Efficacy and safety of CalliSpheres drug-eluting beads for bronchial arterial chemoembolization for refractory non-small-cell lung cancer and its impact on quality of life: A multicenter prospective study

Abstract

ObjectiveThis study aimed to prospectively observe the efficacy and safety of CalliSpheres drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) for refractory non-small-cell lung cancer (NSCLC).MethodsThe interventional therapy plan was as follows: 300–500 μm CalliSpheres drug-loaded microspheres were loaded with epirubicin, and then slow embolization of tumor supplying artery was performed after microcatheter superselection. Chest enhanced computed tomography and related hematological examination were reviewed after 2 months of DEB-BACE, and the tumor response after the first interventional therapy was evaluated using modified response evaluation criteria in solid tumors. The overall survival (OS) of patients was determined, and the quality of life and the incidence rate of adverse reactions were observed.ResultsFrom January 2019 to January 2021, 43 patients with refractory NSCLC were enrolled. The patients were followed up until June 2022. All 43 patients underwent DEB-BACE 1.79 ± 0.69 times on average. The 3-, 6-, 12-, and 24-month survival rates were 100%, 86.0%, 41.9%, and 11.8%, respectively. The median OS was 11.5 months. After the first interventional treatment, cough and wheezing significantly improved in 31 patients, hemoptysis was effectively controlled in 12 patients, and superior vena cava compression disappeared in 2 patients after 2 times of treatment. The general health status of the patients after treatment significantly improved compared with that before treatment, including the improvement in physical and emotional functions. Fatigue, nausea and vomiting, dyspnea, and insomnia improved significantly after treatment. No serious adverse events, such as spinal cord injury and cerebral embolism, were observed during the perioperative period. The main adverse reaction after DEB-BACE was chest pain (13/43, grade 1) followed by fever (10/43, grade 1–2), which was significantly relieved within 3–5 days after symptomatic treatment. Other adverse reactions included irritating cough, nausea and vomiting, and bone marrow suppression, and the incidence was less than 20%.ConclusionsDEB-BACE was effective and safe in treating refractory NSCLC, which could significantly improve patients’ quality of life and was worthy of clinical promotion and application.

Drug-eluting beads bronchial arterial chemoembolization in advanced and standard treatment-refractory/ineligible NSCLC

“…In this study, minor adverse events after D-BACE plus BAIC, such as transient chest pain, nausea, vomiting, fever, and fatigue, were usually self-limiting or resolved after conservative symptomatic therapies, which is consistent with previous studies 8, 20 . Major complications such as esophageal stula, spinal cord infarction, posterior circulation cerebral infarction, and myocardial infarction due to non-target embolization were not observed in our study, and were also rare in a recent bronchial artery embolization series 5,21 .…”

“…However, it should be noted that squamous cancer accounted for 83.7% (36) of the patients in this prospective study, which might have in uenced the observed OS. The study reported promising e cacy with a median PFS of 7.0-11.0 months and OS of 8.0-18.4 months, as well as tolerable toxicity in patients with refractory advanced NSCLC (6, [19][20][21]. The PFS and OS rates in these studies were better than those in our study.…”

“…According to a multicenter prospective study, the use of D-BACE resulted in a notable enhancement in the quality of life for patients with refractory NSCLC. Additionally, the study revealed a median OS of 11.5 months when utilizing this treatment approach 20 . However, it should be noted that squamous cancer accounted for 83.7% (36) of the patients in this prospective study, which might have in uenced the observed OS.…”

“…However, these serious complications should be noted and avoided, with careful monitoring during the procedure. Based on our experience, the following points may help reduce the complications of the operation: iodized oil should be avoided for embolization of lung cancer because the small diameter of iodized oil droplets can easily cause ectopic embolization, which can further lead to serious complications, such as spinal cord injury and cerebral infarction 20 . Drug-eluting beads or microsphere embolization with an inner diameter ranging between 300 and 500 mm is strongly advised based on an in-depth anatomical study.…”

Patient's experiences of coughing after lung cancer surgery: A multicenter qualitative study

“…Hence, there may be no specific medicines suitable for treating postoperative cough. Studies have shown that cough is related to postoperative bronchial morphological changes, and the effect of medication control is often unsatisfactory 44,45 . This suggests that the current methods for treating postoperative cough have many limitations, and there is a need to explore the causes of cough after lung cancer surgery to enable the provision of patient‐targeted interventions.…”