Chemoembolization with drug-eluting microspheres (DEM-TACE) for hepatocellular carcinoma: single-center review of safety and efficacy

Abstract

PurposeThis study examines the safety and efficacy of transarterial chemoembolization using doxorubicin-loaded 30–60 µm QuadraSphere microspheres (DEM-TACE) for the treatment of hepatocellular carcinoma.Materials and methodsOver 10 weeks, patients with hepatocellular carcinoma. (Child–Pugh A/B: 65%/35%) were embolized with 30–60 µm QuadraSphere microspheres. Excluded patients had previous locoregional therapy, macrovascular invasion, extrahepatic disease, Child–Pugh score >B7, ECOG performance status >0, and total bilirubin >3 mg/dL. Technical success, minor and major complications, 30-day hospital readmission rate, and 30-day mortality were assessed. α-Fetoprotein levels before and after treatment were compared. Local response was evaluated by radiologic tumor response per modified Response Evaluation Criteria in Solid Tumors 1 month after treatment.ResultsThirty tumors (mean size, 2.3 cm; range, 1.0–4.9 cm) were treated in 20 patients (16 male and 4 female; mean age, 64.7 years). There were no major complications. Thirty-day mortality was 0%. Minor complications included postembolization syndrome in 16.7% of cases and transient rise in liver enzymes requiring no therapy. Mean α-fetoprotein levels trended down following treatment (71.8±201.9 ng/mL vs 53.4±116.7 ng/mL), but were not statistically significant. Complete response was achieved in 30% of patients, partial response in 35%, stable disease in 30%, and progression of disease in 5%. Overall objective response was 65%. Mean follow-up was 10.4 months (range, 2–16.4 months).ConclusionDEM-TACE with doxorubicin-loaded 30–60 µm QuadraSpheres is feasible, well tolerated, and associated with promising tumor response in early and intermediate stage disease.

Retrospective Study of the Efficacy and Safety of Chemoembolization with Drug-Eluting Microspheres Combined with Intra-Arterial Infusion of Bevacizumab for Unresectable Hepatocellular Carcinoma

“…So far, Hepasphere with a size of 30-60 μm has been marketed, and several studies have examined the efficacy and safety. 56,57 The Child-Pugh score is a well-known prognostic factor for HCC, 58,59 and we found that OS was significantly shorter in patients with a Child-Pugh score of ≥8 than in patients with a score of 5-7. This suggests that patients with a Child-Pugh score of ≤7 may experience a greater benefit of this treatment strategy.…”

Tumor Growth Suppression With Novel Intra-arterial Chemotherapy Using Epirubicin-entrapped Water-in-oil-in-water EmulsionIn Vivo

“…If IPSO microdroplets are too small for the inner diameter of the tumor vasculature, they may pass through the tumor tissues and normal tissues; if the microdroplets are too large, they are trapped proximal to the tumor vasculature (15,16). Drug-eluting beads (DEBs) have been developed for transcatheter treatment of HCC because DEBs can deliver higher dose of the anticancer agents and prolong the contact time with the tumor (17)(18)(19)(20)(21). Treatment with DEBs reduces the amount of anticancer agent reaching the systemic circulation (18).…”

The Use of Microspheres for Cancer Embolization Therapy: Recent Advancements and Prospective

“…TACE is the standard curative treatment and is a well-established procedure for patients with unresectable HCC, according to the Barcelona Clinic Liver Cancer (BCLC) algorithm. ,, In addition, TACE has also been used for metastatic neuroendocrine liver metastases as a palliative treatment . This procedure offers a high dose of chemotherapeutic agents to the tumor tissue while preserving the surrounding normal hepatic parenchyma .…”

“…In addition, the smaller caliber microspheres (<100 μm) provided better outcomes without influencing patient safety . These drug-eluting microspheres offered advantages in highly spherical and smaller sizes compared to microbeads, resulting in higher treatment efficacy and decreased fatigue . Thus, drug-eluting microspheres could increase the distal penetration and embolization of target tissue, decreasing postembolization syndromes .…”

“…It is essential to understand the characteristics of embolic agents used in arterial embolization therapy (TAE, TACE, and TARE) to avoid damage to the hepatic microcirculation . As arterial embolotherapy develops, so have biomaterials developed as embolic agents in many different forms, including particulates (micro and nano) or microparticles (nonspherical and spherical (microspheres)) with additional functionalities (drug carriers, active or therapeutic agents). − The drawbacks associated with the use of micro- or nanoparticulates have included catheter clogging, incomplete occlusion of blood vessels, and unpredictable performance . Due to their spherical morphology, microspheres have been developed to overcome the disadvantages of irregularly shaped particles as they result in smooth deliverability and are more predictable and could potentially be explored for being loaded with radionuclides or therapeutic agents. ,, In TACE, microspheres are employed as embolic agents and chemotherapeutic drug delivery vehicles entrapped in small blood vessels (peritumoral vessels), interrupting the hepatic arterial flow to tumors where the drug can be released in a controlled manner directly to the target site .…”