Review: Endoscopic ultrasound-guided fine needle injection for cancer therapy: The evolving role of therapeutic endoscopic ultrasound

Abstract

Endoscopic ultrasound (EUS) is central to the diagnosis and staging of many malignancies, but now has an evolving role in cancer therapy. EUS-guided fine needle injection (FNI) is already used for palliative interventions such as treatment of pain through nerve blockade and to guide biliary decompression when conventional ERCP is not possible. More recently, EUS-FNI has been used to deliver specific anti-tumor agents for pancreatic cyst ablation and local control of tumor growth in patients with unresectable solid malignancies. The agents used to date include ethanol, brachytherapy seeds, and chemotherapeutic agents such as paclitaxel. In addition, FNI of new immunomodulating cell cultures such as mixed lymphocyte and dendritic cell cultures has also been reported, as has FNI of several different viral vectors for antitumor therapy. Although experience with these agents remains preliminary, EUS-FNI is a minimally invasive approach to deliver local antitumor agents, and is likely to have an expanding role in cancer therapy.

PEGylated apoptotic protein-loaded PLGA microspheres for cancer therapy

“…Furthermore, our PLGA MS system can be efficiently delivered to tumors in the pancreas by using a recently developed method of endoscopic ultrasonographyguided fine needle injection. 28,29 In the context of local targeting efficiency to tumors, this would be more feasible and available for developing as an anticancer drug product because the size of the pancreas is much smaller than that of other organs, such as colon, lungs, and stomach. In this respect, we believe that the PLGA depot system of PEG-TRAIL would be a promising once-weekly antitumor treatment for pancreatic cancer.…”

Endoscopic ultrasound guided injection of iron oxide magnetic nanoparticles for liver and pancreas: a feasibility study in pigs.

“…EUS-FNI local delivery showed a large amount of MNP concentrated in the targeted area with only small concentrations in the surrounding liver tissue. Even though there are concise protocols for patients with HCC tumors, the use of EUS-FNI has been noted so far in animal settings, as well as some case reports [20,21]. On the other hand vascular access in the portal vein and delivery of MNP showed a wider diffusion of MNP in the entire liver, up to the distal branches.…”

Pancreatic cancer: an endoscopic perspective

“…Novel agents described for use with EUS-FNI in the management of pancreatic cancer include activated lymphocyte culture, oncolytic viruses, viral vectors and immature dendritic cells [61,62]. Chang et al in 2000 was the first group to report the use of a biological agent in the treatment of pancreatic cancer using the EUS-FNI technique [63].…”

“…Although results appear promising and technically safe, efficacy needs to be validated in larger patient groups over longer follow-up periods. EUS-guided ethanol ablation has also been used sporadically in patients with insulinoma, who are poor candidates for surgery, with good outcomes, but current guidelines do not support its use in solid pancreatic tumors [59,60].Novel agents described for use with EUS-FNI in the management of pancreatic cancer include activated lymphocyte culture, oncolytic viruses, viral vectors and immature dendritic cells [61,62]. Chang et al in 2000 was the first group to report the use of a biological agent in the treatment of pancreatic cancer using the EUS-FNI technique [63].…”