Drug-eluting beads bronchial arterial chemoembolization plus intercostals arterial infusion chemotherapy is effective and well-tolerated in treating non-small cell lung cancer patients with refractory malignant pleural effusion

Drug-eluting beads bronchial arterial chemoembolization in advanced and standard treatment-refractory/ineligible non-small cell lung cancer

Background

The treatment strategy for previously standard treated non-small cell lung cancer (NSCLC) still remains challenged. This study was to evaluate the effectiveness and safety of epirubicin-loaded drug-eluting bead transbronchial artery chemoembolization (D-BACE) plus bronchial artery infusion chemotherapy (BAIC) in patients with refractory advanced NSCLC.

Methods

Between January 2018 and December 2022, 32 patients with refractory advanced NSCLC [26 males; mean age of 64±9.3 (range, 41-78) years; 19 squamous carcinomas (59.4%)] who had received one or more previous standard treatments and received D-BACE (epirubicin 50 mg) plus BAIC (lobaplatin 30 mg/m2) were included in our study. The study evaluated several parameters including local tumor response based on Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 criteria, progression-free survival (PFS), overall survival (OS), and complication rates. To examine the impact of different factors on PFS and OS, Kaplan-Meier and Cox regression analyses were performed.

Results

A total of 68 D-BACE plus BAIC sessions (median, 1, range 1-7) were performed. Overall response and disease control rates were 25% and 100%, respectively. The median PFS and median OS were 6.0 months [95% confidence interval (CI): 4.1-7.9] and 14.0 months (95% CI: 4.8-23.2), respectively. The number of cycles in the D-BACE plus BAIC treatment was found to be an independent predictor of PFS and OS. There were no instances of severe procedure-related complications or deaths during the study.

Conclusions

The combination of D-BACE and BAIC shows great potential as a treatment choice for patients with refractory advanced NSCLC.

Role of drug-eluting bead bronchial arterial chemoembolisation in the treatment of non-small cell lung cancer: protocol for a meta-analysis

BACKGROUND

Non-small cell lung cancer (NSCLC) has a poor prognosis. Transvascular intervention is an important approach for treating NSCLC. Drug-eluting bead bronchial artery chemoembolisation (DEB-BACE) is a technique of using DEBs loaded with chemotherapeutic drugs for BACE. This study aims to conduct a meta-analysis to comprehensively assess the effectiveness and safety of DEB-BACE in treating NSCLC and investigate a novel therapeutic strategy for NSCLC.

METHODS AND ANALYSIS

Wanfang, China National Knowledge Infrastructure, Medline (via PubMed), Cochrane Library, Scopus and Embase databases will be searched in November 2024. A meta-analysis will be conducted to assess the effectiveness and safety of DEB-BACE in the treatment of NSCLC. The following keywords will be applied: "Carcinoma, Non-Small-Cell Lung", "Non-Small Cell Lung Cancer", "Drug-Eluting Bead Bronchial Arterial Chemoembolization" and "drug-eluting beads". Reports in Chinese or English comparing the efficacy of DEB-BACE with other NSCLC treatment options will be included. Case reports, single-arm studies, conference papers, abstracts without full text and reports published in languages other than English and Chinese will not be considered. The Cochrane Handbook for Systematic Reviews of Interventions will be used to independently assess the risk of bias for each included study. In case of significant heterogeneity between studies, possible sources of heterogeneity will be explored through subgroup and sensitivity analysis. For the statistical analysis of the data, RevMan V.5.3 will be used.

ETHICS AND DISSEMINATION

This meta-analysis will seek publication in a peer-reviewed journal on completion. Ethical approval is not required for this study as it is a database-based study.

PROSPERO REGISTRATION NUMBER

CRD42023411392.

Drug-eluting beads bronchial arterial chemoembolization vs. conventional bronchial arterial chemoembolization in the treatment of advanced non-small cell lung cancer

Purpose

To compare the effectiveness and safety of drug-eluting bead bronchial artery chemoembolization (DEB-BACE) with conventional bronchial artery chemoembolization (cBACE) and provide a novel treatment option for advanced non-small cell lung cancer (NSCLC).

Methods

Patients with advanced NSCLC underwent DEB-BACE or cBACE and were screened retrospectively. Progression-free survival (PFS) and overall survival (OS) were the primary outcome indicators, while technical success rate, objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) were the secondary ones.

Results

A total of 41 patients were enrolled in the study, 12 in the DEB-BACE group and 29 in the cBACE group, according to the treatment regimen. No patient achieved complete response. Eighteen patients achieved partial response (9 in each group), 15 patients achieved stable disease (3 in the DEB-BACE group and 12 in the cBACE group), and eight patients achieved progressive disease (all in the cBACE group) when treated for 2 months. The overall ORR and DCR were 43.9% (18/41) and 80.5% (33/41), respectively. ORR and DCR in the DEB-BACE group were 50.0% (9/12) and 100.0% (12/12), respectively, while ORR and DCR in the cBACE group were 31.0% (9/29) and 72.4% (21/29), respectively. Compared to cBACE, the ORR and DCR of DEB-BACE were significantly improved (p < 0.05). The median PFS was better in the DEB-BACE group than in the cBACE group (6.95 months vs. 3.20 months, respectively, Hazard Ratio [HR] = 0.416; p = 0.005). Furthermore, the median OS was significantly better in the DEB-BACE group than in the cBACE group (28.5 months vs. 22.5 months, respectively, HR = 0.316; p = 0.020).

Conclusion

DEB-BACE has a good safety and therapeutic profile in advanced NSCLC and is superior to cBACE. DEB-BACE can be used as an alternative treatment option for advanced NSCLC, even in elderly patients.

Bronchial artery chemoembolization with drug-eluting beads versus bronchial artery infusion followed by polyvinyl alcohol particles embolization for advanced squamous cell lung cancer: A retrospective study

PURPOSE

To analyze the efficacy and safety of bronchial arterial embolization (BACE) with drug-eluting beads (DEB) versus bronchial artery infusion (BAI) followed by polyvinyl alcohol (PVA) particle embolization for the treatment of advanced squamous cell lung cancer after the failure of systemic therapy.

METHOD

Thirty-six patients with advanced squamous cell lung cancer who underwent bronchial arterial interventional therapy were included in this retrospective study. The DEB group (n = 20) was treated with nedaplatin and DEB loaded with gemcitabine, and the PVA group (n = 16) BAI with nedaplatin and gemcitabine followed by embolization with PVA particles. The treatment efficacy and complications were analyzed.

RESULTS

The technical success rate was 100 %. The two groups were followed up for a median period of 8.9 months. The mean overall survival (OS) in the DEB group was 12.6 months (95 % CI:9.99-15.21), which was significantly longer than 8.14 months (95 % CI:6.07-10.2) in the PVA group (p = 0.007). The median progression-free survival (PFS) in the DEB group was 4.3 months (95 % CI:2.33-6.27), significantly longer than 3.2 months (95 % CI:2.55-3.85) in the PVA group (p = 0.030). The objective response rate (ORR) six months after the procedure was 50 % in the DEB group and 12.5 % in the PVA group. In the univariate and multivariate analyses, DEB-BACE was an independent prognostic factor for survival. Only grade 1 adverse events like fever, chest pain, and cough were seen.

CONCLUSIONS

DEB-BACE may be a good choice for patients with advanced lung squamous cell carcinoma, as it could prolong OS and PFS without increasing adverse events.

Clinical outcomes of vinorelbine loading CalliSpheres beads in the treatment of previously treated advanced lung cancer with progressive refractory obstructive atelectasis

Background: Drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) has been used in the treatment of locally advanced lung cancer and has the potential to improve outcomes and reduce recurrence. However, DEB-BACE shows a poor therapeutic effect in advanced lung cancer after failure of multiple therapies. This study assessed the effect of DEB-BACE in the treatment of progressive lung cancer with refractory obstructive atelectasis. Methods: Progressive advanced lung cancer patients with refractory obstructive atelectasis were voluntarily enrolled in this study after failure of multiple conventional therapies. Baseline information, DEB-BACE treatment process, and changes in clinical symptoms were recorded. The primary endpoints were the objective response rate (ORR) and improvement rate of dyspnea. The secondary endpoints were time-to-progression (TTP), overall survival (OS), and rate of pulmonary re-expansion. Treatment-related adverse events and serious adverse events were analyzed to assess the safety of DEB-BACE. The Cox regression model was performed to analyze the possible factors impacting prognosis of DEB-BACE. Results: DEB-BACE was successfully performed with CalliSpheres beads loaded with vinorelbine in the 20 enrolled patients. ORR and disease control rate were 80% and 85%, respectively, at the first follow-up (43.4 ± 15.26 days). The improvement rate of dyspnea was 85% and 80% at 1 week and 1 month (p < 0.0001, p < 0.0001), respectively. TTP was 41.25 ± 14.43 days and 89.55 ± 61.7 days before and after DEB-BACE, respectively; DEB-BACE delayed the progression of advanced lung cancer (p < 0.0001). OS was 238.03 ± 33.74 days (95% confidence interval: 171.9-304.16). The rate of pulmonary re-expansion was 80% at the first follow-up. The reasons for poor prognosis were tumor necrosis, longer disease duration, and pulmonary atelectasis duration (p = 0.012, p = 0.038, p = 0.029). Massive hemoptysis was observed in two cases, and one patient died of asphyxia caused by hemoptysis. Moderate hemoptysis occurred in one case. All three adverse events were considered as the result of the tumor cavity after DEB-BACE. Conclusion: DEB-BACE loaded with vinorelbine is a feasible option for progressive advanced lung cancer with obstructive atelectasis after failure of other treatments.

The Efficacy of Drug-eluting Bead Transarterial Chemoembolization Loaded With Oxaliplatin for the Treatment of Stage III-IV Non-small-cell Lung Cancer

RATIONALE AND OBJECTIVES

To explore the safety and efficacy of drug-eluting bead transarterial chemoembolization (DEB-TACE) loaded with oxaliplatin for stage III-IV non-small-cell lung cancer (NSCLC).

MATERIALS AND METHODS

From October 2018 to May 2021, a total of 31 patients with stage III-IV NSCLC received DEB-TACE loaded with oxaliplatin. Demographic characteristics, adverse events (AEs), and treatment responses were collected. Overall survival (OS) and progression-free survival (PFS) were calculated using the Kaplan-Meier method.

RESULTS

All 31 patients successfully received DEB-TACE loaded with oxaliplatin. No procedure-related severe adverse events occurred. Hemoptysis symptoms presented in 8 patients but disappeared within 1-3 days. After DEB-TACE for 1, 2, and 6 months, the objective response rate (ORR) was 42%, 35%, and 26%, while the disease control rate (DCR) was 90%, 84% and 61%, respectively. The median PFS was 7 months (range 1-31 months), and the PFS rates at 3, 6, and 12 months were 87%, 71% and 29%, respectively. The median OS was 11 months (range 1-31 months), with OS rates of 87%, 77%, and 39% at 3, 6, and 12 months, respectively.

CONCLUSION

Oxaliplatin-loaded DEB-TACE is a feasible, safe, and effective treatment for patients with advanced refractory non-small-cell lung cancer.

Efficacy and safety of drug-eluting beads bronchial arterial chemoembolization versus conventional bronchial arterial chemoembolization in lung cancer patients with hemoptysis

Background: This study aimed to explore the efficacy and safety of drug-eluting beads bronchial arterial chemoembolization (DEB-BACE) compared with conventional bronchial arterial chemoembolization (cBACE) in lung cancer patients with hemoptysis. Materials & methods: Thirty-six lung cancer patients with hemoptysis treated by DEB-BACE or cBACE were retrospectively analyzed. Results: Technical success of BACE and clinical success of hemoptysis treatment were no different between DEB-BACE and cBACE (both p > 0.050), whereas DEB-BACE achieved increased total clinical response (p = 0.021), objective response rate (p = 0.035) and prolonged hemoptysis relapse-free survival (p = 0.013) compared with cBACE. The adverse event rates were similar between these two groups (all p > 0.05). Conclusion: DEB-BACE presents with higher tumor treatment response, prolonged hemoptysis relapse-free survival and comparable safety profiles compared with cBACE in lung cancer patients with hemoptysis.

Advancements in Interventional Oncology of the Chest: Transarterial Chemoembolization and Related Therapies

While embolization therapy has been used for many years in the treatment of nonmalignant diseases of the chest, such as pulmonary arteriovenous malformation treatment and bronchial artery embolization for hemorrhage, the application of transarterial techniques to the treatment of chest neoplasms is relatively uncommon. Extrapolating from transarterial chemoembolization techniques used for liver malignancy, investigators have recently sought to expand the indications for transarterial techniques from the control of symptoms such as bleeding to the control of disease progression and potentially survival benefit in patients with malignancies in the chest. This article provides an overview of the current embolotherapy techniques used in the treatment of patients with thoracic malignancies.