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Does Bead Size Affect Patient Outcome in Irinotecan-Loaded Beads Chemoembolization Plus Systemic Chemotherapy Regimens for Liver-Dominant Colorectal Cancer? Results of an Observational Study

  • Clinical Investigation
  • Interventional Oncology
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

We investigated the clinical effects of bead size in irinotecan-loaded beads chemoembolization (DEBIRI) used for treating liver-dominant colorectal cancer.

Materials and Methods

Between March 2009 and January 2018, all consecutive patients with colorectal cancer liver metastases referred for DEBIRI at our tertiary center were included in an observational study. Patients were treated exclusively with either 100-mg irinotecan-loaded DC beads of 70–150 μm (small bead group or SB) or 100–300 μm (large bead group or LB) in diameter, in addition to systemic therapy. Liver tumor response rate at 3 months, liver and overall progression-free survival (PFS) and overall survival were estimated.

Results

In total, 84 patients with liver-dominant progressive disease underwent 232 DEBIRI sessions. Fifty-four patients were treated in the SB group and 30 patients in the LB group. Liver progression-free rates at 3 months were 86.7% for the LB group and 79.6% for the SB group (NS). Median liver-PFS and overall PFS were, respectively, 7.15 months and 7.15 months for the LB group and 7.65 and 7.55 months for the SB group (NS). Median overall survival was 13.04 months for the LB group and 15.59 months for the SB group (p = 0.04). Specific treatment grade 3 + 4 toxicity occurrence was 5 (17%) in the LB group and 20 (37%) in the SB group.

Conclusion

No significant difference in patient outcome was observed between DEBIRI bead sizes of 70–150 μm and 100–300 μm. A trend toward higher treatment-specific toxicity was observed with the smaller beads.

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Abbreviations

CRC:

Colorectal cancer

CRCLM:

Colorectal cancer liver metastases

DEBIRI:

Drug-eluted beads loaded with irinotecan

liver-PFS:

Liver progression-free survival

OS:

Overall survival

PD:

Progressive disease

PFS:

Progression-free survival

PR:

Partial response

SD:

Stable disease

References

  1. Arnold M, Sierra MS, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global patterns and trends in colorectal cancer incidence and mortality. Gut. 2017;66(4):683–91. https://doi.org/10.1136/gutjnl-2015-310912.

    Article  PubMed  Google Scholar 

  2. Shah MA, Renfro LA, Allegra CJ, Andre T, de Gramont A, Schmoll HJ, Haller DG, Alberts SR, Yothers G, Sargent DJ. Impact of patient factors on recurrence risk and time dependency of oxaliplatin benefit in patients with colon cancer: analysis from modern-era adjuvant studies in the adjuvant colon cancer end points (ACCENT) database. J Clin Oncol. 2016;34(8):843–53. https://doi.org/10.1200/JCO.2015.63.0558.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Loree JM, Kopetz S. Recent developments in the treatment of metastatic colorectal cancer. Ther Adv Med Oncol. 2017;9(8):551–64. https://doi.org/10.1177/1758834017714997.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Datta J, Narayan RR, Kemeny NE, D’Angelica MI. Role of hepatic artery infusion chemotherapy in treatment of initially unresectable colorectal liver metastases: a review. JAMA Surg. 2019. https://doi.org/10.1001/jamasurg.2019.1694.

    Article  PubMed  Google Scholar 

  5. Yoshino T, Arnold D, Taniguchi H, Pentheroudakis G, Yamazaki K, Xu RH, Kim TW, Ismail F, Tan IB, Yeh KH, Grothey A, Zhang S, Ahn JB, Mastura MY, Chong D, Chen LT, Kopetz S, Eguchi-Nakajima T, Ebi H, Ohtsu A, Cervantes A, Muro K, Tabernero J, Minami H, Ciardiello F, Douillard JY. Pan-Asian adapted ESMO consensus guidelines for the management of patients with metastatic colorectal cancer: a JSMO-ESMO initiative endorsed by CSCO, KACO, MOS, SSO and TOS. Ann Oncol. 2018;29(1):44–70. https://doi.org/10.1093/annonc/mdx738.

    Article  CAS  PubMed  Google Scholar 

  6. Lencioni R, Aliberti C, de Baere T, Garcia-Monaco R, Narayanan G, O’Grady E, Rilling WS, Walker D, Martin RC. Transarterial treatment of colorectal cancer liver metastases with irinotecan-loaded drug-eluting beads: technical recommendations. J Vasc Interv Radiol. 2014;25(3):365–9. https://doi.org/10.1016/j.jvir.2013.11.027.

    Article  PubMed  Google Scholar 

  7. Pernot S, Artru P, Tougeron D, Montérymard C, Smith D, De La Fouchardière C, Raoul J-L, Dahan L, Guimbaud R, Michel P, Jouve J-L, Pellerin O, Taieb J. 461PDFolfox and intra-arterial DEBIRI as front-line treatment in patients with non resectable colorectal cancer liver metastases (FFCD 1201 phase II trial). Ann Oncol. 2018. https://doi.org/10.1093/annonc/mdy281.009.

    Article  PubMed  Google Scholar 

  8. Jones RP, Malik HZ, Fenwick SW, Terlizzo M, O’Grady E, Stremitzer S, Gruenberger T, Rees M, Plant G, Figueras J, Albiol M, Adam R, Awad S, Poston GJ. PARAGON II - A single arm multicentre phase II study of neoadjuvant therapy using irinotecan bead in patients with resectable liver metastases from colorectal cancer. Eur J Surg Oncol. 2016;42(12):1866–72. https://doi.org/10.1016/j.ejso.2016.07.142.

    Article  CAS  PubMed  Google Scholar 

  9. Martin RC, Howard J, Tomalty D, Robbins K, Padr R, Bosnjakovic PM, Tatum C. Toxicity of irinotecan-eluting beads in the treatment of hepatic malignancies: results of a multi-institutional registry. Cardiovasc Interv Radiol. 2010;33(5):960–6. https://doi.org/10.1007/s00270-010-9937-4.

    Article  CAS  Google Scholar 

  10. Martin RC, Joshi J, Robbins K, Tomalty D, O’Hara R, Tatum C. Transarterial chemoembolization of metastatic colorectal carcinoma with drug-eluting beads, irinotecan (DEBIRI): Multi-institutional registry. J Oncol. 2009;2009:539795. https://doi.org/10.1155/2009/539795.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Aliberti C, Tilli M, Benea G, Fiorentini G. Trans-arterial chemoembolization (TACE) of liver metastases from colorectal cancer using irinotecan-eluting beads: preliminary results. Anticancer Res. 2006;26(5B):3793–5.

    CAS  PubMed  Google Scholar 

  12. Eichler K, Zangos S, Mack MG, Hammerstingl R, Gruber-Rouh T, Gallus C, Vogl TJ. First human study in treatment of unresectable liver metastases from colorectal cancer with irinotecan-loaded beads (DEBIRI). Int J Oncol. 2012;41(4):1213–20. https://doi.org/10.3892/ijo.2012.1572.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Fiorentini G, Aliberti C, Tilli M, Mulazzani L, Graziano F, Giordani P, Mambrini A, Montagnani F, Alessandroni P, Catalano V, Coschiera P. Intra-arterial infusion of irinotecan-loaded drug-eluting beads (DEBIRI) versus intravenous therapy (FOLFIRI) for hepatic metastases from colorectal cancer: final results of a phase III study. Anticancer Res. 2012;32(4):1387–95.

    CAS  PubMed  Google Scholar 

  14. Lewis AL, Gonzalez MV, Lloyd AW, Hall B, Tang Y, Willis SL, Leppard SW, Wolfenden LC, Palmer RR, Stratford PW. DC bead: in vitro characterization of a drug-delivery device for transarterial chemoembolization. J Vasc Interv Radiol JVIR. 2006;17(2):335–42. https://doi.org/10.1097/01.RVI.0000195323.46152.B3.

    Article  PubMed  Google Scholar 

  15. Taylor RR, Tang Y, Gonzalez MV, Stratford PW, Lewis AL. Irinotecan drug eluting beads for use in chemoembolization: in vitro and in vivo evaluation of drug release properties. Eur J Pharm Sci. 2007;30(1):7–14. https://doi.org/10.1016/j.jvir.2010.02.042.

    Article  CAS  PubMed  Google Scholar 

  16. Jordan O, Denys A, De Baere T, Boulens N, Doelker E. Comparative study of chemoembolization loadable beads: in vitro drug release and physical properties of DC bead and hepasphere loaded with doxorubicin and irinotecan. J Vasc Interv Radiol JVIR. 2010;21(7):1084–90. https://doi.org/10.1016/j.jvir.2010.02.042.

    Article  PubMed  Google Scholar 

  17. Akinwande OK, Philips P, Duras P, Pluntke S, Scoggins C, Martin RC. Small versus large-sized drug-eluting beads (DEBIRI) for the treatment of hepatic colorectal metastases: a propensity score matching analysis. Cardiovasc Intervent Radiol. 2015;38(2):361–71. https://doi.org/10.1007/s00270-014-1011-1.

    Article  PubMed  Google Scholar 

  18. Martin R, Irurzun J, Munchart J, Trofimov I, Scupchenko A, Tatum C, Narayanan G. Optimal technique and response of doxorubicin beads in hepatocellular cancer: bead size and dose. Korean J Hepatol. 2011;17(1):51–60. https://doi.org/10.3350/kjhep.2011.17.1.51.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Padia SA, Shivaram G, Bastawrous S, Bhargava P, Vo NJ, Vaidya S, Valji K, Harris WP, Hippe DS, Kogut MJ. Safety and efficacy of drug-eluting bead chemoembolization for hepatocellular carcinoma: comparison of small-versus medium-size particles. J Vasc Interv Radiol. 2013;24(3):301–6. https://doi.org/10.1016/j.jvir.2012.11.023.

    Article  PubMed  Google Scholar 

  20. Pua U. Bradycardia associated with drug-eluting beads loaded with irinotecan (DEBIRI) infusion for colorectal liver metastases. Cardiovasc Interv Radiol. 2013;36(3):864–6. https://doi.org/10.1007/s00270-012-0432-y.

    Article  Google Scholar 

  21. Sacco M, Meschi M, Regolisti G, Detrenis S, Bianchi L, Bertorelli M, Pioli S, Magnano A, Spagnoli F, Giuri PG, Fiaccadori E, Caiazza A. The relationship between blood pressure and pain. J Clin Hypertens. 2013;15(8):600–5. https://doi.org/10.1111/jch.12145.

    Article  Google Scholar 

  22. Martin RC, Joshi J, Robbins K, Tomalty D, Bosnjakovik P, Derner M, Padr R, Rocek M, Scupchenko A, Tatum C. Hepatic intra-arterial injection of drug-eluting bead, irinotecan (DEBIRI) in unresectable colorectal liver metastases refractory to systemic chemotherapy: results of multi-institutional study. Ann Surg Oncol. 2011;18(1):192–8. https://doi.org/10.1245/s10434-010-1288-5.

    Article  PubMed  Google Scholar 

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Funding

This study received no specific funding.

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Authors and Affiliations

  1. Interventional Radiology Department, Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France

    Tom Boeken, Nadia Moussa, Abdellahi Abed, Carole Dean, Marc Sapoval & Olivier Pellerin

  2. Université Paris Descartes - Sorbonne - Paris Cité, Paris, France

    Tom Boeken, Nadia Moussa, Simon Pernot, Julien Taieb, Marc Sapoval & Olivier Pellerin

  3. Digestive Oncology Department, Hôpitaux de Paris Hôpital Européen Georges Pompidou, 20 Rue Leblanc, 75015, Paris, France

    Simon Pernot & Julien Taieb

  4. INSERM URM, 970 Equipe 2 Imagerie de L’angiogenèse, Paris, France

    Simon Pernot, Julien Taieb, Marc Sapoval & Olivier Pellerin

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  1. Tom Boeken
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  2. Nadia Moussa
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Correspondence to Tom Boeken.

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All procedures in these studies involving human participants were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Boeken, T., Moussa, N., Pernot, S. et al. Does Bead Size Affect Patient Outcome in Irinotecan-Loaded Beads Chemoembolization Plus Systemic Chemotherapy Regimens for Liver-Dominant Colorectal Cancer? Results of an Observational Study. Cardiovasc Intervent Radiol 43, 866–874 (2020). https://doi.org/10.1007/s00270-020-02438-0

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  • DOI: https://doi.org/10.1007/s00270-020-02438-0

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