Current role of transarterial chemoembolization and radioembolization in the treatment of metastatic colorectal cancer

Abstract

In this article, we review two liver-directed therapies that are currently used for the palliative treatment of primary and secondary hepatic malignancies, transcatheter arterial chemoembolization (TACE), including a new type of TACE with drug-eluting beads, and radioembolization. Important developments and administration techniques for all therapies are discussed, as well as their integration into the current routine clinical care for management of metastatic colorectal cancer. According to published data from clinical trials, as presented in this review, both radioembolization and TACE/TACE with drug-eluting beads have been proven to be safe and effective in selected patients with chemorefractory liver metastases from colorectal cancer. For patients with unresectable liver-only or liver-dominant disease who have failed standard chemotherapy options or for whom chemotherapy is contraindicated, new modalities, such as those discussed, are particularly valid and promising if clinical guidelines for patient selection and treatment administration are followed.

Efficacy and Safety of Trans-Arterial Yttrium-90 Radioembolization in Patients with Unresectable Liver-Dominant Metastatic or Primary Hepatic Soft Tissue Sarcomas

“…Transcatheter liver-directed therapies (LDTs) have been proven to increase survival in patients with hepatocellular carcinoma, cholangiocarcinoma, as well as colorectal cancer (CRC) and neuroendocrine tumors with liver-dominant metastases [ 28 , 29 , 30 , 31 ]. However, there are very few studies describing the efficacy and safety of LDTs in patients with primary or metastatic hepatic sarcomas.…”

Advances in understanding of colorectal liver metastasis and implications for the clinic

“…SIR-Spheres are resin-based, while TheraSpheres are glass-based. Compared with other transarterial therapies, considerably more prospective data are available for this treatment modality [114][115][116][117][118]. In a Phase II trial, Cosimelli et al examined the effects of TARE on CRLM.…”

“…Using RECIST criteria, 1 (2%) patient had a complete response, 11 (22%) had a partial response, 12 (24%) had stable disease, 22 (44%) had progressive disease and 4 (8%) were nonevaluable. Other studies have demonstrated the promising role of TARE, particularly in the patient population refractory to systemic chemotherapy [115,119,120]. Indeed, just as with TACE, more data are required to make appropriate recommendations for the application of TARE in CRLM.…”