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Drug-Eluting Beads for Treating Liver Cancer: Current Experience

June 22, 2009
Written by: , Filed in: Nuclear Medicine
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Drug-eluting beads (DEBs) that can be loaded with chemotherapeutic agents have been developed and are currently being used for the treatment of liver cancer during trans-arterial embolization.

This provides prolonged exposure of the tumor to the chemotherapeutic agent. Large doses of chemotherapy can be used while limiting the plasma dose, and thus the systemic effect.

A recent study, published in the journal CardioVascular and Interventional Radiology, has shown that drug eluting beads with doxorubicin is an efficient, controlled sustained drug delivery system that causes low systemic toxicity. Early data show an improved therapeutic efficiency with lower complication rates and morbidity.

The Study
These researchers present a review of laboratory studies and preliminary clinical experience with these DEBs.

Methods

Patients are candidates for this therapy if they have unresectable hepatocellular carcinoma (HCC) or recurrence and are not candidates for transplantation or ablation.

In general, the maximum dose used was 75 mg/m2, which was lowered to 50 mg/m2 in cases in which there was a bilirubin of 1.5 mg/dL. Tumor response was evaluated by MRI or CT.

CME Courses Available:

 

PET/CT and SPECT/CT To Plan and Monitor the Treatment of Cancer The precise tailoring of treatment for patients with cancer is an unmet challenge. The goal is to only administer treatments that have a high probability of being effective. Imaging with PET/CT and SPECT/CT provides methods that will help achieve this goal. The program covers the current clinical challenges, the new emerging answers from imaging, and how these methods can be applied to patient care. Read more: Nuclear Medicine: PET/CT and SPECT/CT

 

-- Diagnostic Imaging Review: For Residents, Fellows and Radiologists UCSF’s Department of Radiology and Biomedical Imaging recently conducted its annual radiology review course. It will soon be available in two video formats to meet your needs— DVD and MP4. Order now to get your special pre-publication discount. Read more or order: Diagnostic Imaging Review

Results
In animal laboratory studies, after the injection of DEBs, the concentration of doxorubicin in the tumor peaked in 3 days, remained high for 7 days, then declined after 14 days.

Phase 2 trials are being conducted in Hong Kong and Barcelona (PRECISION trials).

A 3-month analysis shows an objective response rate of 61.5% (EASL criteria) and 53.8% (RECIST criteria), with a survival rate of 93%.

In the authors’ institution, at 6 months, complete response was obtained in 27% of patients and a partial response in 13%.

Progressive disease was found in 40% of patients and stable disease in 3%.

The 30-day mortality rate was 1%, and major adverse events occurred in 2% of patients.

The overall survival rate was 93% at 6 months.

Another study with embolization using doxorubicin-impregnated DC beads was performed by treating patients twice, 2 months apart. There was complete tumor ischemia in 58% of cases, a partial response in 35%, and <50% response in only 7% of cases.

Conclusions/Reviewer’s Comments
The DEB system (such as DC Bead Microspheres) loaded with doxorubicin is an efficient, controlled, sustained drug delivery system that causes low systemic toxicity during the treatment of HCC.

Early and preliminary data show an improved therapeutic efficiency with lower complication rates and morbidity.

The elution of the doxorubicin from the smaller beads (100 to 300 microns) was much more effective in producing tumor kill.

Research also determined that the optimal dose for elution is 25 mg of doxorubicin per mL embolization particles.

The DC Beads have the highest ability to load and release doxorubicin compared to Contour SE, Embosphere, or Bead Block.

DEBs have also been used to treat hepatic neuroendocrine and colorectal hepatic metastases with some success.

Author: Sharon Gonzales, MD
Reference:

Kettenbach J, Stadler A, et al. Drug-Loaded Microspheres for the Treatment of Liver Cancer: Review of Current Results. Cardiovasc Intervent Radiol; 2008; 31 (May): 468-476

CME Courses Available:

 

PET/CT and SPECT/CT To Plan and Monitor the Treatment of Cancer The precise tailoring of treatment for patients with cancer is an unmet challenge. The goal is to only administer treatments that have a high probability of being effective. Imaging with PET/CT and SPECT/CT provides methods that will help achieve this goal. The program covers the current clinical challenges, the new emerging answers from imaging, and how these methods can be applied to patient care. Read more: Nuclear Medicine: PET/CT and SPECT/CT

 

-- Diagnostic Imaging Review: For Residents, Fellows and Radiologists UCSF’s Department of Radiology and Biomedical Imaging recently conducted its annual radiology review course. It will soon be available in two video formats to meet your needs— DVD and MP4. Order now to get your special pre-publication discount. Read more or order: Diagnostic Imaging Review
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