Improved efficacy of transcatheter arterial chemoembolization using warmed miriplatin for hepatocellular carcinoma.

Daisuke Yasui,Shiro Onozawa,Satoru Murata,Takahiko Mine,Eiji Uchida,Chiaki Kawamoto,Tatsuo Ueda,Fumie Sugihara,Shin-Ichiro Kumita

doi:10.1155/2014/359296

Abstract

The aim of this study was to evaluate the efficacy and safety of transcatheter arterial chemoembolization (TACE) using warmed and nonwarmed miriplatin for hepatocellular carcinoma. Eighty patients (117 nodules), treated between January 2010 and June 2013, were evaluated. Thirty-two and 85 nodules were treated with nonwarmed and warmed miriplatin, respectively. The efficacy of TACE was evaluated on a per nodule basis according to treatment effect (TE). Adverse events were evaluated according to the Common Terminology Criteria for Adverse Events (CTCAE) v4.0. TE grades were significantly improved in the warmed group compared to the nonwarmed group (nonwarmed: TE 4, 12.5%; TE 3, 0%; TE 2, 15.6%; TE 1, 71.9%; warmed: TE 4, 34.1%; TE 3, 5.9%; TE 2, 9.4%; TE 1, 50.6%; P = 0.017) . Multivariate analysis revealed significant impact of warming miriplatin on objective response rate (odds ratio, 12.35; 95% confidence interval, 2.90–90.0; P = 0.0028). CTCAE grades of elevated aspartate and alanine transaminase after TACE were significantly higher in the warmed group (P = 0.0083 and 0.0068, resp.); however, all adverse events were only transient. The use of warmed miriplatin in TACE significantly improved TE without causing serious complications.

Highlights

Transcatheter arterial chemoembolization (TACE) is a standard therapy for intermediate stage unresectable hepatocellular carcinoma (HCC) [1]
Patients were eligible for this retrospective study if they were diagnosed with HCC by either contrast-enhanced dynamic computed tomography or dynamic magnetic resonance imaging using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid
The improved efficacy of warmed miriplatin compared to nonwarmed miriplatin when used in transcatheter arterial chemoembolization (TACE) for HCC was demonstrated; both treatment effect (TE) and Objective response rate (ORR) were improved in the warmed miriplatin group

Summary

Introduction

Transcatheter arterial chemoembolization (TACE) is a standard therapy for intermediate stage unresectable hepatocellular carcinoma (HCC) [1]. Previous randomized controlled studies have shown that TACE prolongs survival and controls symptoms of HCC [2, 3]. Doxorubicin, epirubicin, cisplatin, and mitomycin C have been widely used as chemotherapeutic agents, either alone or in combination [4]. It is known that epirubicin, cisplatin, and mitomycin C can cause arteritis after injection, leading to hepatic artery occlusion and development of extrahepatic collateral pathways [5]. This change in vascular anatomy can make repetitive TACE difficult and limits the long-term efficacy of TACE. A new platinum agent, miriplatin ((SP-4-2)-[(1R,2R)cyclohexane-1,2-diamine-N,N󸀠] bis (tetradecanoato-O)

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