Review/State of the Art

CardioVascular and Interventional Radiology

, Volume 31, Issue 3, pp 468-476

First online:

Drug-Loaded Microspheres for the Treatment of Liver Cancer: Review of Current Results

  • Joachim KettenbachAffiliated withDivision of Angiography and Interventional Radiology, Department of Radiology, Medical University Vienna, General Hospital of Vienna Email author 
  • , Alfred StadlerAffiliated withDivision of Angiography and Interventional Radiology, Department of Radiology, Medical University Vienna, General Hospital of Vienna
  • , Isabella v. KatzlerAffiliated withDivision of Angiography and Interventional Radiology, Department of Radiology, Medical University Vienna, General Hospital of Vienna
  • , Rüdiger SchernthanerAffiliated withDivision of Angiography and Interventional Radiology, Department of Radiology, Medical University Vienna, General Hospital of Vienna
  • , Melanie BlumAffiliated withDivision of Angiography and Interventional Radiology, Department of Radiology, Medical University Vienna, General Hospital of Vienna
  • , Johannes LammerAffiliated withDivision of Angiography and Interventional Radiology, Department of Radiology, Medical University Vienna, General Hospital of Vienna
  • , Thomas RandAffiliated withDivision of Angiography and Interventional Radiology, Department of Radiology, Medical University Vienna, General Hospital of Vienna

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Abstract

Transarterial chemoembolization (TACE) involves the emulsification of a chemotherapeutic agent in a viscous drug carrier, delivered intra-arterially to liver tumor for maximum effect. TACE reduces arterial inflow, diminishes washout of the chemotherapeutic agent, and decreases systemic exposure. Despite evidence of some clinical success with TACE, a new type of microspheres with drug-eluting capabilities may offer a precisely controlled and sustainable release of the chemotherapeutic agent into the tumor bed. In animal trials tumor necrosis (approaching 100%) was greatest at 7 days, with significantly lower plasma concentrations of doxorubicin than in control animals treated with doxorubicin intra-arterially. Clinically, drug-eluting microspheres loaded with doxorubicin, either at 75 mg/m2 or at a fixed dose of 150 mg, were used recently and no severe disorders of the hepatic function were observed postprocedure, while a substantial reduction of the fetoprotein levels occurred. An interim analysis of the first 15 patients from the Hong Kong group at 3 months showed an objective response rate of 61.54% and 53.84% according to EASL criteria and RECIST criteria, respectively, and a survival rate of 93.3%. In this paper we present how to use microspheres loaded with doxorubicin and review their clinical value and preliminary performance for treatment of unresectable liver cancer.

Keywords

Carcinoma Hepatocellular Chemoembolization Therapeutic Liver Doxorubicin microspheres Embolic agents Drug delivery