Chemoembolization of hepatocellular carcinoma with drug eluting beads: Efficacy and doxorubicin pharmacokinetics

Background/Aims

This study assesses the safety, pharmacokinetics and efficacy of transarterial chemoembolization using drug eluting beads (DEB), an embolizing device that slowly releases chemotherapy to decrease systemic toxicity.

Methods

Twenty-seven Child-Pugh A cirrhotics (76% male, 59% HCV) with untreated large/multifocal HCC received chemoembolization with doxorubicin loaded DEBs at doses adjusted for bilirubin and body surface (range: 47–150mg). Clinical and analytical data were recorded at 24 and 48h, 7, 14 and 30days after first and second TACE. Response rate was assessed by CT at 6months. Blood samples were obtained in 13 patients at 5, 20, 40, 60, 120min, 6, 24, 48 and 168h to determine doxorubicin C_max and AUC.

Results

DEB-TACE was well tolerated with an acceptable safety profile. Two cases developed liver abscess, one leading to death. Response rate was 75% (66.6% on intention-to-treat). Doxorubicin C_max and AUC were significantly lower in DEB-TACE patients (78.97±38.3ng/mL and 662.6±417.6ng/mLmin) than in conventional TACE (2341.5±3951.9ng/mL and 1812.2±1093.7ng/mLmin, p=0.00002 and p=0.001, respectively). After a median follow-up of 27.6months, 1- and 2-year survival is 92.5% and 88.9%, respectively.

Conclusions

Chemoembolization using DEBs is an effective procedure with a favorable pharmacokinetic profile.