Abstract
Purpose
The purpose of this study was to study the pharmacokinetics of irinotecan injected intravenously, intra-arterially, or loaded onto a delivery platform.
Material and Methods
Fifty-four New Zealand White rabbits with VX2 liver tumor, divided in 3 groups of 17 rabbits, each received irinotecan either by intravenous (IV) route, intra-arterial hepatic (IA) route, or loaded on drug-eluting beads (DEBIRI). Animals were killed at 1, 6, and 24 h. Irinotecan and SN-38 concentrations were measured at different time points in serum, tumor, and normal liver.
Results
Twelve milligrams of irinotecan were injected IV and IA, whereas 6–16.5 mg were injected loaded onto DEBIRI. Normalized serum irinotecan reached a peak of 333 ng/ml (range 198.8–502.5) for IV, 327.1 ng/ml (range 277.1–495.6) for IA, and 189.7 ng/ml (range 111.1–261.9) for DEBIRI (P < 0.001) delivery. The area-under-the-curve value from 10 to 60 min of serum irinotecan concentration was significantly lower for DEBIRI (P = 0.0009). Tumor irinotecan levels for IV, IA, and DEBIRI (in ng/200 mg of tissue followed by ranges in parentheses) were, respectively, 23.6 (0.3–24.9), 36.5 (7.7–1914.1), and 20.2 (2.9–319) at 1 h; 4.2 (1–27.9), 99.3 (46.6–159.5), and 42.1 (11.3–189) at 6 h; and 2.7 (2.5–6.9), 18.3 (1.5–369.1), and 174.4 (3.4–5147.3) at 24 h (P = 0.02). At 24 h, tumor necrosis was 25% (10–30), 60% (40–91.25), and 95% (76.25–95) for IV, IA, and DEBIRI, respectively (P = 0.03).
Conclusion
Compared with IV or IA, DEBIRI induces lower early serum levels of irinotecan, a high and prolonged intratumoral level of irinotecan, and a greater rate of tumor necrosis at 24 h. Further evaluation of the clinical benefit of DEBIRI is warranted.
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References
Sharma S, Camci C, Jabbour N (2008) Management of hepatic metastasis from colorectal cancers: an update. J Hepatobiliary Pancreat Surg 15(6):570–580
Jemal A, Murray T, Ward E, Samuels A, Tiwari RC, Ghafoor A et al (2005) Cancer statistics, 2005. CA Cancer J Clin 55(1):10–30
Minagawa M, Makuuchi M, Torzilli G, Takayama T, Kawasaki S, Kosuge T et al (2000) Extension of the frontiers of surgical indications in the treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231(4):487–499
Shimada H, Tanaka K, Matsuo K, Togo S (2006) Treatment for multiple bilobar liver metastases of colorectal cancer. Langenbecks Arch Surg 391(2):130–142
Simmonds PC, Primrose JN, Colquitt JL, Garden OJ, Poston GJ, Rees M (2006) Surgical resection of hepatic metastases from colorectal cancer: a systematic review of published studies. Br J Cancer 94(7):982–999
Steele G Jr, Bleday R, Mayer RJ, Lindblad A, Petrelli N, Weaver D (1991) A prospective evaluation of hepatic resection for colorectal carcinoma metastases to the liver: Gastrointestinal Tumor Study Group protocol 6,584. J Clin Oncol 9(7):1105–1112
Ho WM, Ma B, Mok T, Yeo W, Lai P, Lim R et al (2005) Liver resection after irinotecan, 5-fluorouracil, and folinic acid for patients with unresectable colorectal liver metastases: a multicenter phase II study by the Cancer Therapeutic Research Group. Med Oncol 22(3):303–312
Hurwitz H, Fehrenbacher L, Novotny W, Cartwright T, Hainsworth K, Heim W et al (2004) Bevacizumab plus irinotecan, fluorouracil, and leucovorin for metastatic colorectal cancer. N Engl J Med 350(23):2335–2342
Malka D, Paris E, Caramella C, Boucher E, Guimbaud R, Celebic A et al (2010) Hepatic arterial infusion (HAI) of oxaliplatin plus intravenous (iv) fluorouracil (FU), leucovorin (LV), and cetuximab for first-line treatment of unresectable colorectal liver metastases (CRLM) (CHOICE): a multicenter phase II study. ASCO Meet Abstr 28(Suppl 15):3558
Kemeny NE, Melendez FD, Capanu M, Paty PB, Fong Y, Schwartz LH et al (2009) Conversion to resectability using hepatic artery infusion plus systemic chemotherapy for the treatment of unresectable liver metastases from colorectal carcinoma. J Clin Oncol 27(21):3465–3471
Chang AE, Schneider PD, Sugarbaker PH, Simpson C, Culnane M, Steinberg SM (1987) A prospective randomized trial of regional versus systemic continuous 5-fluorodeoxyuridine chemotherapy in the treatment of colorectal liver metastases. Ann Surg 206(6):685–693
Rougier P, Laplanche A, Huguier M, Hay JM, Ollivier JM, Escat J et al (1992) Hepatic arterial infusion of floxuridine in patients with liver metastases from colorectal carcinoma: long-term results of a prospective randomized trial. J Clin Oncol 10(7):1112–1118
Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35(5):1164–1171
Llovet JM, Real MI, Montana X, Planas R, Coll S, Aponte J et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359(9319):1734–1739
Hong K, Khwaja A, Liapi E, Torbenson MS, Georgiades CS, Geschwind JF (2006) New intra-arterial drug delivery system for the treatment of liver cancer: preclinical assessment in a rabbit model of liver cancer. Clin Cancer Res 12(8):2563–2567
Varela M, Real MI, Burrel M, Forner A, Sala M, Brunet M et al (2007) Chemoembolization of hepatocellular carcinoma with drug eluting beads: efficacy and doxorubicin pharmacokinetics. J Hepatol 46(3):474–481
Aliberti C, Tilli M, Benea G, Fiorentini G (2006) Trans-arterial chemoembolization (TACE) of liver metastases from colorectal cancer using irinotecan-eluting beads: preliminary results. Anticancer Res 26(5B):3793–3795
Martin RC, Joshi J, Robbins K, Tomalty D, O’Hara R, Tatum C (2009) Transarterial chemoembolization of metastatic colorectal carcinoma with drug-eluting beads, irinotecan (DEBIRI): multi-institutional registry. J Oncol (Epub October 29)
Martin RC, Joshi J, Robbins K, Tomalty D, Bosnjakovik P, Derner M et al (2011) 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 18(1):192–198
Kunimoto T, Nitta K, Tanaka T, Uehara N, Baba H, Takeuchi M et al (1987) Antitumor activity of 7-ethyl-10-[4-(1-piperidino)-1-piperidino]carbonyloxy-camptothec in, a novel water-soluble derivative of camptothecin, against murine tumors. Cancer Res 47(22):5944–5947
Slatter JG, Schaaf LJ, Sams JP, Feenstra KL, Johnson MG, Bombardt PA et al (2000) Pharmacokinetics, metabolism, and excretion of irinotecan (CPT-11) following I.V. infusion of [(14)C]CPT-11 in cancer patients. Drug Metab Dispos 28(4):423–433
Haaz MC, Rivory LP, Riche C, Robert J (1997) The transformation of irinotecan (CPT-11) to its active metabolite SN-38 by human liver microsomes. Differential hydrolysis for the lactone and carboxylate forms. Naunyn Schmiedebergs Arch Pharmacol 356(2):257–262
Douillard JY, Cunningham D, Roth AD, Navarro M, James RD, Karasek P et al (2000) Irinotecan combined with fluorouracil compared with fluorouracil alone as first-line treatment for metastatic colorectal cancer: a multicentre randomised trial. Lancet 355(9209):1041–1047
Fiorentini G, Rossi S, Dentico P, Bernardeschi P, Calcinai A, Bonechi F et al (2003) Irinotecan hepatic arterial infusion chemotherapy for hepatic metastases from colorectal cancer: a phase II clinical study. Tumori 89(4):382–384
van Riel JM, van Groeningen CJ, Kedde MA, Gall H, Leisink JM, Gruia G et al (2002) Continuous administration of irinotecan by hepatic arterial infusion: a phase I and pharmacokinetic study. Clin Cancer Res 8(2):405–412
Fiorentini G, Lucchi SR, Giovanis P, Cantore M, Guadagni S, Papiani G et al (2001) Irinotecan hepatic arterial infusion chemotherapy for hepatic metastases from colorectal cancer: results of a phase I clinical study. Tumori 87(6):388–390
De Jong FA, Mathijssen RH, Verweij J (2004) Limited potential of hepatic arterial infusion of irinotecan. J Chemother 16(Suppl 5):48–50
Boige V, Malka D, Elias D, Castaing M, De Baere T, Goere D et al (2008) Hepatic arterial infusion of oxaliplatin and intravenous LV5FU2 in unresectable liver metastases from colorectal cancer after systemic chemotherapy failure. Ann Surg Oncol 15(1):219–226
Ducreux M, Ychou M, Laplanche A, Gemelin E, Lasser P, Husseini F et al (2005) Hepatic arterial oxaliplatin infusion plus intravenous chemotherapy in colorectal cancer with inoperable hepatic metastases: a trial of the gastrointestinal group of the Federation Nationale des Centres de Lutte Contre le Cancer. J Clin Oncol 23(22):4881–4887
Eyol E, Boleij A, Taylor RR, Lewis AL, Berger MR (2008) Chemoembolisation of rat colorectal liver metastases with drug eluting beads loaded with irinotecan or doxorubicin. Clin Exp Metastasis 25(3):273–282
Lewis AL, Gonzalez MV, Leppard SW et al (2007) Doxorubicin eluting beads-1: effects of drug loading on bead characteristics and drug distribution. J Mater Sci Mater Med 18(9):1691–1699
Kaiser J, Thiesen J, Kramer I (2010) Stability of irinotecan-loaded drug eluting beads (DC Bead) used for transarterial chemoembolization. J Oncol Pharm Pract 16(1):53–61
Martin RC, Robbins K, Tomalty D, O’Hara R, Bosnjakovic P, Padr P et al (2009) Transarterial chemoembolization (TACE) using irinotecan-loaded beads for the treatment of unresectable metastases to the liver in patients with colorectal cancer: an interim report. World J Surg Oncol 7:80
Jordan O, Denys A, De Baere T, Boulens N, Doelker E (2010) 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 21(7):1084–1090
Taylor RR, Tang Y, Gonzalez MV, Stratford PW, Lewis AL (2007) Irinotecan drug eluting beads for use in chemoembolization: in vitro and in vivo evaluation of drug release properties. Eur J Pharm Sci 30(1):7–14
Fiorentini G, Aliberti C, Benea G, Massimo T, Graziano F, Mambrini A, Guadagni S (2011) Hepatic arterial chemoembolization adopting Dc bead, drug-eluting bead loaded with irinotecan (Debiri) versus systemic therapy for hepatic metastases from colorectal cancer: a randomized study of efficacy and quality of life. AGH 2012 (in press)
Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33(1):41–52
Santos A, Zanetta S, Cresteil T, Deroussent A, Pein F, Raymond E et al (2000) Metabolism of irinotecan (CPT-11) by CYP3A4 and CYP3A5 in humans. Clin Cancer Res 6(5):2012–2020
Lokiec F, du Sorbier BM, Sanderink GJ (1996) Irinotecan (CPT-11) metabolites in human bile and urine. Clin Cancer Res 2(12):1943–1949
Saenger J, Leible M, Seelig MH, Berger MR (2004) Chemoembolization of rat liver metastasis with irinotecan and quantification of tumor cell reduction. J Cancer Res Clin Oncol 130(4):203–210
Bower M, Metzger T, Robbins K, Tomalty D, Valek V, Boudny J et al (2010) Surgical downstaging and neo-adjuvant therapy in metastatic colorectal carcinoma with irinotecan drug-eluting beads: a multi-institutional study. HPB (Oxford) 12(1):31–36
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This project was supported by a grant from Biocompatibles (Farnham, UK).
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Rao, P.P., Pascale, F., Seck, A. et al. Irinotecan Loaded in Eluting Beads: Preclinical Assessment in a Rabbit VX2 Liver Tumor Model. Cardiovasc Intervent Radiol 35, 1448–1459 (2012). https://doi.org/10.1007/s00270-012-0343-y
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DOI: https://doi.org/10.1007/s00270-012-0343-y