Long-term Histopathologic Follow-up of a Spherical Embolic Agent; Observation of the Transvascular Migration of HepaSphereTM

Evaluation of the effectiveness of transarterial chemoembolization with drug-saturable microspheres with irinotecan for the treatment of patients with neuroendocrine tumors with liver metastases

Since 2021, transarterial chemoembolization of the hepatic arteries (TACHE) has been included in the recommendations of professional communities for the treatment of liver metastases from neuroendocrine tumors. However, the heterogeneity of this group of patients and the methods of chemoembolization with a limited range of cytostatics used in the treatment makes it difficult to analyze the data and introduce the method into combination therapy regimens.The aim of the study was to study the effectiveness of transarterial chemoembolization with drug-saturable microspheres with irinotecan for the treatment of patients with neuroendocrine tumors with liver metastases.Materials and methods. A retrospective, observational, uncontrolled study of 34 patients with liver metastases from neuroendocrine cancer who underwent 52 TACs with irinotecan. Group 1 consisted of 15 patients who already had liver metastases at the time of detection of the primary focus, group 2 - 19 people in whom liver metastases appeared after a lapse of time since the detection of the primary focus. To plan and evaluate the effectiveness of chemoembolization, computed tomography and magnetic resonance imaging were used every 10-15 weeks during systemic treatment. All patients received systemic NEO therapy before and after embolization.Results. An increase in time without progression from 101 [57; 120] and 145 [89; 263] after chemotherapy up to 300 [134; 344] and 304 [240;342] after TACE in groups 1 and 2, respectively, with no difference between groups (p0.05). We did not find a linear relationship between the doubling time of the tumor and the difference in the volume of the tumor lesion (R2 0.1085 and 0.0265 in groups 1 and 2). When comparing intragroup scores, there was a statistically significant difference (p0.05) in tumor volume reduction and progression-free time between patients who underwent TACE immediately and those who underwent TACE after chemotherapy. Radiation and angiographic semiotics of liver metastases varied within the same organ and depended on the size of metastases.Conclusions. TACE with irinotecan drug-saturable microspheres is an effective method for the treatment of liver metastases of neuroendocrine cancer, allowing to increase the time without progression.

Drug-loaded lipid microspheres combined with transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma in elderly patients: Efficacy and impact on survival benefit and PD-L1 and PD-1 levels

BACKGROUND

Traditional hepatic artery embolization chemotherapy for treatment of liver cancer is often associated with an unsatisfactory prognosis since the tumor cells remain. Drug-loaded lipid microspheres can assist in further killing residual cancer cells and play an important role in the regulation of PD-1 and PD-L1 in the immune response.

AIM

To evaluate the efficacy of drug-loaded lipid microspheres combined with transcatheter arterial chemoembolization in the treatment of hepatocellular carcinoma in elderly patients, and to analyze its effect on the survival benefit and programmed death-1 ligand (PD-L1) and programmed death 1 (PD-1) levels.

METHODS

From October 2015 to October 2018, 112 elderly patients with hepatocellular carcinoma treated at our hospital were selected. According to the principle of controlled design, the patients were randomly divided into either an observation group (n = 56) or a control group (n = 56). The control group received traditional transcatheter arterial chemoembolization, and the observation group received HepaSphere drug-loaded lipid microspheres combined with transcatheter arterial chemoembolization. The efficacy and serum tumor markers [alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), carbohydrate antigen 199 (CA199), thymidine kinase 1 (TK-1)], tumor angiogenesis-related indicators [vascular endothelial cell growth factor (VEGF), basic fibroblast growth factor (bFGF), and microvessel density (MVD)], and tissue PD-L1 and PD-1 levels were compared between the two groups. The adverse reactions during the treatment period and the survival status of the two groups at 6 mo, 1 year, and 2 years after treatment were also recorded.

RESULTS

The total effective rate in the observation group was 83.93%, which was higher than that (67.86%) of the control group (P < 0.05). Compared with the values before treatment, serum AFP, CEA, CA199, and TK-1 levels in the two groups were significantly reduced after treatment; these tumor markers in the observation group were significantly lower than those of the control group after treatment (P < 0.05). Compared with the values before treatment, the levels of serum VEGF, bFGF, and MVD in the two groups were significantly reduced after treatment; these tumor angiogenesis-related indicators in the observation group were significantly lower than those of the control group (P < 0.05). Compared with the values before treatment, the levels of PD-L1 and PD-1 in the two groups were significantly reduced after treatment; they were also significantly lower in the observation group than in the control group (P < 0.05). During treatment, there was no significant difference in the incidence of nausea, vomiting, abdominal pain, fever, or fatigue between the two groups (P > 0.05). The 1- and 2-year survival rates of the observation group were significantly higher than those of the control group (P < 0.05).

CONCLUSION

Drug-loaded lipid microspheres combined with transcatheter arterial chemoembolization have a significant effect in the treatment of hepatocellular carcinoma in elderly patients, and this combination therapy can effectively inhibit the expression of PD-L1 and PD-1 in cancer tissues and help improve the survival of patients.

Chinese expert consensus on technical recommendations for the standard operation of drug-eluting beads for transvascular embolization

Liver cancer is among the 10 most common tumors globally. In China, liver cancer ranks 4^th for prevalence and 3^rd for mortality among all malignant tumors. With respect to the treatment of primary liver cancer, there are a number of therapies currently available, including surgical resection, liver transplantation, ablation, transarterial chemoembolization (TACE), systemic chemotherapy, radiation therapy, targeted drug therapy and immunotherapy. Clinical practice and research have shown that, compared with conventional TACE (cTACE), drug-eluting bead TACE (DEB-TACE) can achieve a higher response rate and longer survival time in patients with primary liver cancer. Compared with that of cTACE, DEB-TACE has more favorable basic conditions for achieving uniformity, which could facilitate the standardization of operation techniques. China is the country with the highest incidence of primary liver cancer, accounting for more than 50% of the global patients, and its etiology and epidemiology in Chinese patients differ from those in Europeans and Americans. Therefore, experts in China have drafted these technical recommendations for the standard operation of drug-eluting beads for the treatment of liver cancer on the basis of accumulated abundant clinical experience and evidence-based medical data.