Drug-eluting bead transarterial chemoembolization in the treatment for unresectable soft tissue sarcoma refractory to systemic chemotherapy: a preliminary evaluation of efficacy and safety

Local therapy combined with anti-PD-1 immunotherapy for advanced lung adenocarcinoma: A case report

ABSTRACT

Lung adenocarcinoma (LUAD) encompasses all lung epithelial cancers except small-cell lung cancer. Although programmed cell death protein 1 (PD-1) inhibitors, such as pembrolizumab, and other Food and Drug Administration-approved immune checkpoint inhibitors, offer new hope for LUAD treatment, LUAD's overall efficacy remains limited. Thus, the combination of immunotherapy with other therapeutic approaches has gained widespread attention. Local therapy is an optimal method for treating many advanced unresectable lung cancers. Herein, we present a case of a patient with multiple metastases from LUAD, who attained complete response for more than 3 years until present through local therapy combined with a PD-1 inhibitor.

Transarterial Embolization and Percutaneous Ablation of Primary and Metastatic Soft Tissue Tumors

Soft tissue tumors (STTs) include a range of benign and malignant tumors originating from soft tissues. Transarterial and percutaneous therapies are image-guided and minimally invasive approaches for managing primary and metastatic STTs. The objective of this review is to discuss transarterial and percutaneous therapies by examining the current literature, including indications, patient selection, safety, and effectiveness. Transarterial therapies (e.g., transarterial bland embolization and transarterial chemoembolization) involve the delivery of either embolic or chemotherapeutic particles using a catheter into arteries feeding the tumor, resulting in localized tumor destruction. Percutaneous therapies (e.g., radiofrequency ablation, cryoablation, irreversible electroporation, laser ablation, and magnetic resonance-guided high-intensity focused ultrasound) involve the delivery of either hot or cold temperatures, electrical current, laser, or ultrasound to specifically target tumor cells. Both therapies have been shown to be safe and effective for reducing morbidity and local control of STTs, specifically in patients who are surgically inoperable or who are unresponsive to conventional therapies. Accurate diagnosis, staging, and histological subtype identification are crucial for treatment selection. A multidisciplinary approach, a thorough understanding of tissue anatomy and surrounding structures, as well as individualized strategies based on assessment are essential for optimal patient care.

Clinical Efficacy of Interventional Chemotherapy Embolization Combined with Monopolar Radiofrequency Ablation on Patients with Liver Cancer

Due to the greater prevalence of chronic hepatitis B infection, liver tumor is especially popular in China. In China, it is the 4th most prevalent tumor and the 3rd main reason for cancer fatalities. Hepatocellular carcinomas (HCCs) account for more than 91% of every liver tumor case, and chemotherapy and immunotherapy are the better therapy choices. It is a serious threat to the lives and health of Chinese citizens. Patients diagnosed with liver tumors have a bad prognosis. Surgical resection, liver transplantation, chemotherapeutic embolization, and radiofrequency ablation (RFA) are all choices for patients who are detected early. More effective therapies can result in a better prognosis. This paper analyzes the clinical efficiency of interventional transarterial chemoembolization (TACE) integrated with monopolar radiofrequency ablation (RFA) on patients with a liver tumor. Initially, the dataset is collected and the patients are treated with combined TACE and RFA. The computed tomography (CT) images are obtained using three-phase CT imaging. The images are segmented using adaptive U-Net-based segmentation. The clinical efficiency of the patients is evaluated using Robust Residual Convolutional Neural Network (RR-CNN) which is optimized using Firefly Particle Swarm Optimization (FPSO) algorithm. The performance of the system is analyzed using the MATLAB simulation tool. In performance analysis, the proposed method of RR-CNN is high when compared to the existing method of CNN, logistic regression using genetic algorithm and KNN in overall parameters are accuracy, sensitivity, F1-score, and specificity. These integrated treatments have a suggested greater response frequency, indicating a synergistic impact by combination treatment in the initial stages.

Drug-Eluting Beads Bronchial Arterial Chemoembolization in Treating Relapsed/Refractory Small Cell Lung Cancer Patients: Results from a Pilot Study

Background

We aimed to explore the efficacy and tolerance of drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) treatment in relapsed/refractory small cell lung cancer (SCLC) patients.

Methods

Eleven relapsed/refractory SCLC patients were enrolled and treated with DEB-BACE. Then, treatment response and tumor marker levels were assessed at the first, second and sixth month post treatment. Quality of life was assessed by the EORTC QLQ-C30 scale. Progression-free survival (PFS) and overall survival (OS) were also evaluated.

Results

At the first, second and sixth month post treatment, the objective response rates were 63.6%, 54.5%, and 36.4%, respectively; and the disease control rates were 90.9%, 90.9% and 54.5%, respectively. In addition, the neuron-specific enolase (NSE) and progastrin-releasing peptide levels were reduced at the second and sixth month. Quality of life assessed by EORTC QLQ-C30 scale, which included subscales of general health status, functional domains, symptom domains, and single domains except for financial difficulty, was markedly improved at second month post treatment. Median values of PFS and OS were 5.1 (95% CI: 4.1–5.9) months and 9.0 (95% CI: 6.0–12.0) months, respectively. The ECOG score and preoperative NSE level were independent predictive factors for PFS, and age as well as lesion location were independent predictive factors for OS. Adverse events were all mild and manageable with chest pain and chest stuffiness the most common ones.

Conclusion

DEB-BACE could be a therapeutic option for relapsed/refractory SCLC patients regarding its favorable treatment response, quality of life, survival benefit and safety profile.

Treatment options in unresectable soft tissue and bone sarcoma of the extremities and pelvis - a systematic literature review

In patients with metastatic or unresectable soft tissue and bone sarcoma of extremities and pelvis, survival is generally poor. The aim of the current systematic review was to analyse recent publications on treatment approaches in patients with inoperable and/or metastatic sarcoma.

Original articles published between 1st January 2011 and 2nd May 2020, using the search terms ‘unresectable sarcoma’, ‘inoperability AND sarcoma’, ‘inoperab* AND sarcoma’, and ‘treatment AND unresectable AND sarcoma’ in PubMed, were potentially eligible. Out of the 839 initial articles (containing 274 duplicates) obtained and 23 further articles identified by cross-reference checking, 588 were screened, of which 447 articles were removed not meeting the inclusion criteria. A further 54 articles were excluded following full-text assessment, resulting in 87 articles finally being analysed.

Of the 87 articles, 38 were retrospective (43.7%), two prospective (2.3%), six phase I or I/II trials (6.9%), 22 phase II non-randomized trials (27.6%), nine phase II randomized trials (10.3%) and eight phase III randomized trials (9.2%). Besides radio/particle therapy, isolated limb perfusion and conventional chemotherapy, novel therapeutic approaches, including immune checkpoint inhibitors and tyrosine kinase inhibitors were also identified, with partially very promising effects in advanced sarcomas.

Management of inoperable, advanced or metastatic sarcomas of the pelvis and extremities remains challenging, with the optimal treatment to be defined individually. Besides conventional chemotherapy, some novel therapeutic approaches have promising effects in both bone and soft tissue subtypes. Considering that only a small proportion of studies were randomized, the clinical evidence currently remains moderate and thus calls for further large, randomized clinical trials.

Cite this article: EFORT Open Rev 2020;5:799-814. DOI: 10.1302/2058-5241.5.200069

A novel application of drug-eluting transarterial chemoembolization in treating non-liver cancers

This case series aimed to preliminarily evaluate the efficacy and safety of drug-eluting beads transarterial chemoembolization (DEB-TACE) in patients with lung, renal, gastric, and other non-liver cancers.Twenty-four patients who underwent DEB-TACE or DEB-TACE combined with other therapies were reviewed in this case series. Treatment responses were assessed at 1 month after treatment according to the modified Response Evaluation Criteria in Solid Tumors. Overall survival (OS) and adverse events were recorded.In the total patients, the objective response and disease control rate were 79.2% and 87.5%, respectively. And the mean OS in total patients was 14.7 months (95% confidence interval: 9.6-19.9 months). The number of patients who had generalized aches, nausea, vomit, fever, abdominal discomfort, chest discomfort, elevated blood pressure, cough, loss of appetite, and headache in total patients were 7 (29.2%), 11 (45.8%), 6 (25.0%), 2 (8.3%), 3 (12.5%), 3 (12.5%), 1 (4.2%), 1 (4.2%), 1 (4.2%), and 1 (4.2%), respectively. The objective response rates in patients with lung, renal, gastric, and other non-liver cancer were 70.0%, 85.7%, 100.0%, and 80.0%, respectively. In patients with lung, renal, gastric, and other non-liver cancers, the mean values of the OSs were 13.4 months, 12.4 months, 7.6 months, and 20.3 months, respectively. And the most common adverse events in lung cancer patients, renal carcinoma patients, gastric cancer patients, and patients with other non-liver cancers were post-embolization syndrome.DEB-TACE may be an effective and safe therapeutic option in patients with lung, renal, gastric, and other non-liver cancers.

A temperature-sensitive phase-change hydrogel of topotecan achieves a long-term sustained antitumor effect on retinoblastoma cells

Background

Retinoblastoma (Rb) is one of the most common malignancies among children. Following early diagnosis and prompt treatment, the clinical outcome or prognosis of Rb is promising. However, the prognosis or survival rates of patients with late-stage Rb remain poor. Current therapeutic strategies for advanced Rb mainly involve the use of advanced chemotherapeutic options. However, the efficacy of these strategies is not satisfactory. Therefore, the development of novel strategies to achieve a more effective antitumor effect on late-stage Rb is of crucial importance.

Methods and materials

Topotecan was dissolved in phosphate-buffered saline and prepared into a temperature-sensitive phase-change hydrogel (termed Topo-Gel). Moreover, Topo-Gel was injected into tumor tissues formed by Y79 cells (an Rb cell line) in nude mice to examine the long-term release and long-acting antitumor effect of Topo-Gel on Rb tumors.

Results

Topo-Gel transforms from liquid to a hydrogel at near body temperatures (phase-change temperature [T_1/2] was 37.23±0.473 °C), and maintains the slow release of topotecan in Rb tumor tissues. Following the subcutaneous injection of Topo-Gel, the treatment induced long-acting inhibition of tumor growth and relieved the adverse effects associated with topotecan. Topo-Gel, a temperature-sensitive phase-change hydrogel, is a slow-release system that prolongs the presence of topotecan in Rb tissues, and preserves the efficacy of topotecan in the long term.

Conclusion

Preparation of topotecan into a temperature-sensitive phase-change hydrogel achieves a long-term sustained antitumor effect on Rb cells, and may be a useful strategy for the treatment of intraocular Rb.

Transcatheter arterial chemoembolization improves the resectability of malignant breast phyllodes tumor with angiosarcoma component: a case report

Background

A giant phyllodes tumor of the breast is a rare fibroepithelial lesion, and its treatment is controversial. Many case reports have reported performing skin graft reconstruction after tumor excision. Chest wall resection may be required if the tumor has invaded the chest muscle layer. We speculated that transcatheter arterial chemoembolization (TACE) can improve the resectability of malignant phyllodes tumor of the breast without requiring skin grafting. The English literature contains only one case report similar to our experience.

Case presentation

We report a rare case of a 51-year-old woman who had a giant malignant phyllodes tumor with heterologous sarcomatous differentiation in her right breast. The tumor was 19.43 × 12.98 × 21.47 cm. Whole-body computed tomography (CT) and bone scan did not reveal distant metastasis. Chest magnetic resonance imaging showed chest wall tumor invasion. Considering that skin defects after mastectomy can be extensive, we administered four courses of chemoembolization in the 5 weeks before surgery (30 mg of epirubicin and embozene microspheres [400, 500, and 700 μm]/week). Each process was well tolerated, with no serious complications. Only fever and local pain at the tumor site were noted, and these symptoms resolved with time. The follow-up CT scan showed a 45% reduction in tumor volume. Therefore, simple mastectomy was performed without skin grafting reconstruction. Wound healing was satisfactory, and the patient was discharged 1 week after surgery. Pathological and immunohistochemistry (IHC) findings showed a malignant phyllodes tumor with an angiosarcoma component. Because of tumor invasion of the chest wall, we recommended the patient receive radiotherapy, but she refused. Two months after surgery, recurrence of the malignant phyllodes tumor with right axillary lymph node involvement and lung metastasis was confirmed.

Conclusion

Initial surgical resection of giant phyllodes tumors is often challenging. For initial presentation with unresectable giant phyllodes tumor, we recommend to perform TACE prior to surgery. In our patient, preoperative TACE was effective and safe. If the tumor has invaded the chest wall, early radiotherapy after surgery may be recommended for preventing recurrence.

An investigation of efficacy, safety, and prognostic factors of drug-eluting beads-transarterial chemoembolization operation with CalliSpheres® Microspheres in treating Chinese hepatocellular carcinoma patients

BACKGROUND

We aimed to investigate treatment response, survival profiles, safety profiles, and predictive factors of drug-eluting beads-transarterial chemoembolization (DEB-TACE) with CalliSpheres^® Microspheres (CSM) in treating Chinese hepatocellular carcinoma (HCC) patients.

METHODS

A total of 66 HCC patients about to receive DEB-TACE with CSM therapy were consecutively enrolled in this prospective cohort study. Treatment response was recorded. Besides, progression-free survival (PFS) and overall survival (OS) were also recorded. All adverse events including pain, nausea, vomiting, fever, and liver function damage were recorded during hospitalization.

RESULTS

37.9% of patients achieved complete response (CR) and 81.8% of patients achieved an objective response rate (ORR). For survival, mean PFS and OS were 13.7 (11.7-15.8) months and 18.8 (95% CI: 16.3-21.2) months, respectively. Multivariate logistic regression analysis revealed that a number of nodules ≥2 was an independent factor for worse CR; moreover, multivariate Cox's regression analysis disclosed that largest sample size ≥5 cm was an independent factor for shorter PFS, and Child-Pugh B and BCLC stage B/C were independent predictive factors for unfavorable OS. As to AEs, numbers of patients suffered liver function damage, pain, nausea, vomiting, and fever were 29 (43.9%), 27 (40.9%), 22 (33.3%), 13 (19.7%), and 37 (56.1%), respectively.

CONCLUSION

Drug-eluting beads-transarterial chemoembolization with CSM is an effective and tolerated treatment for Chinese HCC patients, and number of nodules ≥2, largest nodule size ≥5 cm, Child-Pugh stage B, and BCLC stage B/C correlates with unfavorable prognosis.