Clinical efficacy of radioembolisation (RE) using 188Re-human serum albumin (HAS) microspheres in patients with progressive, unresectable primary or secondary liver cancers

Objectives To evaluate the clinical and radiological effectiveness of radioembolisation (RE) using 188Re-human serum albumin (HSA) microspheres in patients with advanced, progressive, unresectable primary or secondary liver cancers, not suitable to any other form of therapy.

Methods Overall 13 pts with 20 therapy sessions, had RE with 188Re HSA microspheres. The administered activity was calculated base on empirical methods, depended on tumor/liver involvement and functional status of the liver and general patient condition. Sequential post-therapy scans were used to calculate personal internal dosimetry. Clinical responses were assessed, 6 weeks (W) after completing therapy, and then after each of the 3 M. The objective response was classified according to RECIST v. 1.1. Toxicity base on CTC NCI v. 3.1.

Results Mean administered activity of 188Re HSA was 7.24 GBq (3.8-12.4). Median OS for all pts was 5 M and PFS 3 M. In selected group of patients those who had clinical partial response(PR), or stable disease (SD), and disease progression (DP) 6 weeks after therapy median OS was 9/5/4 M and PFS 5/2/0 M. Very High labeling efficacy over 97 + 2.1% and low urinary excretion of 188Re (6.5± 2.3%).The toxicity was an acceptable level, immediately after RE only grade 2, after 6 W single case had grade 3 (bilirubin and liver enzymes). After 3 M grade 3 toxicity in 4 pts (bilirubin), 2 pts (liver enzymes) and single albumin depletion, mostly related to rapid disease progresion (DP). After 3 M radiological response was reported only in 2 pts, stable disease in 13 pts and rest had DP.

Conclusions 188Re HSA RE seems to be an option of palliative therapy in patients with extensive progressive liver cancer; is well tolerated in most of the patients with low level of toxicity during and within 3 months of follow-up