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Intra-arterial idarubicin_lipiodol without embolisation in hepatocellular carcinoma: The LIDA-B phase I trial.
- Source :
-
Journal of hepatology [J Hepatol] 2018 Jun; Vol. 68 (6), pp. 1163-1171. Date of Electronic Publication: 2018 Feb 08. - Publication Year :
- 2018
-
Abstract
- Background & Aims: Idarubicin shows high cytotoxicity against hepatocellular carcinoma (HCC) cells, a high hepatic extraction ratio, and high lipophilicity leading to stable emulsions with lipiodol. A dose-escalation phase I trial of idarubicin&#95;lipiodol (without embolisation) was conducted in patients with cirrhotic HCC to estimate the maximum-tolerated dose (MTD) and to assess the safety, efficacy, and pharmacokinetics of the drug, and the health-related quality of life achieved by patients.<br />Methods: Patients underwent two sessions of treatment with a transarterial idarubicin&#95;lipiodol emulsion without embolisation. The idarubicin dose was escalated according to a modified continuous reassessment method. The MTD was defined as the dose closest to that causing dose-limiting toxicity (DLT) in 20% of patients.<br />Results: A group of 15 patients were enrolled, including one patient at 10 mg, four patients at 15 mg, seven patients at 20 mg, and three patients at 25 mg. Only two patients experienced DLT: oedematous ascitic decompensation and abdominal pain at 20 and 25 mg, respectively. The calculated MTD of idarubicin was 20 mg. The most frequent grade ≥3 adverse events were biological. One month after the second session, the objective response rate was 29% (complete response, 0%; partial response, 29%) based on modified Response Evaluation Criteria In Solid Tumours. The median time to progression was 5.4 months [95% confidence limit (CI) 3.0-14.6 months] and median overall survival was 20.6 months (95% CI 5.7-28.7 months). Pharmacokinetic analysis of idarubicin showed that the mean C <subscript>max</subscript> of idarubicin after intra-arterial injection of the idarubicin-lipiodol emulsion is approximately half the C <subscript>max</subscript> after intravenous administration. Health-related quality of life results confirmed the good safety results associated with use of the drug.<br />Conclusions: The MTD of idarubicin was 20 mg after two chemolipiodolisation sessions. Encouraging safety results, and patient responses and survival were observed. A phase II trial has been scheduled.<br />Lay Summary: There is a need for transarterial regimens that improve the responses and survival of patients with unresectable HCC. In this phase I trial, we showed that two sessions of treatment with a transarterial idarubicin&#95;lipiodol emulsion without embolisation was well tolerated and gave promising efficacy in terms of tumour control and patient survival.<br /> (Copyright © 2018 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Aged
Antibiotics, Antineoplastic blood
Antibiotics, Antineoplastic toxicity
Carcinoma, Hepatocellular blood
Emulsions
Ethiodized Oil administration & dosage
Female
Humans
Idarubicin blood
Idarubicin toxicity
Injections, Intra-Arterial
Liver Neoplasms blood
Male
Maximum Tolerated Dose
Middle Aged
Quality of Life
Safety
Treatment Outcome
Antibiotics, Antineoplastic administration & dosage
Carcinoma, Hepatocellular drug therapy
Idarubicin administration & dosage
Liver Neoplasms drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1600-0641
- Volume :
- 68
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- Journal of hepatology
- Publication Type :
- Academic Journal
- Accession number :
- 29427728
- Full Text :
- https://doi.org/10.1016/j.jhep.2018.01.022