Tam
- Department of Interventional Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Gordon AC, White SB, Yang Y, Gates VL, Procissi D, Harris KR, Zhang Z, Lyu T, Huang X, Dreher MR, Omary RA, Salem R, Lewandowski RJ, Larson AC. Feasibility of Combination Intra-arterial Yttrium-90 and Irinotecan Microspheres in the VX2 Rabbit Model. Cardiovasc Intervent Radiol 2020; 43:1528-1537. [PMID: 32533312 PMCID: PMC7529870 DOI: 10.1007/s00270-020-02538-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the combination of 90Y radioembolization (Y90) and drug-eluting bead irinotecan (DEBIRI) microspheres in the VX2 rabbit model. MATERIALS AND METHODS An initial dose finding study was performed in 6 White New Zealand rabbits to identify a therapeutic but subcurative dose of Y90. In total, 29 rabbits were used in four groups: Y90 treatment (n = 8), DEBIRI treatment (n = 6), Y90 + DEBIRI treatment (n = 7), and an untreated control group (n = 8). Hepatic toxicity was evaluated at baseline, 24 h, 72 h, 1 week, and 2 weeks. MRI tumor volume (TV) and enhancing tumor volume were assessed baseline and 2 weeks. Tumor area and necrosis were evaluated on H&E for pathology. RESULTS Infused activities of 84.0-94.4 MBq (corresponding to 55.1-72.7 Gy) were selected based on the initial dose finding study. Infusion of DEBIRI after Y90 was technically feasible in all cases (7/7). Overall, 21/29 animals survived to 2 weeks, and the remaining animals had extrahepatic disease on necropsy. Liver transaminases were elevated with Y90, DEBIRI, and Y90 + DEBIRI compared to control at 24 h, 72 h, and 1 week post-treatment and returned to baseline by 2 weeks. By TV, Y90 + DEBIRI was the only treatment to show statistically significant reduction at 2 weeks compared to the control group (p = 0.012). The change in tumor volume (week 2-baseline) for both Y90 + DEBIRI versus control (p = 0.002) and Y90 versus control (p = 0.014) was significantly decreased. There were no statistically significant differences among groups on pathology. CONCLUSION Intra-arterial Y90 + DEBIRI was safe and demonstrated enhanced antitumor activity in rabbit VX2 tumors. This combined approach warrants further investigation.
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Affiliation(s)
- Andrew C Gordon
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA.
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA.
| | - Sarah B White
- Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Yihe Yang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Vanessa L Gates
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Daniel Procissi
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Kathleen R Harris
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Zhuoli Zhang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Tianchu Lyu
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | - Xiaoke Huang
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
| | | | - Reed A Omary
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Riad Salem
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert J Lewandowski
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
- Department of Medicine-Hematology/Oncology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Surgery-Organ Transplantation, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Andrew C Larson
- Department of Radiology, Northwestern University Feinberg School of Medicine, 737 N. Michigan Ave, 16th Floor, Chicago, IL, 60611, USA
- Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
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3
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LifePearl microspheres loaded with irinotecan in the treatment of Liver-dominant metastatic colorectal carcinoma: feasibility, safety and pharmacokinetic study. Anticancer Drugs 2020; 31:1084-1090. [PMID: 32932279 DOI: 10.1097/cad.0000000000000980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
To evaluate pharmacokinetic and safety profile of LifePearl microspheres loaded with irinotecan (LifePearl-IRI) in the treatment of liver-dominant, metastatic colorectal carcinoma (LM-CRC) by transarterial chemoembolization. In a prospective, multicentre pharmacokinetic study, 14 patients with LM-CRC progressing on at least one line of chemotherapy were treated with LifePearl-IRI. Six patients received unilobar treatment, treating one lobe per session with 100 mg of irinotecan every 2 weeks. Eight patients received bilobar treatment, treating two lobes per session with 100 mg of irinotecan each (200 mg in total), every 4 weeks. At 24 h, near complete plasma clearance occurred for both irinotecan and SN-38, regardless of the dose. Mean plasma Cmax(100 mg) was 254.50 ± 104.17 ng/mL for irinotecan and 46.72 ± 13.75 ng/mL for SN-38. Mean Cmax(200 mg) was 970.09 ± 353.75 ng/mL for irinotecan and 118.45 ± 25.11 ng/mL for SN-38. Significantly higher Cmax-iri(200 mg) than Cmax-iri (100 mg) supported rate-limiting irinotecan-to-SN-38 conversion. Adverse events during the first 30 days upon initial treatment were hypertension in 21.4%, abdominal pain in 14.3%, and increased transaminases and fever in 7.1% of patients. Four serious adverse events were noted: respiratory failure, constipation, necrotizing pancreatitis, and ischaemic cholecystitis. Chemoembolization with LifePearl-IRI is technically feasible and relatively well tolerated, with a good pharmacokinetic profile and minimal systemic exposure of both irinotecan and SN-38, after both unilobar and bilobar treatment with 100 or 200 mg, respectively.
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de Man FM, Goey AKL, van Schaik RHN, Mathijssen RHJ, Bins S. Individualization of Irinotecan Treatment: A Review of Pharmacokinetics, Pharmacodynamics, and Pharmacogenetics. Clin Pharmacokinet 2019. [PMID: 29520731 PMCID: PMC6132501 DOI: 10.1007/s40262-018-0644-7] [Citation(s) in RCA: 232] [Impact Index Per Article: 46.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since its clinical introduction in 1998, the topoisomerase I inhibitor irinotecan has been widely used in the treatment of solid tumors, including colorectal, pancreatic, and lung cancer. Irinotecan therapy is characterized by several dose-limiting toxicities and large interindividual pharmacokinetic variability. Irinotecan has a highly complex metabolism, including hydrolyzation by carboxylesterases to its active metabolite SN-38, which is 100- to 1000-fold more active compared with irinotecan itself. Several phase I and II enzymes, including cytochrome P450 (CYP) 3A4 and uridine diphosphate glucuronosyltransferase (UGT) 1A, are involved in the formation of inactive metabolites, making its metabolism prone to environmental and genetic influences. Genetic variants in the DNA of these enzymes and transporters could predict a part of the drug-related toxicity and efficacy of treatment, which has been shown in retrospective and prospective trials and meta-analyses. Patient characteristics, lifestyle and comedication also influence irinotecan pharmacokinetics. Other factors, including dietary restriction, are currently being studied. Meanwhile, a more tailored approach to prevent excessive toxicity and optimize efficacy is warranted. This review provides an updated overview on today’s literature on irinotecan pharmacokinetics, pharmacodynamics, and pharmacogenetics.
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Affiliation(s)
- Femke M de Man
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015, Rotterdam, The Netherlands
| | - Andrew K L Goey
- Department of Hospital Pharmacy, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ron H N van Schaik
- Department of Clinical Chemistry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015, Rotterdam, The Netherlands
| | - Sander Bins
- Department of Medical Oncology, Erasmus MC Cancer Institute, 's-Gravendijkwal 230, 3015, Rotterdam, The Netherlands.
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Vera R, González-Flores E, Rubio C, Urbano J, Valero Camps M, Ciampi-Dopazo JJ, Orcajo Rincón J, Morillo Macías V, Gomez Braco MA, Suarez-Artacho G. Multidisciplinary management of liver metastases in patients with colorectal cancer: a consensus of SEOM, AEC, SEOR, SERVEI, and SEMNIM. Clin Transl Oncol 2019; 22:647-662. [PMID: 31359336 DOI: 10.1007/s12094-019-02182-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/08/2019] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) has the second-highest tumor incidence and is a leading cause of death by cancer. Nearly 20% of patients with CRC will have metastases at the time of diagnosis, and more than 50% of patients with CRC develop metastatic disease during the course of their disease. A group of experts from the Spanish Society of Medical Oncology, the Spanish Association of Surgeons, the Spanish Society of Radiation Oncology, the Spanish Society of Vascular and Interventional Radiology, and the Spanish Society of Nuclear Medicine and Molecular Imaging met to discuss and provide a multidisciplinary consensus on the management of liver metastases in patients with CRC. The group defined the different scenarios in which the disease can present: fit or unfit patients with resectable liver metastases, patients with potential resectable liver metastases, and patients with unresectable liver metastases. Within each scenario, the different strategies and therapeutic approaches are discussed.
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Affiliation(s)
- R Vera
- Medical Oncology, Complejo Hospitalario de Navarra, Calle Irunlarrea, 3, 31008, Pamplona, Navarra, Spain.
| | | | - C Rubio
- Radiation Oncology Department, University Hospital HM Sanchinarro, Madrid, Spain
| | - J Urbano
- Vascular and Interventional Radiology, Vithas Hospitals Group, Madrid, Spain
| | - M Valero Camps
- Nuclear Medicine, Clínica Rotger (Quiron Salud), Palma de Mallorca, Spain
| | - J J Ciampi-Dopazo
- Interventional Radiology Unit, Complejo Hospitalario de Toledo, Toledo, Spain
| | - J Orcajo Rincón
- Nuclear Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - V Morillo Macías
- Radiation Oncology, Hospital Provincial de Castellón, Castellón, Spain
| | - M A Gomez Braco
- Hepatobiliary and Liver Transplantation Unit, University Hospital Virgen del Rocío, Sevilla, Spain
| | - G Suarez-Artacho
- Hepatobiliary and Liver Transplantation Unit, University Hospital Virgen del Rocío, Sevilla, Spain
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Lewis AL, Hall B. Toward a better understanding of the mechanism of action for intra-arterial delivery of irinotecan from DC Bead (TM) (DEBIRI). Future Oncol 2019; 15:2053-2068. [PMID: 30942614 DOI: 10.2217/fon-2019-0071] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
DC Bead is designed for the embolization of liver malignancies combined with local sustained chemotherapy delivery. It was first demonstrated around a decade ago that irinotecan could be loaded into DC Bead and used in a transarterially directed procedure to treat colorectal liver metastases, commonly referred to as drug-eluting bead with irinotecan (DEBIRI). Despite numerous reports of its safe and effective use in treating colorectal liver metastases patients, there remains a perceived fundamental paradox as to how this treatment works. This review of the mechanism of action of DEBIRI provides a rationale for why intra-arterial delivery of this prodrug from an embolic bead provides for enhanced tumor selectivity, sparing the normal liver while reducing adverse side effects associated with the irinotecan therapy.
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Affiliation(s)
- Andrew L Lewis
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK
| | - Brenda Hall
- Biocompatibles UK Ltd, Lakeview, Riverside Way, Watchmoor Park, Camberley, Surrey, GU15 3YL, UK
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Can cone-beam CT tumor blood volume predicts the response to chemoembolization of colorectal liver metastases? Results of an observational study. Eur Radiol 2019; 29:5022-5031. [PMID: 30788587 DOI: 10.1007/s00330-019-6007-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 12/13/2018] [Accepted: 01/15/2019] [Indexed: 01/28/2023]
Abstract
PURPOSE To determine whether intraprocedural C-arm cone-beam CT (CBCT) parenchymal blood volume (PBV) can predict the response of colorectal cancer liver metastases (CRCLM) 2 months after irinotecan drug-eluting bead (DEBIRI) chemoembolization. MATERIALS AND METHODS This single-center observational study was compliant with the Helsinki Declaration and approved by our institutional review board. Thirty-four consecutive CRCLM patients referred for DEBIRI chemoembolization were enrolled between March 2015 and December 2016. Tumor size was assessed at baseline and 2 months after DEBIRI chemoembolization by multidetector CT (Response Evaluation Criteria in Solid Tumors RECIST 1.0), and PBV was measured before and after DEBIRI chemoembolization. Two independent readers reviewed all data. We determined the potential correlation (Spearman's rank correlation) between intraprocedural PBV values and tumor response at 2 months. The relationship between tumor response and PBV was studied using a mixed model. A logistic regression model was applied to study the relationship between patient "Responder/Non-responder" and PBV. RESULTS There was a strong correlation between baseline PBV or the percent change of PBV and the 2-month tumor response (rho = - 0.8587 (p = 0.00001) and rho = 0.8027 (p = 0.00001), respectively). The mixed model showed that an increase of 1 ml/1000 ml in PBV of a tumor before DEBIRI chemoembolization led to a 0.54 mm decrease in diameter (p < 0.005). A 1% decrease in PBV after DEBIRI chemoembolization resulted in tumor shrinkage of 0.75 mm (p < 0.005). The logistic regression model showed that patients with a 1% smaller mean decrease of PBV after DEBIRI chemoembolization had a 10% lower likelihood of achieving disease control (OR = 0.9, 95% confidence interval (CI) = 0.81-1; p = 0.0493). CONCLUSION Intraprocedural PBV may predict tumor response to DEBIRI chemoembolization. KEY POINTS • There is a strong relationship between the parenchymal blood volume (PBV) of colorectal liver metastases before DEBIRI chemoembolization and tumor response at 2 months. • Higher PBV values before DEBIRI chemoembolization correlate with greater tumor shrinkage, but only if the PBV decreases by more than 70% after DEBIRI chemoembolization. • Each increase of 1% in the mean decrease of PBV after DEBIRI chemoembolization resulted in a 10% lower likelihood of achieving disease control (OR = 0.9, 95% confidence interval (CI) = 0.81-1; p = 0.0493).
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Sato T, Tanaka T, Nishiofuku H, Fukuoka Y, Masada T, Tatsumoto S, Marugami N, Morita K, Obayashi C, Hori S, Kaneko M, Kijima A, Kichikawa K. Superabsorbent Polymer Microspheres Prepared with Hypertonic Saline to Reduce Microsphere Expansion. Cardiovasc Intervent Radiol 2018; 41:1412-1418. [DOI: 10.1007/s00270-018-1990-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 05/19/2018] [Indexed: 01/01/2023]
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9
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New Interventional Treatment Model for Pancreatic Neoplasms Using Gemcitabine-Eluting Hydrogel Devices: In Vitro and In Vivo Results. Cardiovasc Intervent Radiol 2017; 40:1246-1254. [DOI: 10.1007/s00270-017-1627-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 03/07/2017] [Indexed: 02/07/2023]
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10
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Drug-eluting embolic microspheres for local drug delivery - State of the art. J Control Release 2017; 262:127-138. [PMID: 28710006 DOI: 10.1016/j.jconrel.2017.07.016] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 07/07/2017] [Accepted: 07/10/2017] [Indexed: 12/19/2022]
Abstract
Embolic microspheres or beads used in transarterial chemoembolization are an established treatment method for hepatocellular carcinoma patients. The occlusion of the tumor-feeding vessels by intra-arterial injection of the beads results in tumor necrosis and shrinkage. In this short review, we describe the utility of using these beads as devices for local drug delivery. We review the latest advances in the development of non-biodegradable and biodegradable drug-eluting beads for transarterial chemoembolization. Their capability to load different drugs, such as chemotherapeutics and anti-angiogenic compounds with different physicochemical properties, like charge and hydrophilicity/hydrophobicity, are discussed. We specifically address controlled and sustained drug release from the microspheres, and the resulting in vivo pharmacokinetics in the plasma vs. drug distribution in the targeted tissue.
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11
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Potentiation of doxorubicin efficacy in hepatocellular carcinoma by the DNA repair inhibitor DT01 in preclinical models. Eur Radiol 2017; 27:4435-4444. [DOI: 10.1007/s00330-017-4792-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 01/11/2017] [Accepted: 03/06/2017] [Indexed: 12/15/2022]
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12
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de Baere T, Tselikas L, Yevich S, Boige V, Deschamps F, Ducreux M, Goere D, Nguyen F, Malka D. The role of image-guided therapy in the management of colorectal cancer metastatic disease. Eur J Cancer 2017; 75:231-242. [DOI: 10.1016/j.ejca.2017.01.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 11/29/2016] [Accepted: 01/14/2017] [Indexed: 02/07/2023]
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13
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Intraarterial Therapy Using Micellar Nanoparticles Incorporating SN-38 in a Rabbit Liver Tumor Model. J Vasc Interv Radiol 2017; 28:457-464. [DOI: 10.1016/j.jvir.2016.10.032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Revised: 10/31/2016] [Accepted: 10/31/2016] [Indexed: 11/22/2022] Open
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14
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Imai Y, Hirooka M, Koizumi Y, Nakamura Y, Watanabe T, Yoshida O, Tokumoto Y, Takeshita E, Abe M, Tanaka H, Kurata M, Kitazawa S, Hiasa Y. Histological assessment of the efficacy of drug-eluting beads in portal tumor thrombosis of hepatocellular carcinoma. Radiol Case Rep 2016; 12:179-184. [PMID: 28228906 PMCID: PMC5310373 DOI: 10.1016/j.radcr.2016.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 10/25/2016] [Accepted: 11/22/2016] [Indexed: 12/17/2022] Open
Abstract
A 58-year-old man was diagnosed with advanced hepatocellular carcinoma with portal vein tumor thrombosis (PVTT). The tumors were multiple and existed in both lobes. Drug-eluting beads transcatheter arterial chemoembolization (DEB-TACE) was performed for the tumors in the left lobe. Embosphere and Hepasphere were selected for embolization of the arterioportal shunt, followed by loaded epirubicin infusion into the left hepatic artery. Computed tomography showed reduction of PVTT. However, liver failure progressed, and the patient died 67 days after DEB-TACE. Autopsy showed that the beads reached the tumor thrombosis in the portal vein. The prognosis of hepatocellular carcinoma with PVTT is poor. Although there are no established treatments for unresectable PVTT, DEB-TACE might be a useful option for such cases.
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Affiliation(s)
- Yusuke Imai
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Masashi Hirooka
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yohei Koizumi
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yoshiko Nakamura
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Takao Watanabe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Osamu Yoshida
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yoshio Tokumoto
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Eiji Takeshita
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Masanori Abe
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Hiroaki Tanaka
- Department of Radiology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Mie Kurata
- Department of Pathogenomics, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Sohei Kitazawa
- Department of Molecular Pathology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
| | - Yoichi Hiasa
- Department of Gastroenterology and Metabology, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295, Japan
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de Baere T, Tselikas L, Boige V, Ducreux M, Malka D, Goéré D, Benahim E, Deschamps F. Intra-arterial therapies for colorectal cancer liver metastases (radioembolization excluded). Bull Cancer 2016; 104:402-406. [PMID: 27993355 DOI: 10.1016/j.bulcan.2016.10.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 10/29/2016] [Indexed: 02/07/2023]
Abstract
During the past 20 years, advances in systemic therapies have improved overall survival of patients with Colorectal cancer Liver metastases (CRLM) from 6 to 24 months. By reaching CRLM via their preferential arterial vascularization, hepatic arterial infusion of chemotherapy (HAIC) has demonstrated improvement in response rate and deepness of response. Improvement in deepness of response is potentially helpful to convert no surgical patient to surgery. Recent HAIC regimens, including HAIC-FUDR plus systemic oxaliplatin/irinotecan, or HAIC-oxaliplatin plus systemic 5FU and cetuximab yielded a 92% and 90% response rate respectively, and conversion to R0 surgery in 47% and 42% of patients, respectively. When HAIC delivered a drug ineffective through intravenous delivery, this rechallenge provided 62% response rate for HAIC. Nowadays, port-catheter implanted percutaneously by radiologists has 95% feasibility with primary patency equivalent to that of surgically implanted catheters, and secondary patency superior after radiologic revision. Retrospective studies demonstrated prolonged DFS of HAIC over IV chemotherapy in the adjuvant setting after surgery of CRLM. Drug eluting beads loaded with irinotecan (DEBIRI) were developed as drug carrier and embolization platform for treatment of CRLM by chemoembolization. DEBIRI allows for a very high level of SN-38 (SN-38 is the active compound of irinotecan) and a very high rate of complete l response at pathologic studies of treated metastases. DEBIRI was compared to systemic FOLFIRI in a phase III randomized trial including 74 patients with benefit in overall survival and disease-free survival.
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Affiliation(s)
- Thierry de Baere
- Gustave-Roussy Cancer Center, Department of Interventional Radiology, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud XI, UFR Médecine, 94270 Le Kremlin-Bicêtre, France.
| | - Lambros Tselikas
- Gustave-Roussy Cancer Center, Department of Interventional Radiology, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud XI, UFR Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Valérie Boige
- Gustave-Roussy Cancer Center, Department of Interventional Radiology, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud XI, UFR Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Michel Ducreux
- Gustave-Roussy Cancer Center, Department of Interventional Radiology, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud XI, UFR Médecine, 94270 Le Kremlin-Bicêtre, France
| | - David Malka
- Gustave-Roussy Cancer Center, Department of Interventional Radiology, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud XI, UFR Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Diane Goéré
- Gustave-Roussy Cancer Center, Department of Interventional Radiology, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud XI, UFR Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Eléonore Benahim
- Gustave-Roussy Cancer Center, Department of Interventional Radiology, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud XI, UFR Médecine, 94270 Le Kremlin-Bicêtre, France
| | - Frédéric Deschamps
- Gustave-Roussy Cancer Center, Department of Interventional Radiology, 114, rue Edouard-Vaillant, 94805 Villejuif, France; Université Paris-Sud XI, UFR Médecine, 94270 Le Kremlin-Bicêtre, France
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16
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Sato T, Tanaka T, Nishiofuku H, Fukuoka Y, Sakaguchi H, Masada T, Tatsumoto S, Marugami N, Takano M, Yamato I, Sho M, Ohbayashi C, Hirai T, Kichikawa K. Pharmacokinetics and Histopathological Findings of Chemoembolization Using Cisplatin Powder Mixed with Degradable Starch Microspheres in a Rabbit Liver Tumor Model. Cardiovasc Intervent Radiol 2016; 40:438-444. [DOI: 10.1007/s00270-016-1512-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 11/15/2016] [Indexed: 11/30/2022]
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Bize P, Duran R, Fuchs K, Dormond O, Namur J, Decosterd LA, Jordan O, Doelker E, Denys A. Antitumoral Effect of Sunitinib-eluting Beads in the Rabbit VX2 Tumor Model. Radiology 2016; 280:425-35. [PMID: 26919561 DOI: 10.1148/radiol.2016150361] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose To measure plasmatic sunitinib concentration (PSC) and intratumoral sunitinib concentration (ITSC) after transcatheter arterial chemoembolization (TACE) with two different sizes of sunitinib-eluting beads (SEBs) in rabbits with VX2 hepatic allografts and to investigate treatment effects on vascular endothelial growth factor receptor type 2 (VEGFR2) phosphorylation, tumor volume, and histopathologic changes. Materials and Methods The protocol was approved by the French Ethics Committee for Animal Experiments (Comité d'Ethique en Expérimentation Animale du Centre INRA de Jouy-en-Josas et AgroParisTech, or COMETHEA, approval no. 11/028). Two experiments were performed. In the first, seven animals received 0.05 mL of 100-300-μm SEBs (1.5 mg of sunitinib) in the hepatic artery, and six animals received saline injections. In the second, eight animals received 0.05 mL of 70-150-μm SEBs (1.5 mg of sunitinib), seven received 0.05 mL of 70-150-μm unloaded beads, and seven received oral sunitinib (6 mg every day). Tumor size was monitored with ultrasonography. PSC, ITSC, and phosphorylation of VEGFR2 were assessed on days 1 and 14. After the animals were sacrificed, histopathologic analysis was performed. The Kruskal-Wallis test, Mann-Whitney U test, and Fisher exact test were used to look for statistically significant differences between groups. Results Maximum PSC after TACE with 100-300-μm SEBs was 0.002 μg/mL on day 1. ITSC was 17.8 μg/g on day 1 and 0.16 μg/g on day 14. After TACE with 70-150-μm SEBs, ITSC was 40.4 μg/g on day 1 and 27.4 μg/g on day 14. Phosphorylation of VEGFR2 was inhibited until day 14 after TACE with both sizes of SEBs. The size of VX2 tumors treated with 70-150-μm SEB TACE increased less (-2%) than that of tumors treated with unloaded beads (+42%) and oral sunitinib (6 mg every day; +1853%; P = .044). Conclusion SEB TACE resulted in minimal PSC, high ITSC, and sustained VEGFR2 phosphorylation inhibition until day 14. (©) RSNA, 2016.
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Affiliation(s)
- Pierre Bize
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
| | - Rafael Duran
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
| | - Katrin Fuchs
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
| | - Olivier Dormond
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
| | - Julien Namur
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
| | - Laurent A Decosterd
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
| | - Olivier Jordan
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
| | - Eric Doelker
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
| | - Alban Denys
- From the Departments of Radiology (P.B., R.D., A.D.), Surgery (O.D.), and Clinical Pharmacology (L.A.D.), University Hospital of Lausanne, Rue du Bugnon 46, CH-1011 Lausanne, Switzerland; School of Pharmaceutical Sciences, University of Geneva, Geneva, Switzerland (K.F., O.J., E.D.); and Archimmed, Paris, France (J.N.)
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Faigel DO, Lake DF, Landreth TL, Kelman CC, Marler RJ. EUS-guided portal injection chemotherapy for treatment of hepatic metastases: feasibility in the acute porcine model. Gastrointest Endosc 2016; 83:444-6. [PMID: 26358330 DOI: 10.1016/j.gie.2015.08.064] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 08/07/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND AIMS Direct injection of chemotherapy into the portal vein for treatment of liver metastases may increase hepatic tissue levels while decreasing systemic levels and toxicities. We aimed to evaluate EUS-guided portal injection chemotherapy (EPIC) by using drug-eluting microbeads or nanoparticles and compare it with systemic injection. METHODS We conducted a comparative feasibility trial in the acute porcine model (24 anesthetized pigs). Pigs were treated with irinotecan, doxorubicin, or albumin-bound paclitaxel nanoparticles (n = 8/group). Within each group, pigs were treated with EPIC or a systemic intravenous injection of drug and saline solution into the portal vein (n = 4/treatment). Irinotecan or doxorubicin were loaded onto microbeads for EPIC treatment only. We examined drug levels in tissue (1 hour) and plasma (15 minutes). RESULTS EUS-guided access and injection was successful in all animals. EPIC with irinotecan-loaded microbeads showed nearly double the hepatic concentration compared with systemic injection (6242 vs 3692 ng/g) and almost half the systemic levels. EPIC with doxorubicin-loaded microbeads showed a 5-fold increase in hepatic levels (35,450 vs 6930 ng/g) and a 30-fold decrease in cardiac levels (153 vs 4805 ng/g) compared with systemic administration (P < .05 for both). EPIC with albumin-bound paclitaxel nanoparticles increased hepatic concentrations by 60% and decreased systemic levels by 24% to 32%. CONCLUSIONS EPIC holds promise as a new treatment for hepatic metastases.
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Affiliation(s)
- Douglas O Faigel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Douglas F Lake
- School of Life Sciences, Arizona State University, Tempe, Arizona, USA
| | - Tracy L Landreth
- Center for Procedural Innovation, Mayo Clinic, Scottsdale, Arizona, USA
| | | | - Ronald J Marler
- Research Laboratories, Mayo Clinic, Scottsdale, Arizona, USA
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Safety and Efficacy Compared between Irinotecan-Loaded Microspheres HepaSphere and DC Bead in a Model of VX2 Liver Metastases in the Rabbit. J Vasc Interv Radiol 2015; 26:1067-1075.e3. [DOI: 10.1016/j.jvir.2015.03.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/05/2015] [Accepted: 03/17/2015] [Indexed: 11/18/2022] Open
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de Baere T, Tselikas L, Pearson E, Yevitch S, Boige V, Malka D, Ducreux M, Goere D, Elias D, Nguyen F, Deschamps F. Interventional oncology for liver and lung metastases from colorectal cancer: The current state of the art. Diagn Interv Imaging 2015; 96:647-54. [DOI: 10.1016/j.diii.2015.04.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/08/2015] [Indexed: 02/07/2023]
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21
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Liu DM, Thakor AS, Baerlocher M, Alshammari MT, Lim H, Kos S, Kennedy AS, Wasan H. A review of conventional and drug-eluting chemoembolization in the treatment of colorectal liver metastases: principles and proof. Future Oncol 2015; 11:1421-8. [PMID: 25602287 DOI: 10.2217/fon.15.3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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22
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de Baere T, Deschamps F, Tselikas L, Ducreux M, Planchard D, Pearson E, Berdelou A, Leboulleux S, Elias D, Baudin E. GEP-NETS update: Interventional radiology: role in the treatment of liver metastases from GEP-NETs. Eur J Endocrinol 2015; 172:R151-66. [PMID: 25385817 DOI: 10.1530/eje-14-0630] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Neuroendocrine tumors from gastro-pancreatic origin (GEP-NET) can be responsible for liver metastases. Such metastases can be the dominant part of the disease as well due to the tumor burden itself or the symptoms related to such liver metastases. Intra-arterial therapies are commonly used in liver only or liver-dominant disease and encompass trans-arterial chemoembolization (TACE), trans-arterial embolization (TAE), and radioembolization (RE). TACE performed with drug emulsified in Lipiodol has been used for the past 20 years with reported overall survival in the range of 3-4 years, with objective response up to 75%. Response to TACE is higher when treatment is used as a first-line therapy and degree of liver involvement is lower. Benefit of TACE over TAE is unproven in randomized study, but reported in retrospective studies namely in pancreatic NETs. RE provides early interesting results that need to be further evaluated in terms of benefit and toxicity. Radiofrequency ablation allows control of small size and numbered liver metastases, with low invasiveness. Ideal metastases to target are one metastasis <5 cm, or three metastases <3 cm, or a sum of diameter of all metastases below 8 cm. Ablation therapies can be applied in the lung or in the bones when needed, and more invasive surgery should be probably saved for large-size metastases. Even if the indication of image-guided therapy in the treatment of GEP-NET liver metastases needs to be refined, such therapies allow for manageable invasive set of treatments able to address oligometastatic patients in liver, lung, and bones. These treatments applied locally will save the benefit and the toxicity of systemic therapy for more advanced stage of the disease.
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Affiliation(s)
- Thierry de Baere
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Frederic Deschamps
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Lambros Tselikas
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Michel Ducreux
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - David Planchard
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Ernesto Pearson
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Amandine Berdelou
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Sophie Leboulleux
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Dominique Elias
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
| | - Eric Baudin
- Interventional RadiologyMedical OncologyNuclear Medicine and Endocrine OncologyOncology SurgeryEndocrinologyInstitut Gustave Roussy, 39 rue Camille Desmoulins, 94805 Villejuif, FranceUniversité Paris-SudLe Kremlin Bicêtre, France
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Evaluation of the plasmatic and parenchymal elution kinetics of two different irinotecan-loaded drug-eluting embolics in a pig model. J Vasc Interv Radiol 2015; 26:746-54. [PMID: 25704223 DOI: 10.1016/j.jvir.2014.12.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/27/2014] [Accepted: 12/11/2014] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To evaluate and compare irinotecan elution kinetics of two drug-eluting embolic agents in a porcine model. MATERIALS AND METHODS Embolization of the left liver lobe was performed in 16 domestic pigs, with groups of two receiving 1 mL of DC Bead M1 (70-150 µm) or Embozene TANDEM (75 µm) loaded with 50 mg irinotecan. Irinotecan plasma levels were measured at 0, 10, 20, 30, 60, 120, 180, and 240 minutes after completed embolization and at the time of euthanasia (24 h, 48 h, 72 h, or 7 d). Liver tissue samples were taken to measure irinotecan tissue concentrations. RESULTS The highest irinotecan plasma concentrations of both embolic agents were measured 10 and 20 minutes after embolization, and concentrations were significantly higher for DC Bead M1 versus Embozene TANDEM (P = .0019 and P = .0379, respectively). At 48 hours and later follow-up, no irinotecan was measurable in the plasma. For both embolic agents, the highest irinotecan tissue concentration was found after 24 hours and decreased in a time-dependent manner at later follow-up intervals. Additionally, SN-38 tissue levels for both agents were therapeutic at 24 hours, with therapeutic levels of SN-38 at 48 hours in one liver embolized with TANDEM particles. Histopathologic analysis revealed ischemic, inflammatory, and fibrotic tissue reactions. CONCLUSIONS Irinotecan is measurable in plasma and hepatic tissue after liver embolization with both types of irinotecan-eluting embolic agents. DC Bead M1 shows early burst elution kinetics, whereas Embozene TANDEM has a lower and slower release profile. The initial burst is significantly greater after embolization with DC Bead M1 than with Embozene TANDEM.
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In Vivo Evaluation of Irinotecan-Loaded QuadraSphere Microspheres for Use in Chemoembolization of VX2 Liver Tumors. J Vasc Interv Radiol 2014; 25:1727-35.e1. [DOI: 10.1016/j.jvir.2014.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2014] [Revised: 07/10/2014] [Accepted: 07/11/2014] [Indexed: 01/01/2023] Open
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Guiu B, Schmitt A, Reinhardt S, Fohlen A, Pohl T, Wendremaire M, Denys A, Blümmel J, Boulin M. Idarubicin-loaded ONCOZENE drug-eluting embolic agents for chemoembolization of hepatocellular carcinoma: in vitro loading and release and in vivo pharmacokinetics. J Vasc Interv Radiol 2014; 26:262-70. [PMID: 25311967 DOI: 10.1016/j.jvir.2014.08.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Revised: 08/19/2014] [Accepted: 08/20/2014] [Indexed: 12/30/2022] Open
Abstract
PURPOSE To present in vitro loading and release characteristics of idarubicin with ONCOZENE (CeloNova BioSciences, Inc, San Antonio, Texas) drug-eluting embolic (DEE) agents and in vivo pharmacokinetics data after transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents in patients with hepatocellular carcinoma. MATERIALS AND METHODS Loading efficacy of idarubicin with ONCOZENE DEE agents 100 µm and DC Bead (Biocompatibles UK Ltd, Farnham, United Kingdom) DEE agents 100-300 µm was monitored at 10, 20, and 30 minutes loading time by high-pressure liquid chromatography. A T-apparatus was used to monitor the release of idarubicin from the two types of DEE agents over 12 hours. Clinical and 24-hour pharmacokinetics data were recorded after transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents in four patients with unresectable hepatocellular carcinoma. RESULTS Idarubicin loading in ONCOZENE DEE agents was > 99% at 10 minutes. Time to reach 75% of the release plateau level was 37 minutes ± 6 for DC Bead DEE agents and 170 minutes ± 19 for ONCOZENE DEE agents both loaded with idarubicin 10 mg/mL. After transarterial chemoembolization with idarubicin-loaded ONCOZENE DEE agents, three partial responses and one complete response were observed with only two asymptomatic grade 3 biologic adverse events. Median time to maximum concentration for idarubicin in patients was 10 minutes, and mean maximum concentration was 4.9 µg/L ± 1.7. Mean area under the concentration-time curve from 0-24 hours was equal to 29.5 µg.h/L ± 20.5. CONCLUSIONS ONCOZENE DEE agents show promising results with very fast loading ability, a favorable in vivo pharmacokinetics profile with a sustained release of idarubicin during the first 24 hours, and encouraging safety and responses. Histopathologic and clinical studies are needed to evaluate idarubicin release around the DEE agents in tumor tissue and to confirm safety and efficacy.
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Affiliation(s)
- Boris Guiu
- Department of Radiology, Saint-Eloi University Hospital, 80 Avenue Augustin Fliche, Montpellier 34295, France.
| | - Antonin Schmitt
- Department of Pharmacy, Georges-François Leclerc Anticancer Center, Dijon, France
| | | | - Audrey Fohlen
- Department of Radiology, University Hospital, Caen, France
| | | | - Maëva Wendremaire
- Department of Pharmacology-Toxicology, University Hospital, Dijon, France
| | - Alban Denys
- Department of Radiology, University Hospital of Lausanne, Lausanne, Switzerland
| | | | - Mathieu Boulin
- Department of Pharmacy, University Hospital, Dijon, France
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Pharmacokinetics and Antitumor Efficacy of Chemoembolization Using 40 µm Irinotecan-Loaded Microspheres in a Rabbit Liver Tumor Model. J Vasc Interv Radiol 2014; 25:1037-1044.e2. [DOI: 10.1016/j.jvir.2014.04.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 03/21/2014] [Accepted: 04/09/2014] [Indexed: 01/01/2023] Open
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Joskin J, de Baere T, Auperin A, Tselikas L, Guiu B, Farouil G, Boige V, Malka D, Leboulleux S, Ducreux M, Baudin E, Deschamps F. Predisposing Factors of Liver Necrosis after Transcatheter Arterial Chemoembolization in Liver Metastases from Neuroendocrine Tumor. Cardiovasc Intervent Radiol 2014; 38:372-80. [DOI: 10.1007/s00270-014-0914-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 04/09/2014] [Indexed: 01/11/2023]
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CT-guided irreversible electroporation in an acute porcine liver model: effect of previous transarterial iodized oil tissue marking on technical parameters, 3D computed tomographic rendering of the electroporation zone, and histopathology. Cardiovasc Intervent Radiol 2014; 38:191-200. [PMID: 24870700 DOI: 10.1007/s00270-014-0910-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2013] [Accepted: 04/03/2014] [Indexed: 12/27/2022]
Abstract
PURPOSE To evaluate the effect of previous transarterial iodized oil tissue marking (ITM) on technical parameters, three-dimensional (3D) computed tomographic (CT) rendering of the electroporation zone, and histopathology after CT-guided irreversible electroporation (IRE) in an acute porcine liver model as a potential strategy to improve IRE performance. METHODS After Ethics Committee approval was obtained, in five landrace pigs, two IREs of the right and left liver (RL and LL) were performed under CT guidance with identical electroporation parameters. Before IRE, transarterial marking of the LL was performed with iodized oil. Nonenhanced and contrast-enhanced CT examinations followed. One hour after IRE, animals were killed and livers collected. Mean resulting voltage and amperage during IRE were assessed. For 3D CT rendering of the electroporation zone, parameters for size and shape were analyzed. Quantitative data were compared by the Mann-Whitney test. Histopathological differences were assessed. RESULTS Mean resulting voltage and amperage were 2,545.3 ± 66.0 V and 26.1 ± 1.8 A for RL, and 2,537.3 ± 69.0 V and 27.7 ± 1.8 A for LL without significant differences. Short axis, volume, and sphericity index were 16.5 ± 4.4 mm, 8.6 ± 3.2 cm(3), and 1.7 ± 0.3 for RL, and 18.2 ± 3.4 mm, 9.8 ± 3.8 cm(3), and 1.7 ± 0.3 for LL without significant differences. For RL and LL, the electroporation zone consisted of severely widened hepatic sinusoids containing erythrocytes and showed homogeneous apoptosis. For LL, iodized oil could be detected in the center and at the rim of the electroporation zone. CONCLUSION There is no adverse effect of previous ITM on technical parameters, 3D CT rendering of the electroporation zone, and histopathology after CT-guided IRE of the liver.
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Lencioni R, Aliberti C, de Baere T, Garcia-Monaco R, Narayanan G, O’Grady E, Rilling WS, Walker D, Martin RC. Transarterial Treatment of Colorectal Cancer Liver Metastases with Irinotecan-Loaded Drug-Eluting Beads: Technical Recommendations. J Vasc Interv Radiol 2014; 25:365-9. [DOI: 10.1016/j.jvir.2013.11.027] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 11/18/2013] [Accepted: 11/24/2013] [Indexed: 12/21/2022] Open
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Lewis AL, Holden RR, Chung ST, Czuczman P, Kuchel T, Finnie J, Porter S, Foster D. Feasibility, safety and pharmacokinetic study of hepatic administration of drug-eluting beads loaded with irinotecan (DEBIRI) followed by intravenous administration of irinotecan in a porcine model. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2013; 24:115-127. [PMID: 23015264 PMCID: PMC3540360 DOI: 10.1007/s10856-012-4768-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 09/17/2012] [Indexed: 06/01/2023]
Abstract
Irinotecan eluting embolization beads (DEBIRI) are currently being evaluated in the clinic for the treatment of colorectal cancer metastases to the liver. The aim of this study was to determine the safety and pharmacokinetics associated with two cycles of hepatic embolization using DEBIRI followed by intravenous administration of irinotecan. Pigs were embolized with DEBIRI (100-300 μm, 100 mg dose, n = 6) and blood samples taken over 24 h to determine plasma levels of irinotecan and SN-38 metabolite and for haematology and biochemistry. At 24 h an IV infusion of 250 mg/m(2) of irinotecan was administered and the plasma levels taken again. This cycle was repeated 3 weeks later. A single animal was subjected to a more aggressive regimen of embolization with 200 mg bead dose and IV of 350 mg/m(2) for two cycles. Three animals were sacrificed at 6 weeks and the remaining four (n = 3 standard dose, n = 1 high dose) animals at 12 weeks and detailed histopathology performed. All animals tolerated the treatments well, with only minor changes in haematological and biochemical parameters. There was no overlap in drug plasma levels observed from the bead and IV treatments when given 24 h apart and no difference between the pharmacokinetic profiles of the two cycles separated by 3 weeks. Irinotecan plasma AUC values were similar in both the embolization and IV arms of the study. C(max) values obtained during the IV arms of the study are approximately double that of the embolization arms whilst T(max) times are shorter in the IV arms, supporting extended release of drug from the beads. Bioavailability for bead-based delivery was double that for IV administration, which was attributed to reduced clearance of the drug when delivered by this route. No additive toxicity was observed as a consequence of the combined treatments. The combination of irinotecan delivery via drug eluting bead and IV was well-tolerated with no significant clinical effects. Pharmacokinetic analyses suggest the bioavailability from bead-based delivery of drug is double that of IV infusion, attributable to reduced drug clearance for the former.
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Affiliation(s)
- Andrew L Lewis
- Drug Delivery Division, Biocompatibles UK Ltd, Farnham Business Park, Weydon Lane, Farnham, Surrey, UK.
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