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| |  Irinotecan-Coated Beads a Good Option for Hepatic Metastases, Failure in Systemic Chemotherapy: Presented at SIR By Thomas R. Collins TAMPA, Fla -- March 19, 2010 -- Transarterial chemoembolisation (TACE) with irinotecan-coated beads is an effective and well-tolerated treatment for the most difficult to treat patients suffering from hepatic metastases from colorectal cancer, researchers said here at the Society of Interventional Radiology (SIR) 35th Annual Scientific Meeting. Half of the patients in a 16-patient, 26-lesion study showed a partial response and the side effects were tolerable, according to Raj Narayanan, MD, University of Miami and Jackson Memorial Hospital, Miami, Florida. The patients had all failed systemic chemotherapy efforts. “It is an effective technique,” Dr. Narayanan said in a presentation on March 15. “Obviously this is a difficult group of patients to treat. The majority of them, by the time they come to us, have already been through at least 2 rounds of chemotherapy.” About 400,000 people suffer from colorectal cancer worldwide, and 60% of those will develop liver metastases. But only 10% to 15% are treatable by surgical resection. Patients have poor prognoses, with 1-year survival rates reported at 31% and 3-year survival rates reported at 2.6%. Most patients are treated with systemic chemotherapy -- during which irinotecan is included. But when that fails, treatment with irinotecan-coated beads might be a good option, Dr. Narayanan said. Patients requiring the treatment would tend to be considered high risk, with more than 50% of the liver involved, lactate dehydrogenase levels >425 U/L, aspartate aminotransferase levels >100 IU/L, and total bilirubin >2.5 IU/L. A day before the TACE procedure, intravenous hydration is begun and continues through 2 days afterward. Prophylactic treatment for nausea and pain are also administered before and after. The irinotecan microspheres are prepared 2 hours before the procedure. In injecting the beads, the main artery was the target, said Dr. Narayanan. “The main recommendation is not to get super selective but to stay in the main vessel which feeds the tumour,” he said. For pain, morphine 10 mg was administered 30 minutes before the procedure and intra-arterial lidocaine was administered. “Our first 5 patients had a severe amount of pain -- greater than 10 on a scale of 1 to 10, so we added [hydromorphone hydrochloride] to the mix,” Dr. Narayanan said. That drug was administered at the time of the bead injection and “we go up to 4 mg at 5-minute intervals.” Although half of the patients saw a partial response in reducing the tumour size, disease progression was seen in 2 patients, or 12%. Three patients were lost to follow-up, and 3 have since died. Six patients (37%) reported nausea; 5 (31%) reported abdominal pain; 2 (12%) experienced vomiting; and fatigue, loss of appetite, and insomnia was experienced in 1% and 6% each, respectively. Dr. Narayanan praised the treatment as “effective palliative treatment” with a low systemic toxicity profile, making it a “safe and feasible treatment option.” [Presentation title: Trans-Arterial Chemoembolization (TACE) Using Irinotecan-Coated LC Beads for Treatment of Hepatic Metastases From Colorectal Cancer (CRC). Abstract 110]
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