Bronchial or Pulmonary Artery Chemoembolization for Unresectable and Unablatable Lung Metastases: A Phase I Clinical Trial

Abstract

M ost patients with lung metastases have unresectable disease (1). Patients with unresectable and unablatable lung metastases have poor survival and limited treatment options when the metastases stop responding to systemic chemotherapy (2).Transarterial chemoembolization (TACE) of the pulmonary or bronchial arteries is an emerging treatment option for large and multifocal lung tumors (Table E1 [online]). Like the liver, the lung has a dual blood supply. However, unlike liver tumors, which are mostly supplied by the hepatic artery, lung tumors can be supplied by either the bronchial artery or pulmonary artery (3). Response rates are 17% after pulmonary artery chemoembolization (4,5) and 39% after bronchial artery chemoembolization (6-8), bland embolization (9), or chemoinfusion (10-12). The highest reported response rates have been seen with primary lung cancer, treated via the bronchial artery (Table E1 [online]).A major limitation of existing studies of lung chemoembolization is the low response rate. We hypothesize that the low response rate is because of the dual blood supply of lung tumors. Lung tumors primarily supplied by the pulmonary artery will presumably have a low response rate to bronchial artery chemoembolization and Background: Lung chemoembolization is an emerging treatment option for lung tumors, but the optimal embolic, drug, and technique are unknown.Purpose: To determine the technical success rate and safety of bronchial or pulmonary artery chemoembolization of lung metastases using ethiodized oil, mitomycin, and microspheres. Materials and Methods:Patients with unresectable and unablatable lung, endobronchial, or mediastinal metastases, who failed systemic chemotherapy, were enrolled in this prospective, single-center, single-arm, phase I clinical trial (December 2019-September 2020). Pulmonary and bronchial angiography was performed to determine the blood supply to the lung metastases. Based on the angiographic findings, bronchial or pulmonary artery chemoembolization was performed using an ethiodized oil and mitomycin emulsion, followed by microspheres. The primary objectives were technical success rate and safety, according to the National Cancer Institute Common Terminology Criteria for Adverse Events. CIs of proportions were estimated with the equal-tailed Jeffreys prior interval, and correlations were evaluated with the Spearman test. Results:Ten participants (median age, 60 years; interquartile range, 52-70 years; six women) were evaluated. Nine of the 10 participants (90%) had lung metastases supplied by the bronchial artery, and one of the 10 participants (10%) had lung metastases supplied by the pulmonary artery. The technical success rate of intratumoral drug delivery was 10 of 10 (100%) (95% CI: 78, 100). There were no severe adverse events (95% CI: 0, 22). The response rate of treated tumors was one of 10 (10%) according to the Response Evaluation Criteria in Solid Tumors and four of 10 (40%) according to the PET Response Criteria in Solid Tumors. Ethiodized oil retention at 4-6 w...

Analysis on the Efficacy of Bronchial Artery Chemoembolization Combined with 125I Seed Implantation in the Therapy of Advanced Non-Small-Cell Lung Cancer Based on the Medical Database

“…It has been reported that local therapeutic efficacy of BACE is 2-6 times that of intravenous chemotherapy [11]. BACE can maximize the therapeutic effect with a relatively small amount of chemotherapeutic drugs [12]. This work then investigated the use and the effi-cacy of BACE combined with 125I seed implantation in advanced NSCLC therapy based on the medical database.…”

New Hope for Treating Intervertebral Disc Degeneration: Microsphere-Based Delivery System

“…In the last decade, drug delivery technology for microspheres has developed rapidly and clinical trials related to it have been widely conducted worldwide. Microsphere delivery systems have shown exciting potential for application in humans, mainly focused on the control and treatment of several diseases, including cancer ( Vilgrain et al, 2017 ; Chow et al, 2018 ; Ricke et al, 2019 ; Edeline et al, 2020 ; Boas et al, 2021 ; Garin et al, 2021 ), diabetes ( Bode et al, 2015 ; Rosenstock et al, 2015 ; Seaquist et al, 2020 ), and osteoarthritis ( Conaghan et al, 2018 ; Kraus et al, 2018 ). We can fully expect breakthrough efficacy and advances in these diseases from microsphere formulations.…”

Advancements in Interventional Oncology of the Chest: Transarterial Chemoembolization and Related Therapies

“…These studies should be interpreted with caution, as most are small and retrospective, and mild worsening of pulmonary function was reported in a small, prospective trial of TACE. 4 Regarding bleeding complications, TAE is a standard treatment option for most tumor-related indications. Preoperative TAE of tumors to control intraoperative blood loss has been described in case reports for a wide variety of benign and malignant chest neoplasms.…”

“…These studies should be interpreted with caution, as most are small and retrospective, and mild worsening of pulmonary function was reported in a small, prospective trial of TACE. 4…”

“…Quality studies of TACE for metastatic disease are lacking, but Boas et al published a prospective, single-arm, phase I clinical trial of 10 patients with unresectable colorectal (nine) and melanoma (one) lung metastases who underwent TACE. 4 After mapping both distributions for each patient, chemoembolization was performed via the bronchial arteries in nine patients and the pulmonary arteries for one (melanoma) patient. The authors injected an emulsion of ethiodized oil and mitomycin followed by microspheres and achieved the primary objectives of 100% technical success.…”