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Malagari K, Kiakidis T, Moschouris H, Charokopakis A, Vergadis C, Alevisopoulos N, Kartsouni V, Panagiotou I, Pellerin O, Glantzounis G, Filippiadis DK, Emmanouil E, Tsavaris N, Psarros G, Delicha E, Kelekis N. Prospective Series of Transarterial Chemoembolization of Metastatic Colorectal Cancer to the Liver with 30-60 μm Microspheres Loaded with Irinotecan. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03446-6. [PMID: 37337059 DOI: 10.1007/s00270-023-03446-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 04/13/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE To describe safety and clinical outcomes among patients with metastatic colorectal cancer (mCRC) to the liver treated with transarterial chemoembolization with HepaSphere™ Microspheres 30-60 μm loaded with irinotecan (ΙRI-HEP-TACE). MATERIAL AND METHODS In this prospective study (NCT04866290), 100 adults with confirmed mCRC to the liver who were ineligible for resection were enrolled and followed up to 24 months or death. Study outcomes among Salvage (patients not tolerating more cycles of chemotherapy) and Non-salvage patients included overall survival (OS), progression-free survival (PFS), objective response (OR), objective response rate (ORR), best tumor response (BTR), adverse events (AEs), and pharmacokinetics of irinotecan and its active metabolite, 7-ethyl-10-hydroxy-camptothecin (SN38). RESULTS The median age was 66 years (range: 31-89). Median OS was 15.08 months (95% confidence interval [CI]: 12.33-17.25). PFS was 8.52 months (95% CI: 6.0-9.0; p < 0.001). ORR was 42.2% (95% CI: 31.57-53.50) and 35.9% (95% CI: 25.57-47.62) based on modified RECIST (Response Evaluation Criteria in Solid Tumors) and RECIST 1.1 criteria. BTR was not significantly different between mRECIST and RECIST (p = 0.745). The Non-salvage group had a statistically significant difference in median OS relative to the Salvage group (15.3 vs. 3 months; p < 0.001). Pharmacokinetic analyses demonstrated no correlation of OS with plasma concentration of irinotecan and SN38 (all p > 0.05). Most AEs were Grade 2 (257/279), the most common AE was right upper abdominal pain (180/279). One major AE (tumor rupture) was reported. CONCLUSION IRI-HEP-TACE is an alternative treatment for patients with Non-salvage mCRC to the liver.
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Affiliation(s)
- K Malagari
- Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Monis Kyccou, 15 669 Papagou, Athens, Greece.
- Evgenidion and Attikon University Hospitals, Chaidari, Greece.
| | - Th Kiakidis
- Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Monis Kyccou, 15 669 Papagou, Athens, Greece
- Evgenidion and Attikon University Hospitals, Chaidari, Greece
| | - H Moschouris
- Interventional Radiology Department, Tzanion General Hospital, Piraeus, Athens, Greece
| | - A Charokopakis
- Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Monis Kyccou, 15 669 Papagou, Athens, Greece
- Evgenidion and Attikon University Hospitals, Chaidari, Greece
| | | | | | - V Kartsouni
- Department of Interventional Radiology, Agios Savvas Anticancer Hospital, Athens, Greece
| | - Ir Panagiotou
- Department of Internal Medicine, Agios Savvas Anticancer Hospital, Αthens, Greece
| | - O Pellerin
- Interventional Radiology, Université de Paris-Citè, PARCC, INSERM, 75006, Service de Radiologie Interventionnelle Assistance Publique - Hôpitaux de Paris Hôpital Européen Georges Pompidou, Paris, France
| | | | - D K Filippiadis
- Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Monis Kyccou, 15 669 Papagou, Athens, Greece
- Evgenidion and Attikon University Hospitals, Chaidari, Greece
| | - E Emmanouil
- Department of Radiology, Amalia Fleming Hospital, Athens, Greece
| | | | - G Psarros
- ASTAT-Statistics in Clinical Research, 166 75, Athens, Greece
| | - E Delicha
- ASTAT-Statistics in Clinical Research, 166 75, Athens, Greece
| | - N Kelekis
- Department of Radiology, Medical School, National and Kapodistrian University of Athens, 19 Monis Kyccou, 15 669 Papagou, Athens, Greece
- Evgenidion and Attikon University Hospitals, Chaidari, Greece
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Safety, Feasibility and Technical Considerations from a Prospective, Observational Study-CIREL: Irinotecan-TACE for CRLM in 152 Patients. J Clin Med 2022; 11:jcm11206178. [PMID: 36294499 PMCID: PMC9604674 DOI: 10.3390/jcm11206178] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/15/2022] [Accepted: 10/16/2022] [Indexed: 11/17/2022] Open
Abstract
CIREL, a prospective, Europe-wide, observational study aimed to assess the real-world feasibility and tolerability of irinotecan-based transarterial chemoembolization (LP-irinotecan TACE) for unresectable colorectal cancer liver metastases with regard to the treatment plan and adverse events (AEs). CIREL enrolled 152 eligible patients (≥18 years) with liver-only or dominant metastases treated with LP-irinotecan TACE following a multidisciplinary tumor board decision. Data were prospectively collected for baseline, the number of planned and performed sessions, and technical information and safety according to CTCAE 4.03/5.0. Results from 351 analyzed treatment sessions showed technical success for 99% of sessions, and 121 patients (79%) completed all planned sessions. Further, 60% of sessions were performed using opioids, 4% intra-arterial anesthetics, and 25% both. Additionally, 60% of patients experienced at least one peri-interventional AE of any grade; 8% of grade 3−4. Occurrence of AEs was related to larger liver-involvement (p < 0.001), bi-lobar disease (p = 0.002), and larger beads (p < 0.001). Using corticosteroids together with antiemetics showed reduced and lower grade vomiting (p = 0.01). LP-irinotecan TACE was tolerated well and had a high proportion of completed treatment plans. This minimally invasive locoregional treatment can be used together with concomitant systemic therapy or ablation.
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Lucatelli P, Burrel M, Guiu B, de Rubeis G, van Delden O, Helmberger T. CIRSE Standards of Practice on Hepatic Transarterial Chemoembolisation. Cardiovasc Intervent Radiol 2021; 44:1851-1867. [PMID: 34694454 DOI: 10.1007/s00270-021-02968-1] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 09/04/2021] [Indexed: 12/15/2022]
Abstract
This CIRSE Standards of Practice document is aimed at interventional radiologists and provides best practices for performing transarterial chemoembolisation. It has been developed by an expert writing group under the guidance of the CIRSE Standards of Practice Committee. It will encompass all technical details reflecting European practice of different TACE procedures (Lp-TACE, DEM-TACE, DSM-TACE, b-TACE) as well as revising the existing literature on the various clinical indications (HCC, mCRC, ICC, NET). Finally, new frontiers of development will also be discussed.
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Affiliation(s)
- Pierleone Lucatelli
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy.
| | - Marta Burrel
- Radiology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - Boris Guiu
- Department of Radiology, Montpellier School of Medicine, St-Eloi University Hospital, Montpellier, France
| | - Gianluca de Rubeis
- Vascular and Interventional Radiology Unit, Department of Radiological Oncological and Anatomo-Pathological Sciences, Sapienza University of Rome, Rome, Italy
- Department of Diagnostic Radiology, Azienda Ospedaliera San Camillo Forlanini, Rome, Italy
| | - Otto van Delden
- Department of Interventional Radiology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Thomas Helmberger
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, Bogenhausen Hospital, Munich, Germany
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Kovács A, Bischoff P, Haddad H, Kovács G, Schaefer A, Zhou W, Pinkawa M. Personalized Image-Guided Therapies for Local Malignencies: Interdisciplinary Options for Interventional Radiology and Interventional Radiotherapy. Front Oncol 2021; 11:616058. [PMID: 33869002 PMCID: PMC8047426 DOI: 10.3389/fonc.2021.616058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 03/09/2021] [Indexed: 12/19/2022] Open
Abstract
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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Affiliation(s)
- Attila Kovács
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Peter Bischoff
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Hathal Haddad
- Clinic for Radiotherapy and Radiooncology, MediClin Robert Janker Klinik, Bonn, Germany
| | - György Kovács
- Gemelli-INTERACTS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Andreas Schaefer
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Willi Zhou
- Clinic for Diagnostic and Interventional Radiology and Neuroradiology, MediClin Robert Janker Klinik, Bonn, Germany
| | - Michael Pinkawa
- Clinic for Radiotherapy and Radiooncology, MediClin Robert Janker Klinik, Bonn, Germany
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Pereira PL, Iezzi R, Manfredi R, Carchesio F, Bánsághi Z, Brountzos E, Spiliopoulos S, Echevarria-Uraga JJ, Gonçalves B, Inchingolo R, Nardella M, Pellerin O, Sousa M, Arnold D, de Baère T, Gomez F, Helmberger T, Maleux G, Prenen H, Sangro B, Zeka B, Kaufmann N, Taieb J. The CIREL Cohort: A Prospective Controlled Registry Studying the Real-Life Use of Irinotecan-Loaded Chemoembolisation in Colorectal Cancer Liver Metastases: Interim Analysis. Cardiovasc Intervent Radiol 2021; 44:50-62. [PMID: 32974773 PMCID: PMC7728640 DOI: 10.1007/s00270-020-02646-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/05/2020] [Indexed: 02/08/2023]
Abstract
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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Affiliation(s)
- Philippe L Pereira
- Zentrum für Radiologie, Minimal-Invasive Therapien und Nuklearmedizin, SLK-Kliniken Heilbronn GmbH, Am Gesundbrunnen 20-26, 74078, Heilbronn, Germany
| | - Roberto Iezzi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radiologia Diagnostica ed Interventistica Generale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Riccardo Manfredi
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radiologia Diagnostica ed Interventistica Generale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Francesca Carchesio
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, UOC di Radiologia Diagnostica ed Interventistica Generale, Fondazione Policlinico Universitario "A. Gemelli" IRCCS, Rome, Italy
| | - Zoltan Bánsághi
- Medical Imaging Center, Semmelweis University, Korányi Sándor u. 2, Budapest, 1082, Hungary
| | - Elias Brountzos
- Interventional Radiology Unit, 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Rimini 1, Chaidari, 124 62, Athens, Greece
| | - Stavros Spiliopoulos
- Interventional Radiology Unit, 2nd Department of Radiology, School of Medicine, National and Kapodistrian University of Athens, Attikon University General Hospital, Rimini 1, Chaidari, 124 62, Athens, Greece
| | - Javier J Echevarria-Uraga
- Department of Radiology, Osakidetza Basque Health Service, Galdakao-Usansolo Hospital, Barrio Labeaga s/n, 48960, Galdakao, Spain
| | - Belarmino Gonçalves
- Department of Interventional Radiology, Portuguese Oncology Institute, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Riccardo Inchingolo
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Via Montescaglioso, 75100, Matera, Italy
| | - Michele Nardella
- Division of Interventional Radiology, Department of Radiology, Madonna delle Grazie Hospital, Via Montescaglioso, 75100, Matera, Italy
| | - Olivier Pellerin
- Assistance Publique Hôpitaux de Paris, Service de Radiologie Interventionnelle Vasculaire et Oncologique, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris-Cité, 20 Rue Leblanc, 75015, Paris, France
| | - Maria Sousa
- Department of Interventional Radiology, Portuguese Oncology Institute, Rua Dr. António Bernardino de Almeida, 4200-072, Porto, Portugal
| | - Dirk Arnold
- Asklepios Tumorzentrum Hamburg, AK Altona, Paul Ehrlich Str. 1, 22763, Hamburg, Germany
| | - Thierry de Baère
- Service de Radiologie Interventionelle, Institut Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Fernando Gomez
- Servicio de Radiodiagnóstico, Hospital Clínic de Barcelona, Calle Villarroel, 170, 08036, Barcelona, Spain
- Department of Radiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Thomas Helmberger
- Institut für Radiologie, München Klinik Bogenhausen Neuroradiologie und minimal-invasive Therapie, Englschalkinger Str. 77, 81925, Munich, Germany
| | - Geert Maleux
- Radiologie, UZ Leuven, Herestraat 49, 3000, Louvain, Belgium
| | - Hans Prenen
- Oncology Department, UZ Antwerp, Wilrijkstraat 10, 2650, Edegem, Belgium
| | - Bruno Sangro
- Liver Unit, Clinica Universidad de Navarra-IDISNA and CIBEREHD, Av. de Pío XII 36, 31008, Pamplona, Spain
| | - Bleranda Zeka
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria
| | - Nathalie Kaufmann
- Clinical Research Department, Cardiovascular and Interventional Radiological Society of Europe, Neutorgasse 9, 1010, Vienna, Austria.
| | - Julien Taieb
- Assistance Publique Hôpitaux de Paris, Service d'hepatogastroentérologie et d'oncologie digestive, Hôpital Européen Georges Pompidou, Université Paris Descartes, Sorbonne Paris-Cité, 20 Rue Leblanc, 75015, Paris, France
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