title: Chemoembolization with drug eluting beads preloaded with irinotecan (DEBIRI) vs doxorubicin (DEBDOX) as a second line treatment for liver metastases from cholangiocarcinoma: a preliminary study.
abstract: OBJECTIVE
  The aim of our preliminary study was to compare the efficacy of drug-eluting beads preloaded with irinotecan (DEBIRI) vs drug-eluting beads preloaded with doxorubicin (DEBDOX) as second-line treatment of unresectable liver metastases from cholangiocarcinoma (CCA).
  
  
  METHODS
  In 2013, 10 patients affected by multiple liver metastases from CCA, resistant to the first-line chemotherapy regimen, were enrolled: 5 patients were submitted to lobar/segmental transarterial chemoembolization (TACE) with DEBIRI (100-mg irinotecan/1 vial) and 5 patients with DEBDOX (50-mg doxorubicin/1 vial), performed every 3 weeks. Patients treated with DEBIRI received antipain premedication consisting of 30-mg of morphine and 3-4 ml of intra-arterial lidocaine. Complications and efficacy were assessed (response evaluation criteria in solid tumour 1.1).
  
  
  RESULTS
  A total of 32 TACE were performed (mean: 3.2 TACE/patient), all well tolerated, with only 1 case of asymptomatic cholecystitis spontaneously recovered. Response rates of patients treated with DEBDOX and DEBIRI were: 4/5 progressive disease and 1/5 partial response vs 2/5 partial response, 2/5 stable disease and 1/5 progressive disease, respectively, with the appearance of variable necrosis percentage. Progression-free survival from the first procedure and progressive disease were 12.67 weeks for DEBIRI and 15.78 weeks for DEBDOX, respectively. Overall survival from time of primary diagnosis was 176 weeks for DEBIRI and 125 weeks for DEBDOX, respectively.
  
  
  CONCLUSIONS
  In our preliminary experience, DEBIRI was more effective than DEBDOX as a second-line treatment for hepatic metastases from CCA. Antipain drug administration and the use of the microcatheter led to a good treatment tolerability and a low complication rate. Advances in knowledge: In our preliminary experience, DEBIRI was more effective than DEBDOX as a second-line treatment of hepatic metastases from CCA; further studies involving a larger cohort of patients are needed.
authors: 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy.
authors: Massimo
authors: M
authors: Venturini
authors: 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy.
authors: Claudio
authors: C
authors: Sallemi
authors: 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy.
authors: Giulia
authors: G
authors: Agostini
authors: 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy.
authors: Paolo
authors: P
authors: Marra
authors: 2 Department of Oncology, San Raffaele Scientific Institute, Milan, Italy.
authors: Stefano
authors: S
authors: Cereda
authors: 2 Department of Oncology, San Raffaele Scientific Institute, Milan, Italy.
authors: Michele
authors: M
authors: Reni
authors: 3 Department of Hepatobiliary Surgery, San Raffaele Scientific Institute, Milan, Italy.
authors: Luca
authors: L
authors: Aldrighetti
authors: 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy.|4 Vita-Salute University, San Raffaele Hospital, Milan, Italy.
authors: Francesco
authors: F
authors: De Cobelli
authors: 1 Department of di Radiology, San Raffaele Scientific Institute, Milan, Italy.|4 Vita-Salute University, San Raffaele Hospital, Milan, Italy.
authors: Alessandro
authors: A
authors: Del Maschio
mesh_terms: D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage*; D000972:Antineoplastic Agents, Phytogenic / Q000008:administration & dosage*; D001650:Bile Duct Neoplasms / Q000473:pathology*; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016461:Chemoembolization, Therapeutic / Q000379:methods*; D018281:Cholangiocarcinoma / Q000188:drug therapy* / Q000556:secondary*; D003287:Contrast Media; D004317:Doxorubicin / Q000008:administration & dosage*; D016503:Drug Delivery Systems; D005260:Female; D006801:Humans; D000077146:Irinotecan; D008113:Liver Neoplasms / Q000188:drug therapy* / Q000556:secondary*; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D000903:Antibiotics, Antineoplastic; D000972:Antineoplastic Agents, Phytogenic; D003287:Contrast Media; D000077146:Irinotecan; D004317:Doxorubicin; D002166:Camptothecin