title: Lipiodol trans-arterial chemoembolization of hepatocellular carcinoma with idarubicin: first experience.
abstract: BACKGROUND
  There is still no consensus about the best chemotherapeutic agent for transarterial chemoembolization (TACE). A recent in vitro study demonstrated that idarubicin, an anthracycline, was by far the most cytotoxic drug on human hepatocellular carcinoma (HCC) cell lines. Idarubicin is much more lipophilic than doxorubicin, leading to higher cell penetration through lipidic membranes and greater accumulation of the drug in the lipiodol. Furthermore, idarubicin has the ability to overcome multidrug resistance. Therefore, we designed this pilot human study to evaluate the safety and efficacy of lipiodol TACE using idarubicin.
  
  
  METHODS
  In 21 consecutive patients treated by lipiodol TACE with idarubicin (10 mg) for HCC, safety data, tumor response (Response Evaluation Criteria in Solid Tumors, mRECIST), time to treatment failure (TTTF), and overall survival were evaluated.
  
  
  RESULTS
  Postembolization syndrome was observed after 30.9% (17 of 55) of sessions. No patient died from a TACE-related complication. No hematological grade 3-5 adverse event was observed. At least one grade 3 or higher adverse event occurred in 19% (4 of 21) of patients. On imaging, no progression was encountered; four patients (24%) exhibited stable disease, 12 (57%) exhibited a partial response, and five (19%) exhibited a complete response. Median TTTF was 16.7 months (Kaplan-Meier analysis). At 6 months, 94.7% (95% confidence interval [CI] 68.1-99.2) of patients did not reach treatment failure, whereas treatment failure was not reached in 50.6% (95% CI 21.6-73.9) of patients at 1 year. Overall survival was 83.5% (95% CI 57-94.4) at 1 year.
  
  
  CONCLUSIONS
  Idarubicin seems safe and effective in lipiodol TACE of HCC. This warrants further study to determine the potential of this drug to replace doxorubicin for TACE.
authors.affiliation: Digestive, Thoracic and Oncologic Unit, Department of Diagnostic and Interventional Radiology, University Hospital of Dijon, 14, rue Paul Gaffarel, Dijon, 21000, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Favelier
authors.forename: Mathieu
authors.initials: M
authors.lastname: Boulin
authors.forename: Samia
authors.initials: S
authors.lastname: Hamza
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cercueil
authors.forename: Violaine
authors.initials: V
authors.lastname: Cherblanc
authors.forename: Côme
authors.initials: C
authors.lastname: Lepage
authors.forename: Patrick
authors.initials: P
authors.lastname: Hillon
authors.forename: Bruno
authors.initials: B
authors.lastname: Chauffert
authors.forename: Denis
authors.initials: D
authors.lastname: Krausé
authors.forename: Boris
authors.initials: B
authors.lastname: Guiu
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D015331:Cohort Studies; D016001:Confidence Intervals; D018572:Disease-Free Survival; D004998:Ethiodized Oil / Q000008:administration & dosage*; D005260:Female; D005263:Femoral Artery; D005500:Follow-Up Studies; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage*; D007261:Infusions, Intra-Arterial; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D011446:Prospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D004998:Ethiodized Oil; D015255:Idarubicin