Safety and feasibility of repeatable hepatic vascular isolation chemotherapy: a pilot study

Rodney J. Lane, Nyan Y. Khin, Chris M. Rogan, John Magnussen, Nick Pavlakis, David M. Lane, Stephen Clarke

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: The authors herein describe a novel method of repeatable hepatic isolation using an implantable access system allowing simultaneous control of hepatic arterial and portal flows by multiple endovascular catheters.

    Purpose: The aim of this study was to assess the feasibility and safety of the system and to compress standard intravenous chemotherapy into 4 weeks of targeted intra-arterial delivery.

    Methods: An arterial access system was implanted to the axillary artery via an anastomosis. Infusions of oxaliplatin were performed biweekly for 4 weeks, using balloon catheters to achieve hepatic isolation and segmental selectivity for 20–25 min. Fifty-seven treatments under general anesthetic were performed in ten patients with inoperable chemotherapy-refractory metastatic colorectal cancer. Systemic, intrahepatic, and hepatic venous pressures were recorded to assess vascular isolation, and platinum levels were measured to assess chemotherapy distribution.

    Results: Pressure verified, multiple day-only hepatic vascular isolation infusions were achieved in nine of ten patients, with a single patient receiving multiple hepatic arterial infusions. Positron emission tomography–computed tomography (PET–CT) imaging confirmed partial response in three of ten patients and stable disease in three of ten patients. Systemic toxicity was minimal as all treatment-related gastrointestinal and neuropathic symptoms reported throughout the 4 weeks were grades 1–2.

    Conclusions: Intra-arterial chemotherapy infusions with hepatic vascular isolation can be achieved repeatedly with targeted selectivity and minimal complications using an implantable multicatheter access system. Oxaliplatin infusions over a 4-week period may achieve tumor response in selected patients in the salvage setting. The technique should be further assessed in a phase Ib/II study.

    LanguageEnglish
    Pages3699-3708
    Number of pages10
    JournalAnnals of Surgical Oncology
    Volume23
    Issue number11
    DOIs
    Publication statusPublished - 1 Oct 2016

    Fingerprint

    Blood Vessels
    oxaliplatin
    Safety
    Drug Therapy
    Liver
    Catheters
    Axillary Artery
    Intra Arterial Infusions
    General Anesthetics
    Venous Pressure
    Platinum
    Colorectal Neoplasms
    Pressure
    Therapeutics
    Neoplasms

    Cite this

    Lane, Rodney J. ; Khin, Nyan Y. ; Rogan, Chris M. ; Magnussen, John ; Pavlakis, Nick ; Lane, David M. ; Clarke, Stephen. / Safety and feasibility of repeatable hepatic vascular isolation chemotherapy : a pilot study. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 11. pp. 3699-3708.
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    abstract = "Background: The authors herein describe a novel method of repeatable hepatic isolation using an implantable access system allowing simultaneous control of hepatic arterial and portal flows by multiple endovascular catheters. Purpose: The aim of this study was to assess the feasibility and safety of the system and to compress standard intravenous chemotherapy into 4 weeks of targeted intra-arterial delivery. Methods: An arterial access system was implanted to the axillary artery via an anastomosis. Infusions of oxaliplatin were performed biweekly for 4 weeks, using balloon catheters to achieve hepatic isolation and segmental selectivity for 20–25 min. Fifty-seven treatments under general anesthetic were performed in ten patients with inoperable chemotherapy-refractory metastatic colorectal cancer. Systemic, intrahepatic, and hepatic venous pressures were recorded to assess vascular isolation, and platinum levels were measured to assess chemotherapy distribution. Results: Pressure verified, multiple day-only hepatic vascular isolation infusions were achieved in nine of ten patients, with a single patient receiving multiple hepatic arterial infusions. Positron emission tomography–computed tomography (PET–CT) imaging confirmed partial response in three of ten patients and stable disease in three of ten patients. Systemic toxicity was minimal as all treatment-related gastrointestinal and neuropathic symptoms reported throughout the 4 weeks were grades 1–2. Conclusions: Intra-arterial chemotherapy infusions with hepatic vascular isolation can be achieved repeatedly with targeted selectivity and minimal complications using an implantable multicatheter access system. Oxaliplatin infusions over a 4-week period may achieve tumor response in selected patients in the salvage setting. The technique should be further assessed in a phase Ib/II study.",
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    Safety and feasibility of repeatable hepatic vascular isolation chemotherapy : a pilot study. / Lane, Rodney J.; Khin, Nyan Y.; Rogan, Chris M.; Magnussen, John; Pavlakis, Nick; Lane, David M.; Clarke, Stephen.

    In: Annals of Surgical Oncology, Vol. 23, No. 11, 01.10.2016, p. 3699-3708.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Safety and feasibility of repeatable hepatic vascular isolation chemotherapy

    T2 - Annals of Surgical Oncology

    AU - Lane,Rodney J.

    AU - Khin,Nyan Y.

    AU - Rogan,Chris M.

    AU - Magnussen,John

    AU - Pavlakis,Nick

    AU - Lane,David M.

    AU - Clarke,Stephen

    PY - 2016/10/1

    Y1 - 2016/10/1

    N2 - Background: The authors herein describe a novel method of repeatable hepatic isolation using an implantable access system allowing simultaneous control of hepatic arterial and portal flows by multiple endovascular catheters. Purpose: The aim of this study was to assess the feasibility and safety of the system and to compress standard intravenous chemotherapy into 4 weeks of targeted intra-arterial delivery. Methods: An arterial access system was implanted to the axillary artery via an anastomosis. Infusions of oxaliplatin were performed biweekly for 4 weeks, using balloon catheters to achieve hepatic isolation and segmental selectivity for 20–25 min. Fifty-seven treatments under general anesthetic were performed in ten patients with inoperable chemotherapy-refractory metastatic colorectal cancer. Systemic, intrahepatic, and hepatic venous pressures were recorded to assess vascular isolation, and platinum levels were measured to assess chemotherapy distribution. Results: Pressure verified, multiple day-only hepatic vascular isolation infusions were achieved in nine of ten patients, with a single patient receiving multiple hepatic arterial infusions. Positron emission tomography–computed tomography (PET–CT) imaging confirmed partial response in three of ten patients and stable disease in three of ten patients. Systemic toxicity was minimal as all treatment-related gastrointestinal and neuropathic symptoms reported throughout the 4 weeks were grades 1–2. Conclusions: Intra-arterial chemotherapy infusions with hepatic vascular isolation can be achieved repeatedly with targeted selectivity and minimal complications using an implantable multicatheter access system. Oxaliplatin infusions over a 4-week period may achieve tumor response in selected patients in the salvage setting. The technique should be further assessed in a phase Ib/II study.

    AB - Background: The authors herein describe a novel method of repeatable hepatic isolation using an implantable access system allowing simultaneous control of hepatic arterial and portal flows by multiple endovascular catheters. Purpose: The aim of this study was to assess the feasibility and safety of the system and to compress standard intravenous chemotherapy into 4 weeks of targeted intra-arterial delivery. Methods: An arterial access system was implanted to the axillary artery via an anastomosis. Infusions of oxaliplatin were performed biweekly for 4 weeks, using balloon catheters to achieve hepatic isolation and segmental selectivity for 20–25 min. Fifty-seven treatments under general anesthetic were performed in ten patients with inoperable chemotherapy-refractory metastatic colorectal cancer. Systemic, intrahepatic, and hepatic venous pressures were recorded to assess vascular isolation, and platinum levels were measured to assess chemotherapy distribution. Results: Pressure verified, multiple day-only hepatic vascular isolation infusions were achieved in nine of ten patients, with a single patient receiving multiple hepatic arterial infusions. Positron emission tomography–computed tomography (PET–CT) imaging confirmed partial response in three of ten patients and stable disease in three of ten patients. Systemic toxicity was minimal as all treatment-related gastrointestinal and neuropathic symptoms reported throughout the 4 weeks were grades 1–2. Conclusions: Intra-arterial chemotherapy infusions with hepatic vascular isolation can be achieved repeatedly with targeted selectivity and minimal complications using an implantable multicatheter access system. Oxaliplatin infusions over a 4-week period may achieve tumor response in selected patients in the salvage setting. The technique should be further assessed in a phase Ib/II study.

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    VL - 23

    SP - 3699

    EP - 3708

    JO - Annals of Surgical Oncology

    JF - Annals of Surgical Oncology

    SN - 1068-9265

    IS - 11

    ER -