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Chemoembolization - This is an attempt to deliver therapy very specifically to an isolated organ, generally the liver. It involves the use of a material to block circulation, so that the drugs are kept localized at a high concentration. Three articles in particular addressed this issue in this update. Two concerned primary liver cancer. One (ICDB/95613614) used a treated collagen mixed with three chemotherapy drugs - cisplatin, doxorubicin, and mitomycin - applied to the liver by microcatheter in 39 patients. Two patients achieved complete response and 19 had partial response (54% CR + PR). Projected median survival is 491 days with 25% of patients projected to be alive at 1236 days. There was one procedure associated death. Five patients with partial responses were taken to resection (3 patients) or to cryosurgery (2 patients). Pathologic complete response was seen in 2 patients, 2 patients had greater than 95% pathologic necrosis, and one greater than 50%.
A second study using chemoembolization (ICDB/95613654) for liver cancer used intra-arterial chemotherapy followed by chemoembolization achieving a high objective response rate in unresectable hepatocellular carcinoma. The treatment regimen consisted of L-leucovorin 100 mg/m2 iv, fluorouracil 800 mg/m2 ia, carboplatin 250 mg/m2 ia. Chemoembolization with mitoxantrone 10 mg/m2 plus ethiodized oil was performed immediately after chemotherapy. The same treatment plus gelatin sponge was given after 28 days. Eight of 13 patients had a partial response (62%; 95% confidence interval 32 to 86%), 3 had stabilization and 2 progressive disease. In responding patients, the median alpha-fetoprotein value, a measure of tumor extent, decreased from 530 to 58 ng/ml. Median duration of response was 6 months (range 4 to 8+). No toxic deaths or high grade toxicity has been reported.
The third study involved colorectal cancer metastatic to the liver (ICDB/95613622). Chemoembolization consisted of a maximum injection of Angiostat, a bovine collagen material with cisplatin, adriamycin, and mitomycin C, administered under fluoroscopic guidance. Response rates (available to date) as assessed by radiologic evaluation occurred in 16/26 patients (62%), as assessed by a decrease in carcinoembryonic antigen, a tumor marker for colorectal cancer, occurred in 16/17 patients (94%), and by both criteria in 22/27 patients (82%). Best results were obtained after multiple treatments, with a 77% response rate and a median survival of 11+ months in those patients that received three chemoembolizations.