Pilot study of regional, hepatic intra‐arterial paclitaxel in patients with breast carcinoma metastatic to the liver

Abstract

Objective To examine health disparities as a function of ethnicity using data from LUpus in MInorities, NAture versus nurture (LUMINA), a longitudinal study of patients with systemic lupus erythematosus (SLE); to build an explanatory model of how ethnic disparities occur in this setting; and to suggest appropriate interventions. Methods LUMINA patients (meeting American College of Rheumatology criteria for SLE) ages ≥16 years of African American, Hispanic (from Texas), Hispanic (from Puerto Rico), or Caucasian ethnicity were studied. In addition to examining the basic features of the cohort, we examined, by univariable and multivariable analyses, the factors associated with disease activity, damage accrual, lupus nephritis, and mortality. An empiric model based on the data presented (and the literature reviewed) was derived to explain the disparities observed. Results There were substantial differences in the socioeconomic/demographic, clinical, and genetic features among patients from the different ethnic groups, with Texan Hispanic and African American patients exhibiting overall a lower socioeconomic status, different genetic associations, more serious disease at a younger age, and worse intermediate and final outcomes than the Caucasian and Puerto Rican Hispanic patients. A model of disease outcome as a function of the disparities observed was created. Conclusion Ethnic disparities occur in SLE. Environmental, socioeconomic/demographic, psychosocial, genetic, and clinical factors play an important role as determinants of the ethnic differences observed. Measures aimed at eliminating these disparities are suggested while further research is conducted to elucidate the basis of these disparities and their changes at the societal level and to eliminate the gap between the rich and the poor.

Phase I Trial of Hepatic Arterial Infusion of Nanoparticle Albumin–Bound Paclitaxel: Toxicity, Pharmacokinetics, and Activity

“…46). Previous studies showed that the administration of paclitaxel directly into the hepatic artery resulted in a 95% mean hepatic extraction rate during the infusion and a 61% mean extraction rate from 5 to 9 hours after completion of the infusion (16,47). In contrast, this trial showed approximately a 42% mean hepatic extraction rate following HAI nab-paclitaxel when administered over a 60-minute period of time.…”

“…Different agents have been used to treat hepatic metastasis from various tumor types: cisplatin (6-9), oxaliplatin (10)(11)(12)(13)(14), paclitaxel (15,16), floxuridine (FUDR; refs. (17)(18)(19)(20)(21), interleukin-2 (22, 23), 5-fluorouracil/leucovorin (24), and IFN (25)(26)(27)(28).…”

“…At The University of Texas MD Anderson Cancer Center, 10 patients with liverpredominant metastases of breast cancer received once monthly 24-hour continuous HAI of paclitaxel at 200 mg/ m 2 for a total of 56 cycles, resulting in a 30% partial remission rate, including 1 patient with a 48-month response (16).…”

Treatment outcome of patients with liver-only metastases from breast cancer after mastectomy: a retrospective analysis

“…The ability to deliver higher concentrations of cytotoxic drugs to isolated tumor sites makes regional chemotherapy a possible alternative in patients with single metastatic foci, especially if not amenable to other local treatments. Small case series of regional hepatic intra-arterial therapy in patients with liver metastases from breast cancer have been reported (Camacho et al 2007).…”

Oligometastatic Breast Cancer: A Shift from Palliative to Potentially Curative Treatment?

“…Published data suggest that TACE may have a palliative role in delaying progression of isolated LiM. There is currently only scarce data regarding its role in the management of MBC, but tumor shrinkage can be dramatic and may render patients candidates for liver resection with curative intent, potentially resulting in long-term disease-free survival [50]. In the published series, TACE commonly follows progression under ST: a recent study compared combined TACE and ST for liver-only metastases (n = 44) to ST alone (n = 43).…”