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Korsic S, Osredkar J, Smid A, Steblovnik K, Popovic M, Locatelli I, Trontelj J, Popovic P. Idarubicin-loaded drug-eluting microspheres transarterial chemoembolization for intermediate stage hepatocellular carcinoma: safety, efficacy, and pharmacokinetics. Radiol Oncol 2024:raon-2024-0052. [PMID: 39365794 DOI: 10.2478/raon-2024-0052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2024] [Accepted: 08/28/2024] [Indexed: 10/06/2024] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) is the treatment of choice for the intermediate stage hepatocellular carcinoma (HCC). Doxorubicin remains the most used chemotherapeutic agent in TACE, although in vitro screening has demonstrated that idarubicin exhibits greater cytotoxicity against HCC. This study aimed to evaluate safety, efficacy, and pharmacokinetics of idarubicin-loaded drug-eluting microspheres TACE (DEMIDA-TACE) in intermediate stage HCC patients. PATIENTS AND METHODS Between September 2019 and December 2021, 31 consecutive intermediate stage HCC patients (96.8% cirrhotic) were included to this study. 2 mL of LifePearl™ microspheres (100 μm) loaded with 10 mg of 1 mg/mL idarubicin were used for treatment. The adverse events, objective response rate (ORR), progression free survival (PFS), time to TACE untreatable progression (TTUP), median overall survival (mOS), and pharmacokinetics were evaluated. RESULTS There were 68 TACE procedures performed. Adverse events grade ≥ 3 were noted after 29.4% procedures. The ORR was 83.9%, median PFS and TTUP were 10.5 months (95% CI: 6.8-14.3 months) and 24.6 months (95% CI: 11.6-37.6 months), respectively. Median OS was 36.0 months (95% CI: 21.1-50.9 months). Significant differences between patients achieving objective response (OR) and those with progressive disease were observed regarding idarubicinol and combined idarubicin-idarubicinol plasma concentrations at 72 hours post-procedure, higher plasma concentrations were observed in patients achieving OR (p = 0.014 and 0.014; cut-off values 1.2 and 1.29 ng/mL, respectively). CONCLUSIONS DEMIDA-TACE emerges as a safe and effective method of treatment for the intermediate stage HCC with low rates of adverse events alongside high tumor response, favourable disease control and overall survival. Idarubicinol and combined idarubicin-idarubicinol plasma concentrations at 72 hours post-procedure may serve as prognostic factors for achieving OR.
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Affiliation(s)
- Spela Korsic
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Josko Osredkar
- Institute of Clinical Chemistry and Biochemistry, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Alojz Smid
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Gastroenterology and Hepatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Klemen Steblovnik
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Mark Popovic
- Biotechnical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Igor Locatelli
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Jurij Trontelj
- Faculty of Pharmacy, University of Ljubljana, Ljubljana, Slovenia
| | - Peter Popovic
- Clinical Institute of Radiology, University Medical Centre Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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Choi JW, Kim HC, Han J, Jang MJ, Chung JW. Transarterial Chemoembolization Using Idarubicin Versus Doxorubicin Chemoemulsion in Patients with Hepatocellular Carcinoma (IDADOX): Protocol for a Randomized, Non-inferiority, Double-Blind Trial. Cardiovasc Intervent Radiol 2024; 47:372-378. [PMID: 38147153 DOI: 10.1007/s00270-023-03621-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 11/07/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE This study aims to test the hypothesis that idarubicin-based transarterial chemoembolization (IDA-TACE), using one of the most potent chemotherapeutic agents, could yield oncologic outcomes equivalent to or marginally improved over doxorubicin-based TACE (DOX-TACE). MATERIALS AND METHODS This single-center, prospective, phase II, randomized controlled, non-inferiority, double-blind trial will enroll 128 treatment-naïve patients with HCC (≤ 5 tumors, 1-5 cm in diameter) for conventional TACE. Participants will be randomly assigned (1:1) to either IDA-TACE or DOX-TACE, with stratification by Child-Pugh class. Superselective conventional TACE will be performed using cone-beam CT and small-bore microcatheters. Patient evaluations, including dynamic imaging and blood tests, will occur at 1, 3, and 6 months post-initial treatment. The primary outcome measure is the objective response rate (ORR) according to mRECIST at 6 months. Secondary outcomes include 3-month and 6-month tumor responses, time-to-progression, the incidence of treatment-related serious adverse events within 30 days, and the incidence and severity of any adverse events. STATISTICS Non-inferiority will be claimed if the upper limit of a one-sided 97.5% confidence interval for the proportion difference (i.e., "6-month ORR of DOX-TACE" - "6-month ORR of IDA-TACE") falls below 0.15 in both intention-to-treat and per-protocol analyses. The proportion difference and its confidence interval will be calculated by the Cochran-Mantel-Haenszel method to obtain a weighted average of stratum-specific proportion differences. EXPECTED GAIN OF KNOWLEDGE If IDA-TACE demonstrates outcomes comparable to DOX-TACE, this study could provide compelling evidence that various cytotoxic agents yield similar contributions in TACE, considering the minor role of chemotherapeutic agents in TACE. TRIAL REGISTRATION ClinicalTrials.gov ( https://clinicaltrials.gov/ ). Identifier: NCT06114082. World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) ( https://trialsearch.who.int/Default.aspx ). Identifier: KCT0008166.
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Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea.
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.
| | - Hyo-Cheol Kim
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Jiyeon Han
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Jin Wook Chung
- Department of Radiology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
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Zhao C, Yan H, Xiang Z, Wang H, Li M, Huang M. Idarubicin versus epirubicin in drug-eluting beads-transarterial chemoembolization for treating hepatocellular carcinoma: A real-world retrospective study. Invest New Drugs 2023; 41:617-626. [PMID: 37434023 DOI: 10.1007/s10637-023-01377-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 06/21/2023] [Indexed: 07/13/2023]
Abstract
The purpose of this study was to compare the efficacy and safety of idarubicin-loaded drug-eluting beads-transarterial chemoembolization (IDA-TACE) and epirubicin-loaded drug-eluting beads-TACE (EPI-TACE) in treating hepatocellular carcinoma (HCC). All patients with HCC treated with TACE in our hospital between June 2020 and January 2022 were screened. The included patients were divided into the IDA-TACE group and EPI-TACE group to compare overall survival (OS), time to progression (TTP), objective response rate (ORR), and adverse events. There were 55 patients each in the IDA-TACE and EPI-TACE groups. Compared with the EPI-TACE group, the median TTP in the IDA-TACE group was not significantly different (10.50 vs. 9.23 months; HR 0.68; 95% CI 0.40-1.16; P = 0.154), whereas the survival status in the IDA-TACE group tended to be better (neither achieved; HR 0.47; 95% CI 0.22-1.02; P = 0.055). Based on the Barcelona Clinic Liver Cancer staging system for subgroup analysis, considering stage C patients, the IDA-TACE group performed significantly better in terms of ORR (77.1% vs. 54.3%, P = 0.044), median TTP (10.93 vs. 5.20 months; HR 0.46; 95% CI 0.24-0.89; P = 0.021), and median OS (not achieved vs. 17.80 months; HR 0.41; 95% CI 0.18-0.93; P = 0.033). Considering stage B patients, there were no significant differences between the IDA-TACE and EPI-TACE groups in terms of ORR (80.0% vs. 80.0%, P = 1.000), median TTP (10.20 vs. 11.2 months; HR 1.41; 95% CI 0.54-3.65; P = 0.483), or median OS (neither achieved, HR 0.47; 95% CI 0.04-5.24; P = 0.543). Notably, leukopenia was more common in the IDA-TACE group (20.0%, P = 0.052), and fever was more common in the EPI-TACE group (49.1%, P = 0.010). IDA-TACE was more effective than EPI-TACE in treating advanced-stage HCC and comparable in treating intermediate-stage HCC.
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Affiliation(s)
- Chenghao Zhao
- Department of Interventional Radiology, The 3rd Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Lu Road, Guangzhou, 510630, China
| | - Huzheng Yan
- Department of Interventional Radiology, The 3rd Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Lu Road, Guangzhou, 510630, China
| | - Zhanwang Xiang
- Department of Interventional Radiology, The 3rd Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Lu Road, Guangzhou, 510630, China
| | - Haofan Wang
- Department of Interventional Radiology, The 3rd Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Lu Road, Guangzhou, 510630, China
| | - Mingan Li
- Department of Interventional Radiology, The 3rd Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Lu Road, Guangzhou, 510630, China
| | - Mingsheng Huang
- Department of Interventional Radiology, The 3rd Affiliated Hospital of Sun Yat-Sen University, 600 Tianhe Lu Road, Guangzhou, 510630, China.
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Li W, Wang Q, Lu J, Zhao B, Geng Y, Wu X, Chen X. Machine learning-based prognostic modeling of lysosome-related genes for predicting prognosis and immune status of patients with hepatocellular carcinoma. Front Immunol 2023; 14:1169256. [PMID: 37275878 PMCID: PMC10237352 DOI: 10.3389/fimmu.2023.1169256] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 05/10/2023] [Indexed: 06/07/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) is a leading cause of cancer-related deaths worldwide. Lysosomes are organelles that play an important role in cancer progression by breaking down biomolecules. However, the molecular mechanisms of lysosome-related genes in HCC are not fully understood. Methods We downloaded HCC datasets from TCGA and GEO as well as lysosome-related gene sets from AIMGO. After univariate Cox screening of the set of lysosome-associated genes differentially expressed in HCC and normal tissues, risk models were built by machine learning. Model effects were assessed using the concordance index (C-index), Kaplan-Meier (K-M) and receiver operating characteristic curves (ROC). Additionally, we explored the biological function and immune microenvironment between the high- and low-risk groups, and analyzed the response of the high- and low-risk groups to immunotherapy responsiveness and chemotherapeutic agents. Finally, we explored the function of a key gene (RAMP3) at the cellular level. Results Univariate Cox yielded 46 differentially and prognostically significant lysosome-related genes, and risk models were constructed using eight genes (RAMP3, GPLD1, FABP5, CD68, CSPG4, SORT1, CSPG5, CSF3R) derived from machine learning. The risk model was a better predictor of clinical outcomes, with the higher risk group having worse clinical outcomes. There were significant differences in biological function, immune microenvironment, and responsiveness to immunotherapy and drug sensitivity between the high and low-risk groups. Finally, we found that RAMP3 inhibited the proliferation, migration, and invasion of HCC cells and correlated with the sensitivity of HCC cells to Idarubicin. Conclusion Lysosome-associated gene risk models built by machine learning can effectively predict patient prognosis and offer new prospects for chemotherapy and immunotherapy in HCC. In addition, cellular-level experiments suggest that RAMP3 may be a new target for the treatment of HCC.
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Affiliation(s)
- Wenhua Li
- Key Laboratory for Prevention and Treatment of High Morbidity in Central Asia, National Health and Health Commission, Shihezi, China
- Department of Immunology, Shihezi University School of Medicine, Shihezi, China
| | - Qianwen Wang
- Key Laboratory for Prevention and Treatment of High Morbidity in Central Asia, National Health and Health Commission, Shihezi, China
- Department of Immunology, Shihezi University School of Medicine, Shihezi, China
| | - Junxia Lu
- Key Laboratory for Prevention and Treatment of High Morbidity in Central Asia, National Health and Health Commission, Shihezi, China
- Department of Immunology, Shihezi University School of Medicine, Shihezi, China
| | - Bin Zhao
- Key Laboratory for Prevention and Treatment of High Morbidity in Central Asia, National Health and Health Commission, Shihezi, China
- Department of Immunology, Shihezi University School of Medicine, Shihezi, China
| | - Yuqing Geng
- Key Laboratory for Prevention and Treatment of High Morbidity in Central Asia, National Health and Health Commission, Shihezi, China
- Department of Immunology, Shihezi University School of Medicine, Shihezi, China
| | - Xiangwei Wu
- Key Laboratory for Prevention and Treatment of High Morbidity in Central Asia, National Health and Health Commission, Shihezi, China
- Department of Immunology, Shihezi University School of Medicine, Shihezi, China
- The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
| | - Xueling Chen
- Key Laboratory for Prevention and Treatment of High Morbidity in Central Asia, National Health and Health Commission, Shihezi, China
- Department of Immunology, Shihezi University School of Medicine, Shihezi, China
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Zheng Z, Ma M, Han X, Li X, Huang J, Zhao Y, Liu H, Kang J, Kong X, Sun G, Sun G, Kong J, Tang W, Shao G, Xiong F, Song J. Idarubicin-loaded biodegradable microspheres enhance sensitivity to anti-PD1 immunotherapy in transcatheter arterial chemoembolization of hepatocellular carcinoma. Acta Biomater 2023; 157:337-351. [PMID: 36509402 DOI: 10.1016/j.actbio.2022.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 11/23/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
Transarterial chemoembolization (TACE) is an image-guided locoregional therapy used for the treatment of patients with primary hepatocellular carcinoma (HCC). However, conventional TACE formulations such as epirubicin-lipiodol emulsion are rapidly dissociated due to the instability of the emulsion, resulting in insufficient local drug concentrations in the target tumor. To overcome these limitations, we used biodegradable Idarubicin loaded microspheres (BILMs), which were prepared from gelatin and carrageenan and could be loaded with Idarubicin (IDA-MS). The morphology and the ability to load and release IDA of BILMs were characterized in vitro. We evaluated tumor changes and side effects after TACE treatment with IDA-MS in VX2 rabbit and C57BL/6 mice HCC models. In addition, the effect of IDA-MS on the tumor immune microenvironment of HCC tumors was elucidated via mass spectrometry and immunohistochemistry. Result showed that IDA-MS was developed as a new TACE formulation to overcome the poor delivery of drugs due to rapid elimination of the anticancer drug into the systemic circulation. We demonstrated in rabbits and mice HCC models that TACE with IDA-MS resulted in significant tumor shrinkage and no more severe adverse events than those observed in the IDA group. TACE with IDA-MS could also significantly enhance the sensitivity of anti-PD1 immunotherapy, improve the expression of CD8+ T cells, and activate the tumor immune microenvironment in HCC. This study provides a new approach for TACE therapy and immunotherapy and illuminates the future of HCC treatment. STATEMENT OF SIGNIFICANCE: Conventional transarterial chemoembolization (TACE) formulations are rapidly dissociated due to the instability of the emulsion, resulting in insufficient local drug concentrations in hepatocellular carcinoma (HCC). To overcome these limitations, we used biodegradable microspheres called BILMs, which could be loaded with Idarubicin (IDA-MS). We demonstrated in rabbits and mice HCC models that TACE with IDA-MS resulted in significant tumor shrinkage and no more severe adverse events than those observed in the IDA group. TACE with IDA-MS could also significantly enhance the sensitivity of anti-PD1 immunotherapy, improve the expression of CD8+ T cells, and activate the tumor immune microenvironment in HCC. This study provides a new approach for TACE therapy and immunotherapy and illuminates the future of HCC treatment.
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Affiliation(s)
- Zhiying Zheng
- Hepatobiliary Center, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China; Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Mingxi Ma
- State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering & Collaborative Innovation Center of Suzhou Nano-Science and Technology, Southeast University, Nanjing, China
| | - Xiuping Han
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Xiao Li
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jinxin Huang
- State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering & Collaborative Innovation Center of Suzhou Nano-Science and Technology, Southeast University, Nanjing, China
| | - Yuetong Zhao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Hanyuan Liu
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Junwei Kang
- Department of Anesthesiology and Perioperative Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiangyi Kong
- Hepatobiliary Center, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Guoqiang Sun
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Guangshun Sun
- Department of General Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Kong
- Department of Intervention, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Weiwei Tang
- Hepatobiliary Center, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
| | - Guoqiang Shao
- Department of Nuclear Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.
| | - Fei Xiong
- State Key Laboratory of Bioelectronics, Jiangsu Key Laboratory for Biomaterials and Devices, School of Biological Science and Medical Engineering & Collaborative Innovation Center of Suzhou Nano-Science and Technology, Southeast University, Nanjing, China.
| | - Jinhua Song
- Hepatobiliary Center, Key Laboratory of Liver Transplantation, Chinese Academy of Medical Sciences, NHC Key Laboratory of Living Donor Liver Transplantation, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
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Idarubicin combats abiraterone and enzalutamide resistance in prostate cells via targeting XPA protein. Cell Death Dis 2022; 13:1034. [PMID: 36509750 PMCID: PMC9744908 DOI: 10.1038/s41419-022-05490-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
Although second-generation therapies like abiraterone (ABI) and enzalutamide (ENZ) benefit patients with castration-resistant prostate cancer (CRPC), drug resistance frequently occurs, eventually resulting in therapy failure. In this study, we used two libraries, FDA-approved drug library and CRISP/Cas9 knockout (GeCKO) library to screen for drugs that overcome treatment resistance and to identify the potential drug-resistant genes involved in treatment resistance. Our screening results showed that the DNA-damaging agent idarubicin (IDA) overcame abiraterone and enzalutamide resistance in prostate cancer cells. IDA treatment inhibited the DNA repair protein XPA expression in a transcription-independent manner. Consistently, XPA knockout sensitized prostate cancer cells to abiraterone and enzalutamide treatment. In conclusion, IDA combats abiraterone and enzalutamide resistance by reducing XPA protein level in prostate cancer.
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Embolization therapy with microspheres for the treatment of liver cancer: State-of-the-art of clinical translation. Acta Biomater 2022; 149:1-15. [PMID: 35842035 DOI: 10.1016/j.actbio.2022.07.019] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 06/17/2022] [Accepted: 07/07/2022] [Indexed: 02/07/2023]
Abstract
Embolization with microspheres is a therapeutic strategy based on the selective occlusion of the blood vessels feeding a tumor. This procedure is intraarterially performed in the clinical setting for the treatment of liver cancer. The practice has evolved over the last decade through the incorporation of drug loading ability, biodegradability and imageability with the subsequent added functionality for the physicians and improved clinical outcomes for the patients. This review highlights the evolution of the embolization systems developed through the analysis of the marketed embolic microspheres for the treatment of malignant hepatocellular carcinoma, namely the most predominant form of liver cancer. Embolic microspheres for the distinct modalities of embolization (i.e., bland embolization, chemoembolization and radioembolization) are here comprehensively compiled with emphasis on material characteristics and their impact on microsphere performance. Moreover, the future application of the embolics under clinical investigation is discussed along with the scientific and regulatory challenges ahead in the field. STATEMENT OF SIGNIFICANCE: Embolization therapy with microspheres is currently used in the clinical setting for the treatment of most liver cancer conditions. The progressive development of added functionalities on embolic microspheres (such as biodegradability, imageability or drug and radiopharmaceutical loading capability) provides further benefit to patients and widens the therapeutic armamentarium for physicians towards truly personalized therapies. Therefore, it is important to analyze the possibilities that advanced biomaterials offer in the field from a clinical translational perspective to outline the future trends in therapeutic embolization.
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Jia G, Van Valkenburgh J, Chen AZ, Chen Q, Li J, Zuo C, Chen K. Recent advances and applications of microspheres and nanoparticles in transarterial chemoembolization for hepatocellular carcinoma. WILEY INTERDISCIPLINARY REVIEWS. NANOMEDICINE AND NANOBIOTECHNOLOGY 2022; 14:e1749. [PMID: 34405552 PMCID: PMC8850537 DOI: 10.1002/wnan.1749] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/22/2021] [Accepted: 07/28/2021] [Indexed: 12/15/2022]
Abstract
Transarterial chemoembolization (TACE) is a recommended treatment for patients suffering from intermediate and advanced hepatocellular carcinoma (HCC). As compared to the conventional TACE, drug-eluting bead TACE demonstrates several advantages in terms of survival, treatment response, and adverse effects. The selection of embolic agents is critical to the success of TACE. Many studies have been performed on the modification of the structure, size, homogeneity, biocompatibility, and biodegradability of embolic agents. Continuing efforts are focused on efficient loading of versatile chemotherapeutics, controlled sizes for sufficient occlusion, real-time detection intra- and post-procedure, and multimodality imaging-guided precise treatment. Here, we summarize recent advances and applications of microspheres and nanoparticles in TACE for HCC. This article is categorized under: Therapeutic Approaches and Drug Discovery > Nanomedicine for Oncologic Disease.
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Affiliation(s)
- Guorong Jia
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,Department of Nuclear Medicine, Changhai Hospital of Shanghai, Shanghai, China
| | - Juno Van Valkenburgh
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Austin Z. Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Quan Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Jindian Li
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Changjing Zuo
- Department of Nuclear Medicine, Changhai Hospital of Shanghai, Shanghai, China,Corresponding authors ,(Changjing Zuo); , (Kai Chen)
| | - Kai Chen
- Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA,Corresponding authors ,(Changjing Zuo); , (Kai Chen)
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Lai‐Kwon J, Yin Z, Minchom A, Yap C. Trends in patient-reported outcome use in early phase dose-finding oncology trials - an analysis of ClinicalTrials.gov. Cancer Med 2021; 10:7943-7957. [PMID: 34676991 PMCID: PMC8607259 DOI: 10.1002/cam4.4307] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 09/14/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patient-reported adverse events (AEs) may be a useful adjunct to clinician-assessed AEs for assessing tolerability in early phase, dose-finding oncology trials (DFOTs). We reviewed DFOTs on ClinicalTrials.gov to describe trends in patient-reported outcome (PRO) use. METHODS DFOTs commencing 01 January 2007 - 20 January 2020 with 'PROs' or 'quality of life' as an outcome were extracted and inclusion criteria confirmed. Study and PRO characteristics were extracted. Completed trials that reported PRO outcomes and published manuscripts on ClinicalTrials.gov were identified, and PRO reporting details were extracted. RESULTS 5.3% (548/10 372) DFOTs included PROs as an outcome. 231 (42.2%) were eligible: adult (224, 97%), solid tumour (175, 75.8%), and seamless phase 1/2 (108, 46.8%). PRO endpoints were identified in more trials (2.3 increase/year, 95% CI: 1.6-2.9) from an increasing variety of countries (0.7/year) (95% CI: 0.4-0.9) over time. PROs were typically secondary endpoints (207, 89.6%). 15/77 (19.5%) completed trials reported results on the ClinicalTrials.gov results database, and of those eight included their PRO results. Eighteen trials had published manuscripts available on ClinicalTrials.gov. Three (16.7%) used PROs to confirm the maximum tolerated dose. No trials identified who completed the PROs or how PROs were collected. CONCLUSIONS PRO use in DFOT has increased but remains limited. Future work should explore the role of PROs in DFOT and determine what guidelines are needed to standardise PRO use.
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Affiliation(s)
- Julia Lai‐Kwon
- Drug Development UnitThe Institute of Cancer Research and Royal Marsden HospitalLondonUK
| | - Zhulin Yin
- Clinical Trials and Statistics UnitThe Institute of Cancer ResearchSuttonUK
| | - Anna Minchom
- Drug Development UnitThe Institute of Cancer Research and Royal Marsden HospitalLondonUK
| | - Christina Yap
- Clinical Trials and Statistics UnitThe Institute of Cancer ResearchSuttonUK
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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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11
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Liu L, Liang X, Xu X, Zhang X, Wen J, Chen K, Su X, Teng Z, Lu G, Xu J. Magnetic mesoporous embolic microspheres in transcatheter arterial chemoembolization for liver cancer. Acta Biomater 2021; 130:374-384. [PMID: 34082098 DOI: 10.1016/j.actbio.2021.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 05/15/2021] [Accepted: 05/20/2021] [Indexed: 02/07/2023]
Abstract
Transcatheter arterial chemoembolization (TACE) is the main treatment for liver cancer. Although many embolic agents have been exploited in TACE, embolic agents combining embolization, drug loading, and imaging properties have not yet been constructed. Herein, we report a new magnetic mesoporous embolic microsphere that can simultaneously be loaded with doxorubicin (Dox), block vessels, and be observed by magnetic resonance imaging (MRI). The microspheres were prepared by decorating magnetic polystyrene/Fe3O4 particles with mesoporous organosilica microparticles (denoted as PS/Fe3O4@MONs). The PS/Fe3O4@MONs were uniformly spherical and large (50 µm), with a high specific surface area, uniform mesopores, and a Dox loading capacity of 460.8 µg mg-1. Dox-loaded PS/Fe3O4@MONs (PS/Fe3O4@MON@Dox) effectively inhibited liver cancer cell growth. A VX2 rabbit liver tumor model was constructed to study the efficacy of TACE with PS/Fe3O4@MON@Dox. In vivo, PS/Fe3O4@MON@Dox could be smoothly delivered through an arterial catheter to achieve chemoembolization. Moreover, PS/Fe3O4@MON@Dox and residual tumor parenchyma could be distinguished on MRI, which is of great significance for evaluating the efficacy of TACE. Histopathology showed that PS/Fe3O4@MON@Dox could be deposited in the tumor vessels, completely blocking the blood supply. Overall, PS/Fe3O4@MON@Dox showed good drug loading, embolization and imaging performance as well as potential for use in TACE. STATEMENT OF SIGNIFICANCE: Transcatheter arterial chemoembolization (TACE) is the main treatment for liver cancer. Although many embolic agents have been exploited in TACE, embolic agents combining embolization, drug-loading, and imaging properties have not yet been constructed. In this work, we prepared magnetic mesoporous microspheres as a new embolic agent that can simultaneously load doxorubicin (Dox), block blood vessels and enable magnetic resonance imaging. Overall, this new embolic microsphere-mediated TACE strategy for liver cancer showed good therapeutic effects, and the PS/Fe3O4@MON@Dox embolic microspheres provide a new avenue for improving the efficacy of TACE for liver cancer and postoperative evaluation.
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12
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Wohlleber K, Heger P, Probst P, Engel C, Diener MK, Mihaljevic AL. Health-related quality of life in primary hepatic cancer: a systematic review assessing the methodological properties of instruments and a meta-analysis comparing treatment strategies. Qual Life Res 2021; 30:2429-2466. [PMID: 34283381 PMCID: PMC8405513 DOI: 10.1007/s11136-021-02810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Patient-reported outcomes including health-related quality of life (HRQoL) are important oncological outcome measures. The validation of HRQoL instruments for patients with hepatocellular and cholangiocellular carcinoma is lacking. Furthermore, studies comparing different treatment options in respect to HRQoL are sparse. The objective of the systematic review and meta-analysis was, therefore, to identify all available HRQoL tools regarding primary liver cancer, to assess the methodological quality of these HRQoL instruments and to compare surgical, interventional and medical treatments with regard to HRQoL. METHODS A systematic literature search was conducted in MEDLINE, the Cochrane library, PsycINFO, CINAHL and EMBASE. The methodological quality of all identified HRQoL instruments was performed according to the COnsensus-based Standards for the selection of health status Measurements INstruments (COSMIN) standard. Consequently, the quality of reporting of HRQoL data was assessed. Finally, wherever possible HRQoL data were extracted and quantitative analyses were performed. RESULTS A total of 124 studies using 29 different HRQoL instruments were identified. After the methodological assessment, only 10 instruments fulfilled the psychometric criteria and could be included in subsequent analyses. However, quality of reporting of HRQoL data was insufficient, precluding meta-analyses for 9 instruments. CONCLUSION Using a standardized methodological assessment, specific HRQoL instruments are recommended for use in patients with hepatocellular and cholangiocellular carcinoma. HRQoL data of patients undergoing treatment of primary liver cancers are sparse and reporting falls short of published standards. Meaningful comparison of established treatment options with regard to HRQoL was impossible indicating the need for future research.
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Affiliation(s)
- Kerstin Wohlleber
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Patrick Heger
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Pascal Probst
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology (IMISE), University of Leipzig, Härtelstraße 16-18, 04107, Leipzig, Germany
| | - Markus K Diener
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - André L Mihaljevic
- Department of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
- The Study Centre of the German Surgical Society (SDGC), University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
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Brock K, Homer V, Soul G, Potter C, Chiuzan C, Lee S. Is more better? An analysis of toxicity and response outcomes from dose-finding clinical trials in cancer. BMC Cancer 2021; 21:777. [PMID: 34225682 PMCID: PMC8256624 DOI: 10.1186/s12885-021-08440-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 06/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The overwhelming majority of dose-escalation clinical trials use methods that seek a maximum tolerable dose, including rule-based methods like the 3+3, and model-based methods like CRM and EWOC. These methods assume that the incidences of efficacy and toxicity always increase as dose is increased. This assumption is widely accepted with cytotoxic therapies. In recent decades, however, the search for novel cancer treatments has broadened, increasingly focusing on inhibitors and antibodies. The rationale that higher doses are always associated with superior efficacy is less clear for these types of therapies. METHODS We extracted dose-level efficacy and toxicity outcomes from 115 manuscripts reporting dose-finding clinical trials in cancer between 2008 and 2014. We analysed the outcomes from each manuscript using flexible non-linear regression models to investigate the evidence supporting the monotonic efficacy and toxicity assumptions. RESULTS We found that the monotonic toxicity assumption was well-supported across most treatment classes and disease areas. In contrast, we found very little evidence supporting the monotonic efficacy assumption. CONCLUSIONS Our conclusion is that dose-escalation trials routinely use methods whose assumptions are violated by the outcomes observed. As a consequence, dose-finding trials risk recommending unjustifiably high doses that may be harmful to patients. We recommend that trialists consider experimental designs that allow toxicity and efficacy outcomes to jointly determine the doses given to patients and recommended for further study.
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Affiliation(s)
- Kristian Brock
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK.
| | - Victoria Homer
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Gurjinder Soul
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Claire Potter
- Cancer Research UK Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | - Cody Chiuzan
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Shing Lee
- Mailman School of Public Health, Columbia University, New York, NY, USA
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Fohlen A, Bordji K, Assenat E, Gongora C, Bazille C, Boulonnais J, Naveau M, Breuil C, Pérès EA, Bernaudin M, Guiu B. Anticancer Drugs for Intra-Arterial Treatment of Colorectal Cancer Liver Metastases: In-Vitro Screening after Short Exposure Time. Pharmaceuticals (Basel) 2021; 14:ph14070639. [PMID: 34358065 PMCID: PMC8308869 DOI: 10.3390/ph14070639] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 06/25/2021] [Accepted: 06/26/2021] [Indexed: 12/24/2022] Open
Abstract
To treat colorectal liver metastases, intra-arterial chemotherapies may complete therapeutic arsenal. Drugs using intra-arterially are very heterogeneous. The aim of this study was to select the most efficient drug on a panel of colorectal cancer (CRC) cell lines (Caco-2, HCT 116, HT 29, SW 48, SW 480, SW 620) exposed for 30 min to 12 cytotoxic agents (doxorubicin, epirubicin, idarubicin, 5-FU, raltitrexed, gemcitabine, cisplatin, oxaliplatin, mitomycin C, irinotecan, streptozocin, paclitaxel) at different concentrations. The effect on cell viability was measured using the WST-1 cell viability assay. For each drug and cell line, the IC50 and IC90 were calculated, which respectively correspond to the drug concentration (mg/mL) required to obtain 50% and 90% of cell death. We also quantified the cytotoxic index (CyI90 = C Max/IC90) to compare drug efficacy. The main findings of this study are that idarubicin emerged as the most cytotoxic agent to most of the tested CRC cell lines (Caco-2, HT29, HCT116, SW620 and SW480). Gemcitabine seemed to be the most efficient chemotherapy for SW48. Interestingly, the most commonly used cytotoxic agents in the systemic and intra-arterial treatment of colorectal liver metastasis (CRLM) (oxaliplatin, 5-FU, irinotecan) showed very limited cytotoxicity to all the cell lines.
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Affiliation(s)
- Audrey Fohlen
- UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, GIP CYCERON, Normandie University, 14000 Caen, France; (K.B.); (C.B.); (J.B.); (E.A.P.); (M.B.)
- Urodigestive Imagery and Interventional Radiology Department, University Hospital of Caen, CEDEX, 14000 Caen, France
- Correspondence: ; Tel.: +33-616702414
| | - Karim Bordji
- UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, GIP CYCERON, Normandie University, 14000 Caen, France; (K.B.); (C.B.); (J.B.); (E.A.P.); (M.B.)
| | - Eric Assenat
- Medical Oncology Department, Montpellier School of Medicine, Saint-Eloi University Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France;
| | - Céline Gongora
- IRCM, Montpellier Cancerology Research Center, INSERM U1194, Montpellier University, Montpellier Regional Institute of Cancer, 34298 Montpellier, France;
| | - Céline Bazille
- UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, GIP CYCERON, Normandie University, 14000 Caen, France; (K.B.); (C.B.); (J.B.); (E.A.P.); (M.B.)
- Department of Pathology, University Hospital of Caen, CEDEX, 14000 Caen, France
| | - Jérémy Boulonnais
- UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, GIP CYCERON, Normandie University, 14000 Caen, France; (K.B.); (C.B.); (J.B.); (E.A.P.); (M.B.)
| | - Mikaël Naveau
- UNICAEN, CNRS, UMS 3408, GIP CYCERON, Normandie University, 14000 Caen, France;
| | - Cécile Breuil
- Pharmacy Department, University Hospital of Caen, CEDEX, 14000 Caen, France;
| | - Elodie A. Pérès
- UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, GIP CYCERON, Normandie University, 14000 Caen, France; (K.B.); (C.B.); (J.B.); (E.A.P.); (M.B.)
| | - Myriam Bernaudin
- UNICAEN, CEA, CNRS, ISTCT/CERVOxy Group, GIP CYCERON, Normandie University, 14000 Caen, France; (K.B.); (C.B.); (J.B.); (E.A.P.); (M.B.)
| | - Boris Guiu
- Radiology Department, Montpellier School of Medicine, Saint-Eloi University Hospital, 80 Avenue Augustin Fliche, 34295 Montpellier, France;
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Mikhail AS, Negussie AH, Mauda-Havakuk M, Owen JW, Pritchard WF, Lewis AL, Wood BJ. Drug-eluting embolic microspheres: State-of-the-art and emerging clinical applications. Expert Opin Drug Deliv 2021; 18:383-398. [PMID: 33480306 PMCID: PMC11247414 DOI: 10.1080/17425247.2021.1835858] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/07/2020] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Drug-eluting embolic (DEE) microspheres, or drug-eluting beads (DEB), delivered by transarterial chemoembolization (TACE) serve as a therapeutic embolic to stop blood flow to tumors and a drug delivery vehicle. New combinations of drugs and DEE microspheres may exploit the potential synergy between mechanisms of drug activity and local tissue responses generated by TACE to enhance the efficacy of this mainstay therapy. AREAS COVERED This review provides an overview of key drug delivery concepts related to DEE microspheres with a focus on recent technological developments and promising emerging clinical applications as well as speculation into the future. EXPERT OPINION TACE has been performed for nearly four decades by injecting chemotherapy drugs into the arterial supply of tumors while simultaneously cutting off their blood supply, trying to starve and kill cancer cells, with varying degrees of success. The practice has evolved over the decades but has yet to fulfill the promise of truly personalized therapies envisioned through rational selection of drugs and real-time multi-parametric image guidance to target tumor clonality or heterogeneity. Recent technologic and pharmacologic developments have opened the door for potentially groundbreaking advances in how TACE with DEE microspheres is performed with the goal of achieving advancements that benefit patients.
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Affiliation(s)
- Andrew S Mikhail
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Ayele H Negussie
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Michal Mauda-Havakuk
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Joshua W Owen
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - William F Pritchard
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
| | - Andrew L Lewis
- Interventional Medicine Innovation Group, Biocompatibles UK, Ltd. (Now Boston Scientific Corp.), Camberley, UK
| | - Bradford J Wood
- Center for Interventional Oncology, Radiology and Imaging Sciences, Clinical Center, National Institutes of Health, Bethesda, MD, USA
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Guiu B, Assenat E. Doxorubicin for the treatment of hepatocellular carcinoma: GAME OVER! ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1693. [PMID: 33490205 PMCID: PMC7812160 DOI: 10.21037/atm-2020-131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Boris Guiu
- Department of Radiology, St-Eloi University Hospital, Montpellier, France
| | - Eric Assenat
- Department of Oncology, St-Eloi University Hospital, Montpellier, France
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Real Life Prospective Evaluation of New Drug-Eluting Platform for Chemoembolization of Patients with Hepatocellular Carcinoma: PARIS Registry. Cancers (Basel) 2020; 12:cancers12113405. [PMID: 33212917 PMCID: PMC7698357 DOI: 10.3390/cancers12113405] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/07/2020] [Accepted: 11/10/2020] [Indexed: 02/08/2023] Open
Abstract
Simple Summary Hepatocellular carcinoma treatment options depend on stage of disease. In intermediate stage transarterial chemoembolization with drug-eluting microspheres (DEM-TACE) is recommended. DEM-TACE is simultaneous embolization of tumour feeding arteries and local delivery of anticancer drugs. We assessed real-life practice, safety, toxicity and efficacy of this therapy using new embolization microspheres in 97 patients. Toxicity of the treatment in our study was within or below rates reported so far, and the healthy liver parenchyma, the bile ducts and the portal vein were well preserved when compared with previous study using other type of DEM. Tumour response rate was high, achieving disease control in almost all patients. Hepatocellular carcinoma was controlled during 16.7 months with DEM-TCE as the only treatment. At one year 81% and at two years 66% of patients were alive. Our study showed that DEM-TACE in patients from every-day clinical practice is safe and efficient treatment modality. Abstract Background and aim: Transarterial chemoembolization with drug-eluting microspheres (DEM-TACE) is recommended for patients with BCLC stage B hepatocellular carcinoma (HCC) and stage 0-A unsuitable for curative treatments. We assessed efficacy and safety along with hepatobiliary toxicities (HBT) of DEM-TACE using a novel microsphere, LifePearlTM, loaded with anthracyclines. Materials and methods: 97 patients diagnosed with HCC were prospectively enrolled and treated using LifePearlTM loaded with doxorubicin (77%) or idarubicin (23%). Safety and tolerability were assessed using CTCAE, HBT by CT/MRI scans, and tumor response by applying modified Response Evaluation Criteria in Solid Tumors (mRECIST). Follow-up was after 2 years. Results: Adverse events (AE) were reported in 73.2% of patients, majority being Grade 1–2. Grade ≥ 3 AE reported in 13.4% of patients were mainly related to postembolization syndrome. HBT were observed after 15.5% (29/187) of the DEM-TACEs. Objective response and disease control rates were 81% and 99%, respectively, as the best responses. Survival rates at one and two years were 81% and 66%, respectively, while the median overall survival (OS) was not reached. Median progression free survival was 13.7 months (95% CI: 11.3; 15.6) and median time to TACE untreatable progression was 16.7 months (95% CI: 12.7; not estimable (n.e.)). Conclusions: DEM-TACE using LifePearlTM provides a high tumor response rate in HCC patients. HBT rates within or below previously reported results for cTACE and DEM-TACE indicate a good safety profile for LifePearlTM. The trial was registered in National Library of Medicine (ID: NCT03053596).
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Transarterial chemoembolization for hepatocellular carcinoma: quality of life, tumour response, safety and survival comparing two types of drug-eluting beads. Abdom Radiol (NY) 2020; 45:3326-3336. [PMID: 31781900 DOI: 10.1007/s00261-019-02349-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
PURPOSE To compare two different types of drug-eluting microspheres with regard to impact on HRQoL after first TACE, tumour response, peri-procedural complications, adverse events and 1-year survival in patients suffering from unresectable hepatocellular carcinoma (HCC). METHODS HRQoL was prospectively assessed with validated questionnaires (EORTC QLQ-C30 and -HCC18) before and 2 weeks after treatment with their first drug-eluting beads (DEB-)TACE with either acrylamido-polyvinylalcohol-AMPS hydrogel microspheres (groupDCB; 20 patients) or polyvinyl alcohol-co-acrylic acid microspheres (groupHS; 16 patients). Baseline characteristics, peri-procedural complications, treatment-related adverse events and 1-year survival were compared between both types of microspheres. Treatment response and objective response rates (ORR) were analysed using established tumour response criteria. Subgroup analysis for pooled groups with small (groupSMALL; 21 patients) versus large particles (groupLARGE; 15 patients) was performed. RESULTS At baseline, there were no significant differences between the treated microsphere groups. No significant differences were found in absolute HRQoL changes after first DEB-TACE between the different types of microspheres. Response rates and survival were comparable between the investigated microsphere groups. For groupSMALL, we found a significant difference in post-interventional deterioration of physical function (- 19.4%) compared to groupLARGE (- 8%; p = 0.025). Tumour response and ORR according to mRECIST were significantly higher in groupSMALL (p = 0.008; p = 0.009). CONCLUSION DEB-TACE is generally well tolerated and effective, with comparable changes in HRQoL for both types of drug-eluting microspheres. Tumour response is better with small microspheres. A relevant deterioration of physical function underlines that an aggressive TACE using small beads should be well deliberated.
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Karina A, Benzina A, Tazhibayeva S, Fan H, Koole LH. Polymer microparticles with a cavity designed for transarterial chemo-embolization with crystalline drug formulations. J Biomed Mater Res B Appl Biomater 2020; 109:401-409. [PMID: 32860336 DOI: 10.1002/jbm.b.34708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 11/05/2022]
Abstract
Transarterial chemo-embolization with drug-eluting embolic beads (DEB-TACE) is still evolving. Recent developments include the introduction of radiopaque (X-ray imageable) drug-eluting particles. Here, we report on conceptually different radiopaque polymeric drug-eluting embolic particles, which are (i), cross-linked poly(methacrylates); (ii), radiopaque; (iii), microporous. Furthermore, the particles are not perfectly spherical: they have a large indentation in the sense that they are either a spherical/cup-shaped or ellipsoid/mouth-shaped. The micropores and the large indentation can confer useful features upon the particles, since they can be filled with a crystalline lipophilic chemotherapeutic drug. It is important, in this respect that (i), many potent chemotherapeutics are lipophilic and crystalline; (ii), available drug-eluting beads (DEBs) have the limitation that they can only be used in combination with water-soluble chemotherapeutic agents. Cup- and mouth-shaped particles were obtained in a Cu(0) catalyzed free-radical polymerization reaction. The microparticles could be charged with crystalline drug, in such a manner that the crystals reside in both the micropores and the large cavity, and in quantities that would be required for effective local chemotherapy. The antifungal drug voriconazole, lipophilic, and crystalline, was used to demonstrate this. We believe that the ability of the microporous/cavitated DEBs to carry lipophilic chemotherapeutic drugs is especially important. DEB-TACE is likely to become a cornerstone method of interventional oncology in the years ahead, and the new embolic particles described herein hold the promise of becoming scope widening for the technique.
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Affiliation(s)
- Aigerim Karina
- Department of Chemical and Materials Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Abderazak Benzina
- Department of Chemical and Materials Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Samal Tazhibayeva
- Department of Biology, School of Science and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Haiyan Fan
- Department of Chemistry, School of Science and Humanities, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Levinus H Koole
- Department of Chemical and Materials Engineering, School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
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Hulin A, Stocco J, Bouattour M. Clinical Pharmacokinetics and Pharmacodynamics of Transarterial Chemoembolization and Targeted Therapies in Hepatocellular Carcinoma. Clin Pharmacokinet 2020; 58:983-1014. [PMID: 31093928 DOI: 10.1007/s40262-019-00740-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The management of hepatocellular carcinoma (HCC) is based on a multidisciplinary decision tree. Treatment includes loco-regional therapy, mainly transarterial chemoembolization, for intermediate-stage HCC and systemic therapy with oral tyrosine kinase inhibitors (TKIs) for advanced HCC. Transarterial chemoembolization involves hepatic intra-arterial infusion with either conventional procedure or drug-eluting-beads. The aim of the loco-regional procedure is to deliver treatment as close as possible to the tumor both to embolize the tumor area and to enhance efficacy and minimize systemic toxicity of the anticancer drug. Pharmacokinetic studies applied to transarterial chemoembolization are rare and pharmacodynamic studies even rarer. However, all available studies lead to the same conclusions: use of the transarterial route lowers systemic exposure to the cytotoxic drug and leads to much higher tumor drug concentrations than does a similar dose via the intravenous route. However, reproducibility of the procedure remains a major problem, and no consensus exists regarding the choice of anticancer drug and its dosage. Systemic therapy with TKIs is based on sorafenib and lenvatinib as first-line treatment and regorafenib and cabozantinib as second-line treatment. Clinical use of TKIs is challenging because of their complex pharmacokinetics, with high liver metabolism yielding both active metabolites and their common toxicities. Changes in liver function over time with the progression of HCC adds further complexity to the use of TKIs. The challenges posed by TKIs and the HCC disease process means monitoring of TKIs is required to improve clinical management. To date, only partial data supporting sorafenib monitoring is available. Results from further pharmacokinetic/pharmacodynamic studies of these four TKIs are eagerly awaited and are expected to permit such monitoring and the development of consensus guidelines.
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Affiliation(s)
- Anne Hulin
- APHP, Laboratory of Pharmacology, GH Henri Mondor, EA7375, University Paris Est Creteil, 94010, Creteil, France
| | - Jeanick Stocco
- APHP, HUPNVS, Department of Clinical Pharmacy and Pharmacology, Beaujon University Hospital, 92110, Clichy, France
| | - Mohamed Bouattour
- APHP, HUPNVS, Department of Digestive Oncology, Beaujon University Hospital, 92110, Clichy, France.
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common types of malignant tumor. Although radical surgery and liver transplantation are possible cures for the disease, most patients are beyond the optimum stage for radical treatment at the time of diagnosis. Transarterial chemoembolization (TACE) is the first choice of treatment for advanced HCC. Owing to the widespread use of conventional TACE (cTACE), the problems with this treatment cannot be ignored. Drug-eluting beads (DEBs), a new type of embolization material, appear to overcome the problems of cTACE, and they have other advantages such as synchronous controlled continuous drug release after chemotherapy and embolization and low blood concentrations after treatment. This review summarizes the recent advances in the use of DEB-TACE to treat HCC.
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Affiliation(s)
- Guangxu Wei
- Interventional Department, Changhai Hospital, Naval Medical University, No. 168, ChangHai Road, Shanghai, 200433, China
| | - Jijin Yang
- Interventional Department, Changhai Hospital, Naval Medical University, No. 168, ChangHai Road, Shanghai, 200433, China
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22
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Turek A, Stoklosa K, Borecka A, Paul-Samojedny M, Kaczmarczyk B, Marcinkowski A, Kasperczyk J. Designing Biodegradable Wafers Based on Poly(L-lactide-co-glycolide) and Poly(glycolide-co-ε-caprolactone) for the Prolonged and Local Release of Idarubicin for the Therapy of Glioblastoma Multiforme. Pharm Res 2020; 37:90. [PMID: 32382838 PMCID: PMC7205781 DOI: 10.1007/s11095-020-02810-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Accepted: 04/01/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The blood-brain barrier limits the application of idarubicin in the therapy of glioblastoma multiforme. Biodegradable, intracranial wafers with prolonged release may increase therapy efficiency. METHODS Blank wafers, wafers containing 5% w/w and 10% w/w of idarubicin were formulated by solution casting from poly(L-lactide-co-glycolide) and poly(glycolide-co-ε-caprolactone). The following methods were used: NMR, GPC, DSC, FTIR, AFM, UV-VIS, and a viability and proliferation assay for idarubicin action (U87MG cell line). RESULTS Wafers showed a surface with numerous immersions and hills. A lack of interactions between idarubicin and the copolymers was observed. The substance was entrapped in the matrix and released in two phases for all wafers with the appropriate bolus and maintenance dose. The burst effect was observed for all wafers, however, the biggest bolus for poly(L-lactide-co-glycolide) wafers containing 5% w/w of idarubicin was noted. The stable and steady degradation of poly(glycolide-co-ε-caprolactone) wafers containing 5% w/w of idarubicin ensures the most optimal release profile and high inhibition of proliferation. CONCLUSIONS Copolymer wafers with idarubicin are an interesting proposition with great potential for the local treatment of glioblastoma multiforme. The release rate and dose may be regulated by the amount and kind of wafers for various effects.
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Affiliation(s)
- Artur Turek
- Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Chair and Department of Biopharmacy, Jedności 8, 41-200, Katowice, Poland.
| | - Katarzyna Stoklosa
- Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Chair and Department of Biopharmacy, Jedności 8, 41-200, Katowice, Poland
| | - Aleksandra Borecka
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, M. Curie-Sklodowskiej 43, 41-819, Zabrze, Poland
| | - Monika Paul-Samojedny
- Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Chair and Department of Medical Genetics, Jedności 8, 41-200, Sosnowiec, Poland
| | - Bożena Kaczmarczyk
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, M. Curie-Sklodowskiej 43, 41-819, Zabrze, Poland
| | - Andrzej Marcinkowski
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, M. Curie-Sklodowskiej 43, 41-819, Zabrze, Poland
| | - Janusz Kasperczyk
- Faculty of Pharmaceutical Sciences in Sosnowiec, Medical University of Silesia, Katowice, Chair and Department of Biopharmacy, Jedności 8, 41-200, Katowice, Poland
- Centre of Polymer and Carbon Materials, Polish Academy of Sciences, M. Curie-Sklodowskiej 43, 41-819, Zabrze, Poland
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23
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Roth GS, Teyssier Y, Abousalihac M, Seigneurin A, Ghelfi J, Sengel C, Decaens T. Idarubicin vs doxorubicin in transarterial chemoembolization of intermediate stage hepatocellular carcinoma. World J Gastroenterol 2020; 26:324-334. [PMID: 31988592 PMCID: PMC6969879 DOI: 10.3748/wjg.v26.i3.324] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/29/2019] [Accepted: 12/22/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Liver cancer is the fifth most common cancer and the second cause of cancer-related deaths worldwide. Transarterial chemoembolization (TACE) is the best treatment of intermediate hepatocellular carcinoma (HCC). Doxorubicin is the most commonly used drug despite a low level of evidence.
AIM To compare the objective response rate of idarubicin-based TACE (Ida-TACE) against doxorubicin-based TACE (Dox-TACE) in intermediate stage HCC.
METHODS Between January 2012 and December 2014, all patients treated with TACE at our academic hospital were screened. Inclusion criteria were patients with Child-Pugh score A or B, a performance status below or equal to 1, and no prior TACE. Either lipiodol TACE or drug-eluting beads TACE could be performed with 10 mg of idarubicin or 50 mg of doxorubicin. Each patient treated with idarubicin was matched with two doxorubicin-treated patients. The TACE response was assessed by independent radiologists according to the mRECIST criteria.
RESULTS Sixty patients were treated with doxorubicin and thirty with idarubicin. There were 93% and 87% of cirrhotic patients and 87% and 70% of Child-Pugh A in the doxorubicin and idarubicin groups, respectively. The median number of HCC per patient was two in both groups with 31% and 26% of single nodules in doxorubicin and idarubicin groups, respectively. Objective response rate after first TACE was 76.7% and 73.3% (P = 0.797) with 41.7% and 40.0% complete response in doxorubicin and idarubicin groups, respectively. Progression-free survival was 7.7 mo in both groups, and liver transplant-free survival was 24.9 mo and 21.9 mo in doxorubicin and idarubicin groups, respectively. Safety profiles were similar in both groups, with grade 3-4 adverse events in 35% of Dox-TACE and 43% of Ida-TACEs.
CONCLUSION Ida-TACE and Dox-TACE showed comparable results in terms of efficacy and safety. Ida-TACE may represent an interesting alternative to Dox-TACE in the management of patients with intermediate stage HCC.
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Affiliation(s)
- Gaël Stéphane Roth
- Clinique Universitaire d’Hépato-Gastroentérologie et Oncologie Digestive, CHU Grenoble-Alpes, Grenoble 38043, France
- Faculté de Médicine, Université Grenoble-Alpes, Domaine de la Merci, La Tronche 38700, France
- Institute for Advanced Biosciences - INSERM U1209/CNRS UMR 5309/Université Grenoble-Alpes, Site Santé - Allée des Alpes, La Tronche 38700, France
| | - Yann Teyssier
- Faculté de Médicine, Université Grenoble-Alpes, Domaine de la Merci, La Tronche 38700, France
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, Grenoble 38043, France
| | - Mélodie Abousalihac
- Clinique Universitaire d’Hépato-Gastroentérologie et Oncologie Digestive, CHU Grenoble-Alpes, Grenoble 38043, France
| | - Arnaud Seigneurin
- Faculté de Médicine, Université Grenoble-Alpes, Domaine de la Merci, La Tronche 38700, France
- Département de Santé Publique - CHU Grenoble-Alpes, Grenoble 38043, France
| | - Julien Ghelfi
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, Grenoble 38043, France
| | - Christian Sengel
- Clinique Universitaire de Radiologie et Imagerie Médicale, CHU Grenoble-Alpes, Grenoble 38043, France
| | - Thomas Decaens
- Clinique Universitaire d’Hépato-Gastroentérologie et Oncologie Digestive, CHU Grenoble-Alpes, Grenoble 38043, France
- Faculté de Médicine, Université Grenoble-Alpes, Domaine de la Merci, La Tronche 38700, France
- Institute for Advanced Biosciences - INSERM U1209/CNRS UMR 5309/Université Grenoble-Alpes, Site Santé - Allée des Alpes, La Tronche 38700, France
- Department of Hepatology and Gastroenterology, Grenoble-Alpes University Hospital, Grenoble 38043, France
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24
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Das A, Gabr A, O'Brian DP, Riaz A, Desai K, Thornburg B, Kallini JR, Mouli S, Lewandowski RJ, Salem R. Contemporary Systematic Review of Health-Related Quality of Life Outcomes in Locoregional Therapies for Hepatocellular Carcinoma. J Vasc Interv Radiol 2019; 30:1924-1933.e2. [PMID: 31685362 DOI: 10.1016/j.jvir.2019.07.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 06/03/2019] [Accepted: 07/19/2019] [Indexed: 12/12/2022] Open
Abstract
Health-related quality of life has become an important aspect in oncologic decision making. Recent data suggest that Health-Related Quality of Life (HRQoL) measurements can play an important prognostic role in patients with hepatocellular carcinoma (HCC). Locoregional therapies (LRTs) such as radiofrequency ablation, transarterial chemoembolization, and radioembolization (TARE) are important parts of HCC management. Results demonstrated that radiofrequency ablation treatment results in improving HRQoL compared to surgery for up to 3 years after treatment. Between TARE and transarterial chemoembolization, TARE provides the most benefit in terms of HRQoL. This systematic review investigated contemporary data surrounding HRQoL in patients undergoing LRTs and its impact on clinical decision making.
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Affiliation(s)
- Arighno Das
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Ahmed Gabr
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Daniel P O'Brian
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Ahsun Riaz
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Kush Desai
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Bartley Thornburg
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Joseph R Kallini
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Samdeep Mouli
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois
| | - Robert J Lewandowski
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago Illinois
| | - Riad Salem
- Department of Radiology, Section of Interventional Radiology, Northwestern University, Chicago Illinois; Department of Medicine, Division of Hematology and Oncology, Northwestern University, Chicago Illinois.
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25
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Guiu B, Colombat S, Piron L, Hermida M, Allimant C, Pierredon-Foulongne MA, Belgour A, Escal L, Cassinotto C, Boulin M. Transarterial Chemoembolization of Hepatocellular Carcinoma with Idarubicin-Loaded Tandem Drug-Eluting Embolics. Cancers (Basel) 2019; 11:E987. [PMID: 31311170 PMCID: PMC6678754 DOI: 10.3390/cancers11070987] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 07/07/2019] [Accepted: 07/13/2019] [Indexed: 12/15/2022] Open
Abstract
: Objective: To describe the responses, toxicities and outcomes of HCC patients treated by transarterial chemoembolization (TACE) using idarubicin-loaded TANDEM beads. Materials and Methods: Seventy-two consecutive patients (mean age: 71 years (58-84 years)) with HCC were treated by TACE using idarubicin-loaded TANDEM in a first line, over a five-year period. Most patients (89%) had liver cirrhosis classified as Child-Pugh A (90%). BCLC B classification applied in 85% of cases. Baseline tumor burden was limited to one to three nodules in 92% of cases, unilobar in 88% cases, with a median tumor diameter of 55 mm (range: 13-150 mm). Toxicity was assessed using NCI CTC AE v4.0. Response was assessed using mRECIST criteria. Time-to-treatment failure (TTTF) and overall survival (OS) were also calculated based on Kaplan-Meier method. Result: Of 141 TACE sessions performed with bead sizes of 100 and 75 µm in 42 (29.8%) and 99 (70.2%) sessions, respectively. In 78% of all TACE sessions, the full dose of idarubicin-loaded beads was injected. Grade 3-4 AE were observed after 73 (52%) sessions, most of them being biological. Multi-organ failure was observed three days after the first TACE in a Child B patients, unfortunately leading to death. Overall, the best objective response rate (ORR) was 65%. Median follow-up lasted 14.3 months (95% CI: 11.2-18.8 months). Median TTTF and OS were 14.4 months (95% CI: 7.2-24.6 months) and 34.6 months (95% CI: 24.7-not reached) respectively. Conclusion: In this retrospective study involving well-selected HCC patients, high ORR and long TTTF and OS are observed after TACE using idarubicin-loaded TANDEM. A randomized trial is needed.
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Affiliation(s)
- Boris Guiu
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France.
| | | | - Lauranne Piron
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | - Margaux Hermida
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | - Carole Allimant
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | | | - Ali Belgour
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | - Laure Escal
- Department of Radiology, St-Eloi University Hospital, 34980 Montpellier, France
| | | | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital, 21000 Dijon, France
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26
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Guiu B, Hincapie G, Thompson L, Wu Y, Boulin M, Cassinotto C, Cruise GM. An In Vitro Evaluation of Four Types of Drug-Eluting Embolics Loaded with Idarubicin. J Vasc Interv Radiol 2019; 30:1303-1309. [PMID: 31155500 DOI: 10.1016/j.jvir.2018.12.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 01/25/2023] Open
Abstract
PURPOSE This study compared loading, elution, and stability of drug-eluting embolic beads (DEBs) loaded with idarubicin. MATERIALS AND METHODS DC Bead (100-300 μm), HepaSphere (30-60 μm), LifePearl (200 μm), and Tandem (100 μm) DEBs were loaded with 5 mg/mL idarubicin. Loading, elution, diameter changes, loading stability over 2 weeks in storage, and time in suspension were determined for each of the DEBs. RESULTS Loading of more than 99% of idarubicin was achieved within 15 minutes for LifePearl, DC Bead, and Tandem beads. LifePearl, DC Bead, HepaSphere, and Tandem beads eluted 75% of the total idarubicin released in 13, 24, 42, and 91 minutes, respectively. In vitro elution was completed in 2 hours with 73% ± 3%, 74% ± 3%, 65% ± 6%, and 7% ± 0% of the loaded idarubicin eluted for LifePearl, DC Bead, HepaSphere, and Tandem, respectively. Statistically significant differences were observed at every time point between at least 2 of the products. Overall, in vitro idarubicin elution was rapid and nearly complete for LifePearl, DC Bead, and HepaSphere beads but was minimal and slow from Tandem beads. The average diameter of DEBs after loading was reduced by 5% for LifePearl, whereas it was increased by 9% and 1% for DC Bead and Tandem, respectively. After loading, time in suspension was 11 ± 4 and 10 ± 2 minutes for LifePearl and HepaSphere, respectively, whereas DC Bead and Tandem beads were held in suspension for greater than 20 minutes. CONCLUSIONS Although all 4 DEBs loaded idarubicin within 15 minutes with minimal changes in diameter, the elution amounts, rates of release, and time in suspension varied.
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Affiliation(s)
- Boris Guiu
- Department of Radiology, St.-Eloi University Hospital, 80 avenue Augustin Fliche, 34925 Montpellier, France.
| | | | | | - Yue Wu
- MicroVention, Inc., Aliso Viejo, California
| | | | - Christophe Cassinotto
- Department of Radiology, St.-Eloi University Hospital, 80 avenue Augustin Fliche, 34925 Montpellier, France
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27
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Hagan A, Caine M, Press C, Macfarlane WM, Phillips G, Lloyd AW, Czuczman P, Kilpatrick H, Bascal Z, Tang Y, Garcia P, Lewis AL. Predicting pharmacokinetic behaviour of drug release from drug-eluting embolization beads using in vitro elution methods. Eur J Pharm Sci 2019; 136:104943. [PMID: 31152772 DOI: 10.1016/j.ejps.2019.05.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 05/03/2019] [Accepted: 05/27/2019] [Indexed: 12/18/2022]
Abstract
Drug-eluting Embolic Bead - Transarterial Chemoembolisation (DEB-TACE) is a minimally invasive embolising treatment for liver tumours that allows local release of chemotherapeutic drugs via ion exchange, following delivery into hepatic arterial vasculature. Thus far, no single in vitro model has been able to accurately predict the complete kinetics of drug release from DEB, due to heterogeneity of rate-controlling mechanisms throughout the process of DEB delivery. In this study, we describe two in vitro models capable of distinguishing between early phase and late phase drug release by mimicking in vivo features of each phase. First, a vascular flow system (VFS) was used to simulate the early phase by delivering DEB into a silicon vascular cast under high pulsatile flow. This yielded a burst release profile of drugs from DEB which related to the dose adjusted Cmax observed in pharmacokinetic plasma profiles from a preclinical swine model. Second, an open loop flow-through cell system was used to model late phase drug release by packing beads in a column with an ultra-low flow rate. DEB loaded with doxorubicin, irinotecan and vandetanib showed differential drug release rates due to their varying chemical properties and unique drug-bead interactions. Using more representative in vitro models to map discrete phases of DEB drug release will provide a better capability to predict the pharmacokinetics of developmental formulations, which has implications for treatment safety and efficacy.
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Affiliation(s)
- Alice Hagan
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK; Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK.
| | - Marcus Caine
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK
| | - Cara Press
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK
| | - Wendy M Macfarlane
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK
| | - Gary Phillips
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK
| | - Andrew W Lloyd
- School of Pharmacy and Biomolecular Sciences, University of Brighton, Moulsecoomb, Brighton BN2 4GJ, UK
| | - Peter Czuczman
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK
| | - Hugh Kilpatrick
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK
| | - Zainab Bascal
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK
| | - Yiqing Tang
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK
| | - Pedro Garcia
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK
| | - Andrew L Lewis
- Biocompatibles UK Ltd, a BTG International Group Company, Lakeview, Riverside Way, Watchmoor Park, Camberley, GU15 3YL, UK.
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28
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Guiu B, Chevallier P, Assenat E, Barbier E, Merle P, Bouvier A, Dumortier J, Nguyen-Khac E, Gugenheim J, Rode A, Oberti F, Valette PJ, Yzet T, Chevallier O, Barbare JC, Latournerie M, Boulin M. Idarubicin-loaded Beads for Chemoembolization of Hepatocellular Carcinoma: The IDASPHERE II Single-Arm Phase II Trial. Radiology 2019; 291:801-808. [PMID: 31038408 DOI: 10.1148/radiol.2019182399] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background A prior in vitro study showed that idarubicin was the most cytotoxic agent for hepatocellular carcinoma (HCC) cell lines. Idarubicin-loaded beads for transarterial chemoembolization (TACE) were previously evaluated for the appropriate dose in a phase I dose-escalation study. Purpose To evaluate objective response rate (ORR), safety, and survival after TACE by using idarubicin-loaded beads for unresectable HCC. Materials and Methods This prospective single-arm phase II study was conducted between January 2015 and January 2017. Participants with unresectable HCC were included in the trial and underwent TACE with idarubicin-eluting beads. The primary end point was 6-month ORR assessed with independent central review by using modified Response Evaluation Criteria in Solid Tumors. Secondary end points were best ORR during the first 6 months, overall survival, progression-free survival, time to progression, and safety. A two-stage Fleming statistical design was used. Results Forty-six study participants (mean age, 71.2 years ± 10.2; six women and 40 men) were included; 44 participants underwent at least one TACE session. The 6-month ORR was 52% (23 of 44). The best ORR achieved was 68% (30 of 44). Fourteen of 44 (32%) participants underwent a curative treatment after TACE. Median progression-free survival, time to progression, and overall survival were 6.6 months, 9.5 months, and 18.6 months, respectively. TACE was discontinued for toxicity in four of 44 (9%) participants. The most frequent grade 3-4 adverse events were elevated aspartate aminotransferase (14 of 44, 32%), elevated γ-glutamyl transpeptidase (eight of 44, 18%), hyperbilirubinemia (seven of 44, 16%), elevated alanine aminotransferase (seven of 44, 16%), and pain (seven of 44, 16%). Conclusion Idarubicin-eluting beads showed a good safety profile and promising objective response rate and time to progression when used as part of a transarterial chemoembolization regimen for unresectable hepatocellular carcinoma. © RSNA, 2019 See also the editorial by Padia in this issue.
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Affiliation(s)
- Boris Guiu
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Patrick Chevallier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Eric Assenat
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Emilie Barbier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Philippe Merle
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Antoine Bouvier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jérôme Dumortier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Eric Nguyen-Khac
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jean Gugenheim
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Agnès Rode
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Frédéric Oberti
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Pierre-Jean Valette
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Thierry Yzet
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Olivier Chevallier
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Jean-Claude Barbare
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Marianne Latournerie
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
| | - Mathieu Boulin
- From the Saint-Eloi University Hospital, 80 avenue Augustin Fliche, 34295 Montpellier, France (B.G., E.A.); Archet University Hospital, Nice, France (P.C., J.G.); Biostatistics, Fédération Francophone de Cancérologie Digestive, EPICAD INSERM LNC-UMR 1231, Burgundy & Franche-Comté University Dijon, France (E.B.); Croix Rousse University Hospital, Lyon, France (P.M., A.R.); Hôtel Dieu University Hospital, Angers, France (A.B., F.O.); Edouard Herriot University Hospital, Lyon, France (J.D., P.J.V.); University Hospital, Amiens, France (E.N.K., T.Y., J.C.B.); and Dijon University Hospital, EPICAD INSERM LNC-UMR1231, Burgundy & Franche-Comté University, Dijon, France (O.C., M.L., M.B.)
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Fiorentini G, Sarti D, Carandina R, Mulazzani L, Mincarelli C, Candelari R, Argirò R, Fiorentini C, Aliberti C. A review discussing the use of polyethylene glycol microspheres in the treatment of hepatocellular carcinoma. Future Oncol 2019; 15:695-703. [DOI: 10.2217/fon-2018-0425] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Transarterial chemoembolization (TACE) is indicated in unresectable hepatocellular carcinoma and allows the delivery of embolics inside tumor vascularization to reduce blood supply and release gradually the drug. This lowers the systemic exposure to chemotherapeutics, while increasing their local concentration and tissue necrosis that is higher than conventional TACE. The technology of TACE has seen the introduction of several types of embolics that are made of different materials. Available embolics for TACE include: drug-eluting beads (DC beads), acrylic copolymer, tris-acrylic microspheres and polyethylene glycol (PEG) microspheres. Few studies are available on PEG embolics and their use for TACE. This review focuses on the efficacy and safety of TACE performed with PEG microspheres for the treatment of hepatocellular carcinoma and discusses future therapeutic advantages.
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Affiliation(s)
- Giammaria Fiorentini
- Department of Onco-Hematology, Azienda Ospedaliera ‘Ospedali Riuniti Marche Nord’, 61122 Pesaro, Italy
| | - Donatella Sarti
- Department of Onco-Hematology, Azienda Ospedaliera ‘Ospedali Riuniti Marche Nord’, 61122 Pesaro, Italy
| | - Riccardo Carandina
- Oncology Radiodiagnostics, Oncology Institute of Veneto, Institute for the Research & Treatment of Cancer (IRCC), 35128 Padova, Italy
| | - Luca Mulazzani
- Diagnostics for Images Unit & Interventional Radiology, Azienda Ospedaliera ‘Ospedali Riuniti Marche Nord’, 61122 Pesaro, Italy
| | - Cinzia Mincarelli
- Interventional Radiology, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette, Ancona, Italy
| | - Roberto Candelari
- Interventional Radiology, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette, Ancona, Italy
| | - Renato Argirò
- Department of Radiological Oncological & Pathological Sciences, Sapienza University, 0161 Rome, Italy
| | - Caterina Fiorentini
- Department of Medical Biothecnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy
| | - Camillo Aliberti
- Oncology Radiodiagnostics, Oncology Institute of Veneto, Institute for the Research & Treatment of Cancer (IRCC), 35128 Padova, Italy
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Englert C, Brendel JC, Majdanski TC, Yildirim T, Schubert S, Gottschaldt M, Windhab N, Schubert US. Pharmapolymers in the 21st century: Synthetic polymers in drug delivery applications. Prog Polym Sci 2018. [DOI: 10.1016/j.progpolymsci.2018.07.005] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Guiu B, Jouve JL, Schmitt A, Minello A, Bonnetain F, Cassinotto C, Piron L, Cercueil JP, Loffroy R, Latournerie M, Wendremaire M, Lepage C, Boulin M. Intra-arterial idarubicin_lipiodol without embolisation in hepatocellular carcinoma: The LIDA-B phase I trial. J Hepatol 2018; 68:1163-1171. [PMID: 29427728 DOI: 10.1016/j.jhep.2018.01.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/04/2018] [Accepted: 01/20/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND & AIMS Idarubicin shows high cytotoxicity against hepatocellular carcinoma (HCC) cells, a high hepatic extraction ratio, and high lipophilicity leading to stable emulsions with lipiodol. A dose-escalation phase I trial of idarubicin_lipiodol (without embolisation) was conducted in patients with cirrhotic HCC to estimate the maximum-tolerated dose (MTD) and to assess the safety, efficacy, and pharmacokinetics of the drug, and the health-related quality of life achieved by patients. METHODS Patients underwent two sessions of treatment with a transarterial idarubicin_lipiodol emulsion without embolisation. The idarubicin dose was escalated according to a modified continuous reassessment method. The MTD was defined as the dose closest to that causing dose-limiting toxicity (DLT) in 20% of patients. RESULTS A group of 15 patients were enrolled, including one patient at 10 mg, four patients at 15 mg, seven patients at 20 mg, and three patients at 25 mg. Only two patients experienced DLT: oedematous ascitic decompensation and abdominal pain at 20 and 25 mg, respectively. The calculated MTD of idarubicin was 20 mg. The most frequent grade ≥3 adverse events were biological. One month after the second session, the objective response rate was 29% (complete response, 0%; partial response, 29%) based on modified Response Evaluation Criteria In Solid Tumours. The median time to progression was 5.4 months [95% confidence limit (CI) 3.0-14.6 months] and median overall survival was 20.6 months (95% CI 5.7-28.7 months). Pharmacokinetic analysis of idarubicin showed that the mean Cmax of idarubicin after intra-arterial injection of the idarubicin-lipiodol emulsion is approximately half the Cmax after intravenous administration. Health-related quality of life results confirmed the good safety results associated with use of the drug. CONCLUSIONS The MTD of idarubicin was 20 mg after two chemolipiodolisation sessions. Encouraging safety results, and patient responses and survival were observed. A phase II trial has been scheduled. LAY SUMMARY There is a need for transarterial regimens that improve the responses and survival of patients with unresectable HCC. In this phase I trial, we showed that two sessions of treatment with a transarterial idarubicin_lipiodol emulsion without embolisation was well tolerated and gave promising efficacy in terms of tumour control and patient survival.
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Affiliation(s)
- Boris Guiu
- Department of Interventional Radiology, INSERM U1194, St-Eloi University Hospital, Montpellier School of Medicine, 80 Avenue Augustin Fliche, 34295 Montpellier, France.
| | - Jean-Louis Jouve
- Department of Hepatogastroenterology, Dijon University Hospital and EPICAD LNC-UMR1231, Burgundy & Franche Comté University, BP 87900, 21079 Dijon, France
| | - Antonin Schmitt
- Department of Pharmacy, Georges-François Leclerc Anticancer Centre and LNC-UMR1231, Burgundy & Franche Comté University, BP 87900, 21079 Dijon, France
| | - Anne Minello
- Department of Hepatogastroenterology, Dijon University Hospital and EPICAD LNC-UMR1231, Burgundy & Franche Comté University, BP 87900, 21079 Dijon, France
| | - Franck Bonnetain
- Methodology and Quality of Life in Oncology Unit (EA 3181) and Quality of Life and Cancer Clinical Research Platform, University Hospital Besançon, 2 Place Saint Jacques, 25000 Besançon, France
| | - Christophe Cassinotto
- Department of Interventional Radiology, INSERM U1194, St-Eloi University Hospital, Montpellier School of Medicine, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Lauranne Piron
- Department of Interventional Radiology, INSERM U1194, St-Eloi University Hospital, Montpellier School of Medicine, 80 Avenue Augustin Fliche, 34295 Montpellier, France
| | - Jean-Pierre Cercueil
- Department of Interventional Radiology, University Hospital, 14 rue Gaffarel, 21000 Dijon, France
| | - Romaric Loffroy
- Department of Interventional Radiology, University Hospital, 14 rue Gaffarel, 21000 Dijon, France
| | - Marianne Latournerie
- Department of Hepatogastroenterology, Dijon University Hospital and EPICAD LNC-UMR1231, Burgundy & Franche Comté University, BP 87900, 21079 Dijon, France
| | - Maëva Wendremaire
- Department of Pharmacology-Toxicology, University Hospital, 2 rue Angélique Ducoudray, 21000 Dijon, France
| | - Côme Lepage
- Department of Hepatogastroenterology, Dijon University Hospital and EPICAD LNC-UMR1231, Burgundy & Franche Comté University, BP 87900, 21079 Dijon, France
| | - Mathieu Boulin
- Department of Pharmacy, Dijon University Hospital and EPICAD LNC-UMR1231, Burgundy & Franche Comté University, BP 87900, 21079 Dijon, France
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Nazzal M, Gadani S, Said A, Rice M, Okoye O, Taha A, Lentine KL. Liver targeted therapies for hepatocellular carcinoma prior to transplant: contemporary management strategies. GLOBAL SURGERY (LONDON) 2018; 4. [PMID: 29782618 DOI: 10.15761/gos.1000171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hepatocellular carcinoma (HCC) is an aggressive neoplastic disease that has been rapidly increasing in incidence. It usually occurs in the background of liver disease, and cirrhosis. Definitive therapy requires surgical resection. However, in majority of cases surgical resection is not tolerated, especially in the presence of portal hypertension and cirrhosis. Orthotopic liver transplant (OLT) in well selected candidates has been accepted as a viable option. Due to a relative scarcity of donors compared to the number of listed recipients, long waiting times are anticipated. To prevent patients with HCC from dropping out from the transplant list due to progression of their disease, most centers utilize loco-regional therapies. These loco-regional therapies(LRT) include minimally invasive treatments like percutaneous thermal ablation, trans-arterial chemoembolization, trans-arterial radio-embolization or a combination thereof. The type of therapy or combination used is determined by the size and location of the HCC and Barcelona Clinic Liver Cancer (BCLC) classification. The data regarding the efficacy of LRT in reducing post-transplant recurrence or disease-free survival is limited. This article reviews the available therapies, their strengths, limitations, and current use in the management of patients with hepatocellular carcinoma awaiting transplant.
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Affiliation(s)
- Mustafa Nazzal
- Division of Abdominal Transplant Surgery, Department of General Surgery, St. Louis University Hospital, USA
| | - Sameer Gadani
- Interventional Radiology, Department of Radiology, St. Louis University Hospital, USA
| | - Abdullah Said
- Division of Abdominal Transplant Surgery, Department of General Surgery, St. Louis University Hospital, USA
| | - Mandy Rice
- Division of Abdominal Transplant Surgery, Department of General Surgery, St. Louis University Hospital, USA
| | - Obi Okoye
- Division of Abdominal Transplant Surgery, Department of General Surgery, St. Louis University Hospital, USA
| | - Ahmad Taha
- Division of Abdominal Transplant Surgery, Department of General Surgery, St. Louis University Hospital, USA
| | - Krista L Lentine
- Division of Abdominal Transplant Surgery, Department of General Surgery, St. Louis University Hospital, USA.,Division of Nephrology, Department of Medicine, St Louis University Hospital, USA
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Yang Y, Si T. Yttrium-90 transarterial radioembolization versus conventional transarterial chemoembolization for patients with hepatocellular carcinoma: a systematic review and meta-analysis. Cancer Biol Med 2018; 15:299-310. [PMID: 30197797 PMCID: PMC6121048 DOI: 10.20892/j.issn.2095-3941.2017.0177] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Objective: To compare the effects and safety of conventional transarterial chemoembolization (cTACE) and yttrium-90 transarterial radioembolization [TARE (90Y)] for hepatocellular carcinoma (HCC) Methods: Nine high-quality observational studies, one low bias-risk randomized controlled trial (RCT), and one moderate bias-risk RCT included 1,652 patients [cTACE, 1,124; TARE (90Y), 528], from whom data were extracted for this systematic review and meta-analysis. Results: The extracted study outcomes included 1-year and 2-year overall survival (OS) rates, objective responses (ORs), and serious adverse events (AEs). 1-year OS rates: OR = 0.939, 95 % CI: 0.705-1.251, P = 0.66. 2-year OS rates: overall pooled OR = 0.641, 95% CI: 0.382-1.075, P = 0.092; observational study subgroup OR = 0.575, 95% CI: 0.336-0.984, P = 0.043; RCT subgroup OR* = 0.641, 95% CI: 0.382-1.075, P = 0.346. OR: overall pooled OR = 0.781, 95% CI: 0.454-1.343, P = 0.371; mRECIST subgroup OR = 0.584, 95 % CI: 0.349-0.976, P = 0.040; WHO subgroup OR = 1.065; 95% CI: 0.500-2.268, P = 0.870. Serious AEs: overall pooled RR = 1.477, 95% CI: 0.864-2.526, P = 0.154; RCT subgroup RR = 0.680, 95% CI: 0.325-1.423, P = 0.306; observational study subgroup RR = 1.925; 95 % CI: 0.978-3.788, P = 0.058.
Conclusions: TARE (90Y) increased 2-year OS rates in the observational subgroup and resulted in better OR rates, according to mRECIST criteria, in comparison with cTACE. Furthermore, a lower risk of AEs was observed for TARE (90Y) than for cTACE.
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Affiliation(s)
- Yi Yang
- School of Medical Imaging, Tianjin Medical University, Tianjin 300203, China.,Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
| | - Tongguo Si
- Department of Interventional Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer; Key Laboratory of Cancer Prevention and Therapy, Tianjin; Tianjin's Clinical Research Center for Cancer, Tianjin 300060, China
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Gaba RC, Lokken RP, Hickey RM, Lipnik AJ, Lewandowski RJ, Salem R, Brown DB, Walker TG, Silberzweig JE, Baerlocher MO, Echenique AM, Midia M, Mitchell JW, Padia SA, Ganguli S, Ward TJ, Weinstein JL, Nikolic B, Dariushnia SR. Quality Improvement Guidelines for Transarterial Chemoembolization and Embolization of Hepatic Malignancy. J Vasc Interv Radiol 2017; 28:1210-1223.e3. [PMID: 28669744 DOI: 10.1016/j.jvir.2017.04.025] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 04/29/2017] [Indexed: 02/07/2023] Open
Affiliation(s)
- Ron C Gaba
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612.
| | - R Peter Lokken
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612
| | - Ryan M Hickey
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Andrew J Lipnik
- Division of Interventional Radiology, Department of Radiology, University of Illinois Hospital & Health Sciences System, 1740 West Taylor Street, MC 931, Chicago, IL 60612
| | - Robert J Lewandowski
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Riad Salem
- Section of Vascular and Interventional Radiology, Department of Radiology, Northwestern Memorial Hospital, Chicago, Illinois
| | - Daniel B Brown
- Department of Radiology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - T Gregory Walker
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Ana Maria Echenique
- Department of Interventional Radiology, University of Miami School of Medicine, Coral Gables, Florida
| | - Mehran Midia
- Interventional Radiology, McMaster University, Hamilton, Ontario, Canada
| | - Jason W Mitchell
- Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Siddharth A Padia
- Division of Interventional Radiology, Department of Radiology, David Geffen School of Medicine at University of California, Los Angeles, California
| | - Suvranu Ganguli
- Division of Interventional Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; Center for Image Guided Cancer Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas J Ward
- Vascular and Interventional Radiology, Florida Hospital, Orlando, Florida
| | - Jeffrey L Weinstein
- Vascular and Interventional Radiology, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Boris Nikolic
- Department of Radiology, Stratton Medical Center, Albany, New York
| | - Sean R Dariushnia
- Interventional Radiology and Image Guided Medicine, Emory University School of Medicine, Atlanta, Georgia
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Hinrichs JB, Hasdemir DB, Nordlohne M, Schweitzer N, Wacker F, Vogel A, Kirstein MM, Marquardt S, Rodt T. Health-Related Quality of Life in Patients with Hepatocellular Carcinoma Treated with Initial Transarterial Chemoembolization. Cardiovasc Intervent Radiol 2017; 40:1559-1566. [PMID: 28488104 DOI: 10.1007/s00270-017-1681-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 04/28/2017] [Indexed: 02/06/2023]
Abstract
PURPOSE To investigate the impact of the first transarterial chemoembolization (TACE) for hepatocellular carcinoma (HCC) on health-related quality of life (HRQoL) and identify predictors for low HRQoL following TACE. MATERIALS AND METHODS HRQoL was prospectively evaluated in 79 patients with standardized questionnaires (QlQ-C30 and HCC18) pre- and 2 weeks post-TACE. Treatment response was evaluated using common tumour response criteria. Clinical parameters [e.g. Eastern Cooperative Oncology Group (ECOG) performance status, Model of End Stage Liver Disease (MELD) score], tumour load and pre-TACE HRQoL scores were tested for predicting HRQoL after TACE. RESULTS Patients showed a 12.1% decrease in global health score (GHS). Major decreases were observed for physical (-21.4%), role (-23.4%), and social (-21.5%) functioning and increases in symptom severity for fatigue (+30.1%), loss of appetite (+25.3%), pain (+19.4%) after TACE. ECOG performance status >1 was associated with increased nausea/vomiting (p = 0.002) and decreased GHS (p = 0.01). MELD score >10 was associated with increased fatigue (p = 0.021) and abdominal swelling (p < 0.001). Our study showed an increase in symptom severity in patients with no symptoms before TACE for pain (p = 0.005) and abdominal swelling (p < 0.001). CONCLUSION The first TACE for treatment of HCC does not result in a major loss of HRQoL in general. For TACE as a palliative therapy maintaining HRQoL is of critical importance and standardized HRQoL assessment can help to detect HRQoL problems.
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Affiliation(s)
- Jan B Hinrichs
- Institute for Diagnostic and Interventional Radiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Davut B Hasdemir
- Institute for Diagnostic and Interventional Radiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Maximilian Nordlohne
- Institute for Diagnostic and Interventional Radiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Nora Schweitzer
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Frank Wacker
- Institute for Diagnostic and Interventional Radiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Arndt Vogel
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Martha M Kirstein
- Department of Gastroenterology, Hepatology and Endocrinology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Steffen Marquardt
- Institute for Diagnostic and Interventional Radiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Thomas Rodt
- Institute for Diagnostic and Interventional Radiology, Medical School Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Chiuzan C, Shtaynberger J, Manji GA, Duong JK, Schwartz GK, Ivanova A, Lee SM. Dose-finding designs for trials of molecularly targeted agents and immunotherapies. J Biopharm Stat 2017; 27:477-494. [PMID: 28166468 DOI: 10.1080/10543406.2017.1289952] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recently, there has been a surge of early phase trials of molecularly targeted agents (MTAs) and immunotherapies. These new therapies have different toxicity profiles compared to cytotoxic therapies. MTAs can benefit from new trial designs that allow inclusion of low-grade toxicities, late-onset toxicities, addition of an efficacy endpoint, and flexibility in the specification of a target toxicity probability. To study the degree of adoption of these methods, we conducted a Web of Science search of articles published between 2008 and 2014 that describe phase 1 oncology trials. Trials were categorized based on the dose-finding design used and the type of drug studied. Out of 1,712 dose-finding trials that met our criteria, 1,591 (92.9%) utilized a rule-based design, and 92 (5.4%; range 2.3% in 2009 to 9.7% in 2014) utilized a model-based or novel design. Over half of the trials tested an MTA or immunotherapy. Among the MTA and immunotherapy trials, 5.8% used model-based methods, compared to 3.9% and 8.3% of the chemotherapy or radiotherapy trials, respectively. While the percentage of trials using novel dose-finding designs has tripled since 2007, the adoption of these designs continues to remain low.
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Affiliation(s)
- Cody Chiuzan
- a Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , New York , USA
| | - Jonathan Shtaynberger
- a Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , New York , USA
| | - Gulam A Manji
- b Division of Hematology and Oncology, Department of Medicine , Columbia University , New York , New York , USA
| | - Jimmy K Duong
- a Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , New York , USA
| | - Gary K Schwartz
- b Division of Hematology and Oncology, Department of Medicine , Columbia University , New York , New York , USA
| | - Anastasia Ivanova
- c Department of Biostatistics , UNC at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Shing M Lee
- a Department of Biostatistics, Mailman School of Public Health , Columbia University , New York , New York , USA
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Brown KT, Do R, Gönen M, Covey AM, Getrajdman GI, Sofocleous CT, Jarnagin WR, D'Angelica MI, Allen PJ, Erinjeri JP, Brody LA, O'Neill GP, Johnson K, Garcia AR, Beattie CM, Zhao B, Solomon SB, Schwartz LH, DeMatteo RP, Abou-Alfa GK. Reply to A. Braillon, M. Boulin et al, and J.-H. Zhong et al. J Clin Oncol 2017; 35:258-259. [PMID: 28056199 DOI: 10.1200/jco.2016.69.7961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Karen T Brown
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Richard Do
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Mithat Gönen
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Anne M Covey
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - George I Getrajdman
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Constantinos T Sofocleous
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - William R Jarnagin
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Michael I D'Angelica
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Peter J Allen
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Joseph P Erinjeri
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Lynn A Brody
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Gerald P O'Neill
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Kristian Johnson
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Alessandra R Garcia
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Christopher M Beattie
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Binsheng Zhao
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Stephen B Solomon
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Lawrence H Schwartz
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ronald P DeMatteo
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
| | - Ghassan K Abou-Alfa
- Karen T. Brown and Richard Do, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Mithat Gönen, Memorial Sloan Kettering Cancer Center, New York, NY; Anne M. Covey, George I. Getrajdman, and Constantinos T. Sofocleous, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; William R. Jarnagin, Michael I. D'Angelica, and Peter J. Allen, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; Joseph P. Erinjeri and Lynn A. Brody, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Gerald P. O'Neill, Kristian Johnson, Alessandra R. Garcia, and Christopher M. Beattie, Memorial Sloan Kettering Cancer Center, New York, NY; Binsheng Zhao, Columbia University College of Physicians and Surgeons, New York, NY; Stephen B. Solomon, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY; Lawrence H. Schwartz, Columbia University College of Physicians and Surgeons, New York, NY; Ronald P. DeMatteo, Memorial Sloan Kettering Cancer Center, Columbia University College of Physicians and Surgeons, and Weill Cornell Medical College, New York, NY; and Ghassan K. Abou-Alfa, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY
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Delicque J, Boulin M, Guiu B, Pelage JP, Escal L, Schembri V, Assenat E, Fohlen A. Interventional oncology for hepatocellular carcinoma. Clin Res Hepatol Gastroenterol 2016; 40:530-537. [PMID: 27055387 DOI: 10.1016/j.clinre.2016.01.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 01/17/2016] [Indexed: 02/04/2023]
Abstract
Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and is increasing in incidence. The overall prognosis of patients with liver cancer is poor. The Barcelona Clinic Liver Cancer (BCLC) classification in 5 stages is endorsed by European Association for the Study of the Liver (EASL) and American Association for the Study of Liver Disease (AASLD). This classification is recommended for treatment allocation. Because a small proportion of patients are suitable for curative surgical treatment, various locoregional therapies are widely used to manage patients with HCC. The image-guided therapies, also called interventional radiology or interventional oncology (IO) techniques consisted in percutaneous or endovascular approach. This article reviews the different IO treatments available in HCC patients and the strength of the data.
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Affiliation(s)
- Julien Delicque
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France
| | - Mathieu Boulin
- Dijon University Hospital, Department of Pharmacy, 21000 Dijon, France
| | - Boris Guiu
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France.
| | - Jean-Pierre Pelage
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France
| | - Laure Escal
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France
| | - Valentina Schembri
- St-Eloi University Hospital, Department of Radiology, 34000 Montpellier, France
| | - Eric Assenat
- St-Eloi University Hospital, Department of Oncology, 34000 Montpellier, France
| | - Audrey Fohlen
- University and Medical Center of Caen, 14033 Caen cedex, France.
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Boulin M, Guiu B. Chemoembolization or Bland Embolization for Hepatocellular Carcinoma: The Question Is Still Unanswered. J Clin Oncol 2016; 35:256-257. [PMID: 28056196 DOI: 10.1200/jco.2016.67.2915] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mathieu Boulin
- Mathieu Boulin, University Hospital, Dijon, France; and Boris Guiu, Saint-Eloi University Hospital, Montpellier, France
| | - Boris Guiu
- Mathieu Boulin, University Hospital, Dijon, France; and Boris Guiu, Saint-Eloi University Hospital, Montpellier, France
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Chehimi M, Boone M, Chivot C, Deramond H, Constans JM, Ly MC, Chauffert B. Intra-Arterial Delivery of Idarubicin in Two Patients with Glioblastoma. Case Rep Oncol 2016; 9:499-505. [PMID: 27721775 PMCID: PMC5043287 DOI: 10.1159/000448654] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 07/25/2016] [Indexed: 12/13/2022] Open
Abstract
There is no effective treatment for recurrent glioblastoma (GB) when temozolomide-based radiochemotherapy fails. In theory, intra-arterial (IA) delivery of cytotoxic agents could achieve higher drug concentrations in tumors compared to intravenous injection. Moreover, choosing a highly lipid-soluble drug could make the most of the first-pass effect. Here, we evaluated idarubicin (IDA), a lipophilic anthracycline, in an in vitro assay using four human GB cell lines and compared it with 11 other drugs previously used for the IA treatment of brain tumors. Despite impressive in vitro cytotoxicity, IA IDA did not produce a beneficial effect in 2 patients with recurrent GB.
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Affiliation(s)
- Mohamad Chehimi
- Department of Medical Oncology, University Hospital, Amiens, France
| | - Mathieu Boone
- Department of Medical Oncology, University Hospital, Amiens, France
| | - Cyril Chivot
- Department of Radiology, University Hospital, Amiens, France
| | - Hervé Deramond
- Department of Radiology, University Hospital, Amiens, France
| | | | - Mony Chenda Ly
- Department of Medical Oncology, University Hospital, Amiens, France
| | - Bruno Chauffert
- Department of Medical Oncology, University Hospital, Amiens, France
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Ludwig JM, Zhang D, Xing M, Kim HS. Meta-analysis: adjusted indirect comparison of drug-eluting bead transarterial chemoembolization versus 90Y-radioembolization for hepatocellular carcinoma. Eur Radiol 2016; 27:2031-2041. [PMID: 27562480 DOI: 10.1007/s00330-016-4548-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Revised: 07/29/2016] [Accepted: 08/08/2016] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate comparative effectiveness of drug-eluting bead transarterial chemoembolization (DEB-TACE) versus Yttrium-90 (90Y)-radioembolization for hepatocellular carcinoma (HCC). METHODS Studies comparing conventional (c)TACE versus 90Y-radioembolization or DEB-TACE for HCC treatment were identified using PubMed/Medline, Embase, and Cochrane databases. The adjusted indirect meta-analytic method for effectiveness comparison of DEB-TACE versus 90Y-radioembolization was used. Wilcoxon rank-sum test was used to compare baseline characteristics. A priori defined sensitivity analysis of stratified study subgroups was performed for primary outcome analyses. Publication bias was tested by Egger's and Begg's tests. RESULTS Fourteen studies comparing DEB-TACE or 90Y-radioembolization with cTACE were included. Analysis revealed a 1-year overall survival benefit for DEB-TACE over 90Y-radioembolization (79 % vs. 54.8 %; OR: 0.57; 95 %CI: 0.355-0.915; p = 0.02; I-squared: 0 %; p > 0.5), but not for the 2-year (61 % vs. 34 %; OR: 0.65; 95%CI: 0.294-1.437; p = 0.29) and 3-year survival (56.4 % vs. 20.9 %; OR: 0.713; 95 % CI: 0.21-2.548; p = 0.62). There was significant heterogeneity in the 2- and 3-year survival analyses. The pooled median overall survival was longer for DEB-TACE (22.6 vs. 14.7 months). There was no significant difference in tumour response rate. CONCLUSION DEB-TACE and 90Y-radioembolization are efficacious treatments for patients suffering from HCC; DEB-TACE demonstrated survival benefit at 1-year compared to 90Y-radioembolization but direct comparison is warranted for further evaluation. KEY POINTS • This meta-analysis shows greater 1-year survival benefit for DEB-TACE over 90 Y-radioembolization. • DEB-TACE has a favourable 2- & 3-year survival benefit trend over 90 Y-radioembolization. • No significant difference for tumour response was detected. • Direct comparison of these methods for a more robust evaluation is warranted.
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Affiliation(s)
- Johannes M Ludwig
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA
| | - Di Zhang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, Pittsburgh, PA, 15261, USA
| | - Minzhi Xing
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA
| | - Hyun S Kim
- Division of Interventional Radiology, Department of Radiology and Biomedical Imaging, Yale School of Medicine, 330 Cedar Street, TE 2-224, New Haven, CT, 06510, USA. .,Yale Cancer Center, Yale School of Medicine, 333 Cedar Street, New Haven, CT, 06510, USA.
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Anota A, Boulin M, Dabakuyo-Yonli S, Hillon P, Cercueil JP, Minello A, Jouve JL, Paoletti X, Bedenne L, Guiu B, Bonnetain F. An explorative study to assess the association between health-related quality of life and the recommended phase II dose in a phase I trial: idarubicin-loaded beads for chemoembolisation of hepatocellular carcinoma. BMJ Open 2016; 6:e010696. [PMID: 27342239 PMCID: PMC4932346 DOI: 10.1136/bmjopen-2015-010696] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES The objective of this study was to explore the association between health-related quality of life (HRQoL) and the recommended phase 2 dose in a phase I clinical trial according to the Time to HRQoL deterioration approach (TTD). SETTING This is a phase I dose-escalation trial of transarterial chemoembolisation (TACE) with idarubicin-loaded beads performed in cirrhotic patients with hepatocellular carcinoma. Patients had to complete the EORTC QLQ-C30 HRQoL questionnaire at baseline and at days 15, 30 and 60 after TACE. PARTICIPANTS Patients aged ≥18 years with HCC unsuitable for curative treatments were evaluated for the study (N=21). PRIMARY AND SECONDARY OUTCOME MEASUREMENTS The primary objective was to determine the maximum tolerated dose (MTD) of idarubicin loaded after a single TACE session. MTD was defined as the dose level closest to that causing dose-limiting toxicity in 20% of patients. HRQoL was the secondary end point. RESULTS Between March 2010 and March 2011, 9, 6 and 6 patients were included at idarubicin dose levels of 5, 10 and 15 mg, respectively. Calculated MTD of idarubicin was 10 mg. At the 10 mg idarubicin dose, patients presented a longer TTD than at 5 mg, for global health status (HR=0.91 (95% CI 0.18 to 4.72)), physical functioning (HR=0.38 (0.04 to 3.22)), fatigue (HR=0.67 (0.18 to 2.56)) and pain (HR=0.47 (0.05 to 4.24)). CONCLUSIONS These HRQoL results were consistent with the estimated MTD, with a median TTD for global health status of 41 days (21 to NA) at 5 mg, 23 days (20 to NA) at 10 mg and 25 days (17 to NA) at 15 mg. These results show the importance of studying HRQoL in phase I trials. TRIAL REGISTRATION NUMBER NCT01040559; Post-results.
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Affiliation(s)
- Amélie Anota
- Quality of Life in Oncology National Platform, Besançon, France
- Methodological and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
| | - Mathieu Boulin
- INSERM U866, University of Burgundy, Dijon, France
- Department of Pharmacy, University Hospital, Dijon, France
| | - Sandrine Dabakuyo-Yonli
- Quality of Life in Oncology National Platform, Besançon, France
- Biostatistics and Quality of Life Unit (EA 4184), Centre Georges Francois Leclerc, Dijon, France
| | - Patrick Hillon
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Jean-Pierre Cercueil
- INSERM U866, University of Burgundy, Dijon, France
- Department of Interventional Radiology, University Hospital, Dijon, France
| | - Anne Minello
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Jean-Louis Jouve
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Xavier Paoletti
- Department of Biostatistics and Epidemiology, Institut Gustave Roussy, Paris, France
| | - Laurent Bedenne
- INSERM U866, University of Burgundy, Dijon, France
- Department of Hepatogastroenterology, University Hospital, Dijon, France
| | - Boris Guiu
- Department of Radiology, St-Eloi University Hospital, Montpellier, France
| | - Franck Bonnetain
- Quality of Life in Oncology National Platform, Besançon, France
- Methodological and Quality of Life in Oncology Unit (INSERM UMR 1098), University Hospital of Besançon, Besançon, France
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Favelier S, Pottecher P, Estivalet L, Loffroy R. Reply: Which is the Best Chemotherapeutic Agent for Transarterial Chemoembolization of Hepatocellular Carcinoma? Cardiovasc Intervent Radiol 2016; 39:955-6. [DOI: 10.1007/s00270-016-1320-7] [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: 02/17/2016] [Accepted: 02/24/2016] [Indexed: 11/30/2022]
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Which is the Best Chemotherapeutic Agent for Transarterial Chemoembolization of Hepatocellular Carcinoma? Cardiovasc Intervent Radiol 2016; 39:953-4. [DOI: 10.1007/s00270-016-1319-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
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Mauer K, O'Kelley R, Podda N, Flanagan S, Gadani S. New treatment modalities for hepatocellular cancer. Curr Gastroenterol Rep 2015; 17:442. [PMID: 25869473 DOI: 10.1007/s11894-015-0442-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Heptatocellular (HCC) is a rapidly progressive fatal malignancy often presenting at an advanced stage at the time of initial diagnosis. Loco-regional therapies for early-stage HCC including surgical options (surgical resection and liver transplant) and percutaneous ablations could be potentially curative. Recent technological advances in percutaneous image-guided ablations have provided clinicians with a range of options which have proven to be equal to or better than surgical resection. For intermediate- and advanced-stage HCC, palliative therapies are available which significantly increase overall and progression-free survival. These palliative therapies include intra-arterial chemo- or radioembolization as monotherapy or in combination with percutaneous ablation or antiangiogenic drugs. Availability of a multitude of treatment options for various stages of HCC as well as conflicting data comparing their safety and efficacy presented in the several randomized controlled trials poses a significant challenge to hepatologists, surgeons, and interventional radiologists in selecting optimal therapy for their patients. The aim of this article is to review and discuss currently available therapies at each stage of HCC along with presenting clinical data published in most recent and relevant randomized controlled trials.
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Affiliation(s)
- Kurt Mauer
- Division of Interventional Radiology, Department of Radiology, Saint Louis University School of Medicine, 3635 Vista Ave at Grand Blvd, St Louis, MO, 63110, USA,
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Active Treatments Prolong the Survival in Patients With Hepatocellular Carcinoma and Performance Status 3 or 4: A Propensity Score Analysis. J Clin Gastroenterol 2015; 49:878-84. [PMID: 25710525 DOI: 10.1097/mcg.0000000000000300] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
GOALS AND BACKGROUNDS Best supportive care is suggested as the standard treatment for hepatocellular carcinoma (HCC) patients with performance status (PS) 3-4 by the Barcelona Clinic Liver Cancer (BCLC) system. To investigate the rationale of treatment allocation. STUDY A total of 2660 HCC patients were reviewed. One-to-one matched pairs between PS 3 and 4 patients receiving supportive care and anti-HCC treatments were generated by using the propensity score with matching model. The survival analysis was performed with the Kaplan-Meier method and log-rank test. The hazard ratio was calculated with the Cox proportional hazards model. RESULTS Among 328 patients with PS 3-4, 38% of patients received active anti-HCC treatments against the BCLC system. Compared with patients undergoing supportive care, patients receiving anti-HCC treatments more often had milder cirrhosis, smaller tumor burden, and lower serum α-fetoprotein levels (all P<0.05). Patients undergoing supportive care had significantly decreased survival (P<0.0001). With propensity scores, 101 pairs of similar HCC patients with PS 3-4 were selected from different treatment groups. They were comparable in age, sex, etiologies of liver disease, severity of cirrhosis, tumor burden, and prevalence of diabetes mellitus (all P>0.05) at baseline. In the matching model, patients with PS 3-4 undergoing supportive care had significantly shortened survival with an adjusted hazard ratio of 4.711 (confidence interval: 3.041-7.297, P<0.0001). CONCLUSIONS Over one-third of patients with PS 3-4 receive active anti-HCC treatments against the BCLC allocation algorithm in this study. Active anticancer therapies rather than best supportive care should be performed if there is no apparent contraindication.
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Boulin M, Schmitt A, Delhom E, Cercueil JP, Wendremaire M, Imbs DC, Fohlen A, Panaro F, Herrero A, Denys A, Guiu B. Improved stability of lipiodol-drug emulsion for transarterial chemoembolisation of hepatocellular carcinoma results in improved pharmacokinetic profile: Proof of concept using idarubicin. Eur Radiol 2015; 26:601-9. [PMID: 26060065 DOI: 10.1007/s00330-015-3855-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 05/06/2015] [Accepted: 05/20/2015] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To investigate the relationship between the improved stability of an anticancer drug-lipiodol emulsion and pharmacokinetic (PK) profile for transarterial chemoembolisation (TACE) of hepatocellular carcinoma (HCC). METHODS The stability of four doxorubicin- or idarubicin-lipiodol emulsions was evaluated over 7 days. PK and clinical data were recorded after TACE with the most stable emulsion in eight unresectable HCC patients, after institutional review board approval. RESULTS The most stable emulsion was the one that combined idarubicin and lipiodol (1:2 v:v). At 7 days, the percentages of aqueous, persisting emulsion and oily phases were 50-0-50, 33-0-67, 31-39-30, and 10-90-0 for the doxorubicin-lipiodol (1:1 v:v), doxorubicin-lipiodol (1:2 v:v), idarubicin-lipiodol (1:1 v:v), and the idarubicin-lipiodol (1:2 v:v) emulsion, respectively. After TACE, mean idarubicin Cmax and AUC0-24h were 12.5 ± 9.4 ng/mL and 52 ± 16 ng/mL*h. Within 24 h after injection, 40% of the idarubicin was in the liver, either in vessels, tumours, or hepatocytes. During the 2 months after TACE, no clinical grade >3 adverse events occurred. One complete response, five partial responses, one stabilisation, and one progression were observed at 2 months. CONCLUSION This study showed a promising and favourable PK and safety profile for the idarubicin-lipiodol (1:2 v:v) emulsion for TACE. KEY POINTS • Transarterial chemoembolisation (TACE) regimens that improve survival in hepatocellular carcinoma are needed. • Improved emulsion stability for TACE resulted in a favourable pharmacokinetic profile. • Preliminary safety and efficacy data for the idarubicin-lipiodol emulsion for TACE were encouraging.
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Affiliation(s)
- Mathieu Boulin
- EA 4184, University of Burgundy and Department of Pharmacy, Dijon University Hospital, 14 rue Gaffarel, 21000, Dijon, France.
| | - Antonin Schmitt
- EA 4184, University of Burgundy and Department of Pharmacy, Georges-François Leclerc Anticancer Center, Dijon, France
| | - Elisabeth Delhom
- Department of Radiology, Saint-Eloi University Hospital, Montpellier, France
| | | | - Maëva Wendremaire
- Department of Pharmacoloy-Toxicology, University Hospital, Dijon, France
| | | | - Audrey Fohlen
- Department of Radiology, University Hospital, Caen, France
| | - Fabrizio Panaro
- Department of General and Liver Transplant Surgery, Saint-Eloi University Hospital, Montpellier, France
| | - Astrid Herrero
- Department of General and Liver Transplant Surgery, Saint-Eloi University Hospital, Montpellier, France
| | - Alban Denys
- Department of Radiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Boris Guiu
- Department of Radiology, Saint-Eloi University Hospital, Montpellier, France
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Transarterial chemoembolization for hepatocellular carcinoma: An old method, now flavor of the day. Diagn Interv Imaging 2015; 96:607-15. [DOI: 10.1016/j.diii.2015.04.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 04/15/2015] [Indexed: 01/08/2023]
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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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50
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Lee GH, Lim SG. Editorial: IDASPHERE phase I trial for chemoembolisation of HCC. Aliment Pharmacol Ther 2014; 40:209-10. [PMID: 24946059 DOI: 10.1111/apt.12811] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 12/14/2022]
Affiliation(s)
- G H Lee
- Department of Gastroenterology and Hepatology, National University Hospital, Singapore
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