Interventional Oncology Research Round-up

Read below for a summary of some important interventional oncology studies published in 2015.

Randomized Controlled Trial of Irinotecan Drug-Eluting Beads With Simultaneous FOLFOX and Bevacizumab for Patients With Unresectable Colorectal Liver-Limited Metastasis

A study led by Martin et al aimed to assess the response and adverse event rates for irinotecan drug-eluting beads (DEBIRI) with folinic acid, 5-fluorouracil, and oxaliplatin (FOLFOX) and bevacizumab as a first-line treatment for unresectable colorectal liver metastasis. With the primary endpoint of response rate and the secondary endpoint of adverse events, the rate of conversion to resection, and progression-free survival, the team studied 70 patients with colorectal liver metastases who were randomly assigned to modified FOLFOX and bevacizumab or mFOLFOX6, bevacizumab, and DEBIRI. 

The study concluded that the simultaneous administration of mFOLFOX6 and DEBIRI through the hepatic artery is safe and does not cause treatment delays or increase the systemic toxicity of chemotherapy, leading to improved overall response rates, improved hepatic progression-free survival, and more durable overall progression-free survival in patients downsized to resection.

Martin RC, Scoggins CR, Schreeder M, et al. Randomized controlled trial of irinotecan drug-eluting beads with simultaneous FOLFOX and bevacizumab for patients with unresectable colorectal liver-limited metastasis. Cancer. 2015. doi: 10.1002/cncr.29534.

Imaging Predictors of Elevated Lung Shunt Fraction in Patients Being Considered for Yttrium-90 Radioembolization

In a study by Olorunsola et al, researchers aimed to identify imaging findings associated with elevated lung shunt function in patients being considered for yttrium-90 radioembolization. From 2009 to 2014, 152 consecutive patients underwent planning hepatic arteriography with technetium-99m macroaggregated albumin (MAA) injection. After computed tomography (CT) or magnetic resonance (MR) imaging, each patient was assessed for hepatic vein (HV) tumor thrombus or occlusion from external compression by tumor. The study concluded that early HV opacification and HV tumor thrombus or occlusion on cross-sectional imaging performed before radioembolization are associated with elevated LSF, which may contraindicate or limit the dose delivered in radioembolization, which could be helpful during patient counseling for anticipating the most appropriate mode of liver-directed therapy.

Olorunsola OG, Kohi MP, Behr SC, et al. Imaging predictors of elevated lung shunt fraction in patients being considered for Yttrium-90 radioembolization. J Vasc Interv Radiol. 2015;26(10):1472-1478.

Efficacy and Safety of Radiofrequency Ablation for Treatment of Locally Recurrent Thyroid Cancers Smaller Than 2 Cm

A trial conducted by Kim et al evaluated the efficacy and safety of radiofrequency ablation for localized small recurrent thyroid cancers less than 2 cm by comparing them with those at repeat surgery. The study evaluated 73 patients with recurrent thyroid cancer who had been treated with radiofrequency ablation (RFA) or repeat surgery, who had three or fewer recurrences or lesions with high probability of recurrence at ultrasonography, no tumor other than the targeted tumors, and at least 1 year of follow-up. 

Recurrence-free survival rates and post-treatment complication rates were compared between RFA and reoperation groups, showing that the 1- and 3-year recurrence-free survival rates and post-treatment hoarseness rates were comparable for RFA and reoperation groups, and post-treatment hypocalcemia occurred exclusively in the reoperation group. The study concluded that RFA may be an effective and safe alternative to repeat surgery in patients with locally recurrent small thyroid cancers.

Kim JH, Yoo WS, Park YJ, et al. Efficacy and safety of radiofrequency ablation for treatment of locally recurrent thyroid cancers smaller than 2 cm. Radiology. 2015;276(3):909-918.

Yttrium-90 Glass-Based Microsphere Radioembolization in the Treatment of Hepatocellular Carcinoma Secondary to the Hepatitis B Virus: Safety, Efficacy, and Survival

A study by Biederman et al evaluated outcomes of yttrium-90 radioembolization performed with glass-based microspheres in the treatment of hepatocellular carcinoma (HCC) secondary to the hepatitis B virus (HBV). A total of 675 patients treated between January 2006 and July 2014 were reviewed, of which 45 received glass-based radioembolization for HCC secondary to HBV. A total of 50 radioembolization treatments were performed, with a 100 percent technical success rate. Clinical toxicities included pain and nausea. The study concluded that glass-based radioembolization for HCC secondary to HBV can be safely performed, with favorable target lesion response and overall survival.

Biederman DM, Titano JJ, Lee KM, et al. Yttrium-90 glass-based microsphere radioembolization in the treatment of hepatocellular carcinoma secondary to the hepatitis B virus: safety, efficacy, and survival. J Vasc Interv Radiol. 2015. doi: 10.1016/j.jvir.2015.07.019.

Intrahepatic Activity Distribution in Radioembolization With Y-90-Labeled Resin Microspheres Using the Body Surface Area Method

Grosser et al studied data from 283 consecutive patients treated with radioembolization to retrospectively assess the influence of the parameters of the body surface area (BSA) method in hepatic radioembolization using Y-90-labeled microspheres on the determination of the prescribed activity. The study concluded that in the BSA model, BSA and liver volume showed only a moderate correlation, resulting in a significantly lower activity concentration in patients with larger livers. Tumor burden percentage contributed little to the prescribed activity because the BSA model did not account for actual liver and tumor volumes.

Grosser OS, Ulrich G, Furth C, et al. Intrahepatic activity distribution in radioembolization with yttrium-90-labeled resin microspheres using the body surface area method-a less than perfect model. J Vasc Interv Radiol. 2015;26(11):1615-1621.

Predictive Value of 99mTc-labeled MAA Scintigraphy for Y-90 Microspheres Distribution for Primary and Secondary Hepatic Tumors

Ilhan et al evaluated 99mTc-labeled MAA uptake in scintigraphy/SPECT to analyze the predictive value of Y-90 SIRSpheres therapy in 502 patients who received Y-90 radioembolization between 2005 and 2013 due to primary and secondary liver malignancies, neuroendocrine tumors, breast cancer, hepatocelluar carcinoma, cholangiocelluar carcinoma, and urologic tumors. The classification of tracer uptake in four grades revealed that lesions with high uptake in 99mTc-MAA scintigraphy maintain high uptake within radioembolization. Lesions with pretherapeutic lower uptake than healthy liver tissue, however, showed high uptake within radioembolization in more than 60%. This indicates that patients with low tumor uptake in pretherapeutic 99mTc-MAA imaging should not be excluded from radioembolization.

Ilhan H, Goritschan A, Paprottka P, et al. Predictive value of 99mTc-labelled MAA scintigraphy for 90Y-microspheres distribution in radioembolization treatment with resin microspheres in primary and secondary hepatic tumors. J Nucl Med.  2015;56(11):1654-1660. 

Study of Magnetic Resonance Parameters in Uterine Fibroid Patients Screened for MR-Guided High-Intensity Focused Ultrasound Ablation

A study by Kim et al evaluated the relationships between T2 signal intensity and semiqualitative perfusion MR parameters of uterine fibroids in patients who were screened for MR-guided high-intensity ultrasound ablation (HIFU). The authors retrospectively studied 170 most symptom-relevant, nondegenerated uterine fibroids in 170 women undergoing screening MR examinations for MR-guided HIFU ablation. The study concluded that in possible candidates for MR-guided HIFU ablation, the T2 signal intensity of nondegenerated uterine fibroids showed an independently significant positive correlation with relative peak enhancement in most cases, except those of submucosal intracavitary or type III fibroids.

Kim YS, Lee JW, Choi CH, et al. Uterine fibroids: correlation of T2 signal intensity with semiquantitative perfusion MR parameters in patients screened for MR-guided high-intensity focused ultrasound ablation. Radiology. 2015. [Epub ahead of print.]

Sorafenib With Percutaneous RFA for the Treatment of Medium-Sized HCC

Kan et al explored the efficacy and safety of sorafenib combined with RFA therapy for 62 patients with medium-sized HCC, eyeing treatment outcomes, including recurrence rates, time to progression and adverse reactions induced by sorafenib. The study concluded that sorafenib combined with RFA significantly decreased recurrence rates and prolonged the survival time of medium-sized HCC patients.

Kan X, Jing Y, Wan QY, et al. Sorafenib combined with percutaneous radiofrequency ablation for the treatment of medium-sized hepatocellular carcinoma. Eur Rev Med Pharmacol Sci. 2015;19(2):247-255.

Percutaneous CT-Guided RFA of Solitary Small Renal Masses

A study by Pieper et al analyzed the outcomes of patients undergoing percutaneous CT-guided RFA of small renal masses (SRM) at a single center during a 10-year time period. Patient records of renal RFAs were reviewed. Indications were SRM suspicious of malignancy on imaging and one of the following: severe comorbidity, old age, solitary kidney, impaired renal function, or patient wish. Biopsy was performed at the time of RFA. Patients were excluded if no follow-up was available. Results indicated RFA of SRM is successful in a large percentage of cases with a low complication rate and durable local control; overall survival seems to depend on comorbidities rather than cancer progression.

Pieper CC, Fischer S, Strunk H, et al. Percutaneous CT-guided radiofrequency ablation of solitary small renal masses: a single center experience. Rofo. 2015;187(7):577-583.

Trial of Active Specific Immunotherapy With Autologous Dendritic Cells Pulsed With Autologous Irradiated Tumor Stem Cells in Hepatitis B-Positive Patients With HCC

Wang et al released a phase 1 study indicating that active specific immunotherapy (ASI) might benefit high-risk primary HCC patients following surgical resection. According to the study, HCC is often associated with chronic hepatitis due to hepatitis-B or -C viruses. 

Active specific immunotherapy with autologous dendritic cells (DC) presenting antigens from autologous tumor stem cell (TC) lines is associated with promising long-term survival in metastatic cancer. Hepatitis patients were excluded from the study, which concluded that autologous DC-TC did not exacerbate HBV in HCC patients. A phase 2 efficacy study is being planned.

Wang X, Bayer ME, Chen X, et al. Phase I trial of active specific immunotherapy with autologous dendritic cells pulsed with autologous irradiated tumor stem cells in hepatitis B-positive patients with hepatocellular carcinoma. J Surg Oncol. 2015;111(7):862-867.

Surgical Resection Vs Transarterial Chemoembolization for Stage C HCC

Liu et al aimed to compare surgical resection (SR) and transarterial chemoembolization (TACE) for advanced HCC patients in a recent study of 264 and 389 advanced HCC patients, who received SR and TACE, respectively. The trial concluded that SR provides significantly better long-term survival than TACE in patients with Barcelona Clinic Liver Cancer stage C HCC, and should be an integral part in the management of advanced HCC.

Liu PH, Hsia CY, Lee YH, et al. Surgical resection versus transarterial chemoembolization for BCLC stage C hepatocellular carcinoma. J Surg Oncol. 2015;111(4):404-409.

ARSENIC TRIOXIDE TACE With and Without Additional Administration of Arsenic Trioxide in Unresectable HCC With Lung Metastasis

Liu et al released a recent study aiming to evaluate the efficacy and safety of arsenic trioxide TACE and intravenous administration in unresectable HCC with lung metastasis. In a single-blind, 2-parallel group, a randomized trial was conducted at three medical centers, including patients with both biopsy-confirmed hepatocellular carcinoma and lung metastasis. The experimental group received arsenic trioxide TACE and intravenous administration of arsenic trioxide, while the control group only received arsenic trioxide TACE. The study concluded that arsenic trioxide TACE and intravenous administration were safe and effective in the patient group.

Liu B, Huang JW, Li Y, et al. Arsenic trioxide transarterial chemoembolization with and without additional intravenous administration of arsenic trioxide in unresectable hepatocellular carcinoma with lung metastasis: a single-blind, randomized trial. J Cancer Res Clin Oncol. 2015;141(6):1103-1108.

Clinical and Economic Impact of Drug Eluting Beads in TACE for HCC

A study by Vadot et al aimed to compare the efficacy, safety, and economic profile of 2 strategies of TACE without or with the possibility of using drug eluting beads (DEBs). All patients at the researchers’ hospital treated with TACE from March 2006 to May 2014 were included in the study, which concluded that the possibility of using DEBs did not improve the prognosis in hepatocellular carcinoma patients treated by TACE, though it had a better medico-economic profile.

Vadot L, Boulin M, Guiu B, et al. Clinical and economic impact of drug eluting beads in transarterial chemoembolization for hepatocellular carcinoma. J Clin Pharm Ther. 2015;40(1):83-90.

Volumetric Assessment of Tumor Response Using Functional Magnetic Resonance Imaging 

Corona-Villalobos et al prospectively assessed treatment response using volumetric functional magnetic resonance imaging metrics in patients with hepatocellular carcinoma (HCC) treated with the combination of doxorubicin-eluting bead-transarterial chemoembolization (DEB-TACE) and sorafenib in a recent study. A single center study enrolled 41 patients treated with systemic sorafenib combined with DEB-TACE and concluded that volumetric portal venous phase enhancement was demonstrated to be significantly correlated with survival in the combination of DEB-TACE and sorafenib for patients with HCC, enabling precise stratification of responders and nonresponders.

Corona-Villalobos CP, Halappa VG, Geschwind JF, et al. Volumetric assessment of tumour response using functional MR imaging in patients with hepatocellular carcinoma treated with a combination of doxorubicin-eluting beads and sorafenib. Eur Radiol. 2015;25(2):380-390.

The START Trial: TACE Plus Sorafenib Is Well Tolerated and Effective in Asian Patients With Hepatocellular Carcinoma

Chao et al recently evaluated sorefenib in combination with doxorubicin-based TACE in patients with intermediate-stage, unresectable HCC in a phase 2, investigator initiated, prospective single-arm multinational study. The full analysis comprised 192 patients who received TACE with interrupted dosing of sorafenib; cycles were repeated every 6 weeks to 8 weeks. The study concluded that the combination of TACE and sorafenib is well tolerated and efficacious, and may have contributed to a considerably lower adverse event profile than observed in other combination trials. 

Chao Y, Chung YH, Han G, et al. The combination of transcatheter arterial chemoembolization and sorafenib is well tolerated and effective in Asian patients with hepatocellular carcinoma: final results of the START trial. Int J Cancer. 2015;136(6):1458-1467.

Editor’s note: This article first appeared in the Synergy Daily conference newspaper, available to attendees of the Synergy Miami interventional oncology meeting in November 2015. 

Suggested citation: Wolfgang K. Interventional oncology research round-up. Articles from the official show daily for Synergy 2015. Intervent Oncol 360. 2015;3(12):E159-E164.