Epirubicin-loaded beads transarterial prostatic arterial chemoembolization is a promising treatment for advanced prostate cancer with lower urinary tract obstruction or hematuria—a case series report

BackgroundProstatic arterial embolization (PAE) is an effective minimally invasive treatment for lower urinary tract obstruction and hematuria in patients with benign prostatic hyperplasia (BPH). This study was aim to evaluate the safety and short-term efficacy of drug epirubicin-loaded beads transarterial prostatic arterial chemoembolization (DEB-PACE) for the treatment of advanced prostate cancer (PC) with lower urinary tract obstruction or hematuria.MethodsA total of 8 patients with advanced PC undergoing DEB-PACE from August 2020 to February 2022 were retrospectively enrolled. The patients were followed up at 1 week, 1, 3, 6 and 12 months after DEB-PACE. The origin of prostatic arteries, technical success, clinical success rate, duration of the indwelling urinary catheter, International Prostate Symptom Score (IPSS), QoL score (quality of life), prostate volume (PV), prostate-specific antigen (PSA) level and complications were recorded. The short-term efficacy (changes in IPSS, PV and QoL value from baseline to 3 months) were analysed.ResultsThere were 17 prostatic arteries in 8 patients, which mainly originated from internal pudendal artery (11/17, 64.7%), the technical success rate is 100%. After treatment, the symptoms of lower urethral obstruction in 8 patients were significantly improved that PSA, PV, IPSS and QoL level were significantly reduced. The catheter was successfully removed within 1 week on average, and 2 patients with hematuria disappeared within 5 days. The clinical success rate is 100%. At 1 month postoperatively, mean PV reduction was 30.28±6.963 cm³ (P=0.0457), mean IPSS reduction was 21.13±2.887 points (P=0.0042), mean QoL reduction was 3.75±0.366 points (P=0.006). At 3 months postoperatively, mean PV reduction was 46.14±8.906 cm³ (P=0.0112), mean IPSS reduction was 24.5±2.398 points (P=0.0003), mean QoL reduction was 4.25±0.25 points (P=0.0003). There were no serious complications occurred in all patients.ConclusionsDEB-PACE is a promising treatment for advanced PC with lower urinary tract obstruction or hematuria. However, the efficacy and safety of DEB-PACE for advanced PC is needed to validated by prospective large sample randomized controlled study.     

Pilot study of intravesical instillation of two new generation anthracycline antibiotics in prevention of superficial bladder cancer recurrence

Background Superficial bladder cancer accounts for 60%-70% of all bladder cancer cases in China, when treatment consists of only transurethral resection of the bladder tumor （TUR-BT）, recurrence and progresses in the bladder are observed in some patients. There are numerous reports of trials of intravesical instillation of anticancer agents with the objective of lowering this recurrence rate. The aim of this study was to compare the prophylactic efficacy and safety of epirubicin （EPI）, pirarubicin （THP） and hydroxycamptothecin （HCPT） in superficial bladder cancer.Methods This study enrolled a total of 189 patients who had been diagnosed with superficial bladder cancer during the period from 2004 through 2007 at Beijing Friendship Hospital. All patients were randomly allocated to one of three treatment groups. Patients in group A received 29 doses of EPI 30 mg/30 ml, patients in group B received 29 doses of THP 30 mg/30 ml, and patients in group C received 29 doses of HCPT 30 mg/30 ml, over a period of 24 months.Results The recurrence-free rate in the 2 anthracycline treatment groups （A and B） were significantly better than that of the HCPT treatment group. In the safety evaluation, the incidences of pollakiuria, pain on urination, dysuria, hematuria,and contracted bladder were not significantly different between groups A and B, but some were significantly higher in groups A and B than that in group C.Conclusion The efficacy of EPI and THP was significantly better than HCPT in the prevention of bladder cancer recurrence.     

Changes in Cellular Immunity during Chemotherapy for Primary Breast Cancer with Anthracycline Regimens

Abstract

Anthracyclines are the most widely used anticancer agents for breast cancer, of which doxorubicin and epirubicin have been reported to have equal efficacy. Unfortunately, the integrity of the immune system of breast cancer patients is severely affected by chemotherapy. This study compared the effect of combination chemotherapy with epirubicin (5-fluorouracil, epirubicin, cyclophosphamide (FEC)) and doxorubicin (5-fluorouracil, doxorubicin, cyclophosphamide (FDC)) regimens on subsets of the immune cells of patients with primary malignant breast tumors. Our aim was to determine the best regimen that produces the least degree of myelosuppression. Blood from 80 breast cancer patients undergoing chemotherapy (40 FEC and 40 FDC) was taken before chemotherapy and after every cycle (3 weeks) for 6 cycles. Blood was also taken from 40 normal healthy donors who served as normal control. Subsets of lymphocytes T-helper cells (CD3+CD4+), T-cytotoxic cells (CD3+CD8+), B-cells (CD19+CD20+) and NK cells (CD16+/CD56+CD3-) were analyzed by flow cytometry (FacsCalibur, BD) using monoclonal antibodies (Multitest, BD). All patients in the FEC and FDC groups suffered from myelosuppressive side effects. Both regimens led to an increase in the counts of monocytes but decreased polymorphonuclear cells (PMNs) and lymphocytes. Percentages of T-cytotoxic cells and NK cells were increased, but the percentage of B-cells was dramatically decreased. The phagocytic and intracellular killing ability of PMNs were also suppressed (p<0.01). No significant difference was found between the epirubicin-based regimen and doxorubicin-based regimen with regard to numbers of immune cells, percentages of lymphocytes subsets, Th/CTL ratio, engulfment and killing abilities of PMNs. In conclusion, we found that the epirubicin-based regimen is not superior to the doxorubicin-based regimen with respect to their toxicity of the immune cells, Th/CTL ratio and PMN count and functions. Moreover, both FEC and FDC regimens appear to conserve the cell-mediated immunity response needed for fighting against cancer cells.     

Small Cell Bronchogenic Carcinoma: a Cyclical Alternating Combination of Epirubicin plus Cisplatin and Cyclophosphamide plus Etoposide

Summary

Forty-seven patients with advanced small-cell bronchogenic carcinoma (SCLC) were treated with a combination of epirubicin (4-EPIDX) (60 mg/m² i.v.) and cisplatin (CDDP) (50 mg/m² i.v.) on day 1, alternated with cyclophosphamide (CTX) (800 mg/m² i.v.) day 1 and etoposide (VP16) (120 mg/m² i.v.) on days 21-23. Four patients (9%) obtained a complete remission and 27 (57%) a partial remission with an overall remission rate of 66%. The median duration of response was 37 weeks (range 13-150) and the median duration of survival was 43 weeks (range 10-150). No severe bone marrow depression was noted. The other side-effects were of a mild grade.     

EOX和XELOX方案治疗晚期胃癌的疗效与毒副作用比较

目的探讨表阿霉素联合奥沙利铂、希罗达的化疗方案（EOX）与奥沙利铂联合希罗达方案（XELOX）治疗晚期胃癌的疗效和毒副作用比较。方法对我院2002年5月～2005年4月采用EOX化疗方案治疗的晚期胃癌进行回顾性分析，并与奥沙利铂联合希罗达化疗方案（XELOX）进行比较。EOX组30例，XELOX组35例。结果EOX方案组总有效率为36．7％，XELOX方案组总有效率34．3％，两组间无显著性差异（P=0．84）；XELOX方案组手足综合征的发病率较EOX方案组高，但大多都为I～Ⅱ度反应，而Ⅲ-Ⅳ度白细胞减少、恶心呕吐、脱发的发病率较EOX低，两组差异有统计学意义（P〈0．05）。结论XELOX和EOX方案治疗晚期胃癌的疗效相近，毒副作用可耐受，在一些年老体弱或多次化疗后骨髓耐受差的患者可能更适合XELOX方案。在临床方案选择上，可根据不同患者的实际情况进行选择。     

还原型谷胱甘肽预防表柔比星心肌毒性的临床观察

目的:探讨还原型谷胱甘肽防治表柔比星心肌毒性的疗效。方法:共116例乳腺癌术后患者入组并随机接受4周期TA方案化疗 还原型谷胱甘肽(治疗组)治疗或仅TA方案化疗(对照组);利用心电图和AHA心功能评价标准评价两组患者的心脏毒性。结果:116例乳腺癌患者随机分入治疗组(60例)和对照组(56例),化疗后治疗组8例患者心电图诊断异常,比率为13.3%,对照组14例,比率为25%,两组比较有显著性差异(P<0.05);治疗组化疗前后心功能无改变,对照组经化疗后有3例出现心功能Ⅱ级,差别无统计学意义(P>0.05)。结论:本研究证实还原型谷胱甘肽可防治表柔比星的心肌毒性,可提高表柔比星化疗后患者生活质量。     

腺病毒介导IL-24联合化疗药物增强对肝癌细胞PLC/PRF/5增殖的抑制

目的：研究腺病毒介导IL-24基因（Ad.IL-24）与化疗药物联用对肝癌细胞株PLC/PRF/5增殖的抑制作用。方法：用Ad.IL-24分别联合化疗药物氟尿嘧啶（fluorouracil,5-Fu）和表柔比星（epirubicin,EPI）处理培养的肝癌细胞株PLC/PRF/5,MTT法检测细胞增殖抑制率,流式细胞术（FCM）检测细胞周期和凋亡率。结果：10 MOI Ad.IL-24与25μg/ml5-Fu联合应用后72h,PLC/PRF/5细胞增殖抑制率达（67.4±0.58）%,显著高于单用Ad.IL-24组的（46.8±0.74）%和5-Fu组的（29.3±0.60）%（均P〈0.05）;10MOIAd.IL-24与2.5μg/mlEPI联合应用后72h,PLC/PRF/5细胞增殖抑制率达（72.5±0.92）%,显著高于单用Ad.IL-24组的（46.8±0.74）%和EPI组的（32.2±0.69）%（均P〈0.05）。流式细胞术检测结果显示,Ad.IL-24与5-Fu或EPI联合应用明显导致细胞在G2/M期阻滞;Ad.IL-24＋5-Fu组细胞凋亡率为（52.15±2.32）%,显著高于单用Ad.IL-24组的（28.36±3.49）%和5-Fu组的（8.27±2.61）%（均P〈0.05）;Ad.IL-24＋EPI组细胞凋亡率为（58.67±1.73）%,显著高于单用Ad.IL-24组的（28.36±3.49）%和EPI组的（11.82±1.91）%（均P〈0.05）。结论：Ad.IL-24与5-Fu或EPI联用能显著提高对肝癌细胞株PLC/PRF/5增殖的抑制作用。     

High-dose epirubicin and r-met-hu G-CSF (Filgrastim) in the treatment of patients with advanced breast cancer: A hellenic cooperative oncology group study

The delivery of high-dose epirubicin in patients with advanced breast cancer usually entails serious myelotoxicity and frequent treatment delays. Concurrent administration of G-CSF probably allows the administration of epirubicin on schedule with minimal morbidity. From August 1990 to February 1992, 42 women with advanced breast cancer were treated with six cycles of epirubicin 110 mg/m² every 4 weeks. Filgrastim 5 μg/kg per day for 14 days was administered subcutaneously starting 24 hours after chemotherapy. All patients had multiple metastatic sites, and 39 had visceral metastases. All cases were evaluable for response, toxicity, and survival. Treatment was delayed in only two cases. The actually administered average dose per unit time per patient amounted to 99.6% of the dose prescribed by the protocol. Two (4.5%; 95% confidence interval [C.I.] 0–16%) patients demonstrated a complete response and 14 (33%; 95% C.I. 19–49%) a partial response. Median time to progression was 31 weeks and median survival was 60 weeks. Severe granulocytopenia was seen in six patients; stomatitis and diarrhea in one patient each. Myoskeletal pain was noticed in 23 (55%) patients, while cardiac problems were reported in 3 cases. The present study shows that the prophylactic use of r-met-hu G-CSF allows the administration of high-dose epirubicin every 4 weeks with minimal morbidity and an improved quality of life. © 1995 Wiley-Liss, Inc.     

Squamous oesophageal cancer can be downstaged using protracted venous infusion of 5-fluorouracil with epirubicin and cisplatin (ECF)

21 patients with squamous oesophageal carcinoma were treated with a new regimen designed in our unit and effective in treating gastric adenocarcinoma, consisting of continuous venous infusion of 5-fluorouracil for up to 24 weeks (200 mg/m²/day) with epirubicin (50 mg/m²) and cisplatin (60 mg/m²) every 3 weeks. 12 patients (57%) had an objective response. The median relapse free period was 7 months, median survival from start of chemotherapy 8.4 months, and median survival from diagnosis, 14 months. Symptomatic improvements were reported by 10/11 patients with pain (91%), 8/9 with anorexia (89%), 8/10 with reflux (80%) and 10/14 with dysphagia (71%). Grade 3 or 4 toxicity was reported by 11 patients: 5 had haematological toxicity, 3 vomiting, 2 infection and 1 diarrhoea. One patient developed peripheral neuropathy, 1 renal impairment and another peripheral vascular disease. Following chemotherapy, surgery was attempted in 5 patients. One remains well 3 years on, 2 had macroscopic clearance of tumour but died of postoperative complications. In 2, disease was irresectable. This regimen of moderate toxicity is effective at improving symptoms in the majority of patients. In some patients, tumours are briefly downstaged so that inoperable tumours may become operable.     

表柔比星、奥沙利铂、氟尿嘧啶联合治疗晚期胃癌的疗效及安全性评价

背景与目的：对进展期及转移性胃癌目前还没有标准化疗方案，迄今为止，仅少数方案如ECF（表柔比星，顺铂，氟尿嘧啶）联合方案疗效被Ⅲ期试验所验证。但ECF方案中5-Fu持续滴注21天，不良反应大且不便。近来，有研究示奥沙利铂在胃癌中疗效优于顺铂，而不良反应较顺铂轻。因此，我们以奥沙利铂取代ECF方案中的顺铂，将5-Fu持续滴注21天改为5天，组成EOF5方案，用于晚期胃癌的治疗，以期提高疗效及安全性。本试验曰的是评价EOF5方案治疗复发转移或进展期胃癌的疗效与安全性。方法：对符合人组条件的胃癌患者采用表柔比星50mg／m^2静脉推汴，dl；奥沙利铂130mg／m^2静脉滴注2h，dl；氟尿嘧啶375—425mg／m^2．d1-5d静脉持续输注120h，每3周重复，每化疗2疗程评价1次疗效。对该方案的安全性、近期疗效及生活质量（包括症状的改善）进行评估。结果：入组晚期胃癌患暂17例，其中进展期胃癌无法手术的6例，术后复发转移的11例，可评价疗效者16例，其中完全有效（CR）2例（2／16，12．5％），部分有效（PR）5例（5／16，31．3％），稳定（SD）8例（50％），进展（PD）1例，其中一线治疗总有效率（ORR）50％（7／14）。主要的毒副作用为骨髓抑制、粘膜炎、肢端麻木及消化道反应。17例患者共接受64周期EOF，厅案化疗，其中Ⅲ度以上不良反应周期百分比为：白细胞及中性粒细胞减少各为6．3％，血红蛋白下降1．6％，血小板下降1．6％，恶心呕吐3．2％，口腔粘膜炎1．6％，手足麻木1．6％，静脉炎1．6％。其中除血小板下降外，余不良反应均未达Ⅳ度，所有周期治疗中未出现肝肾功能损害，未有患者出现心功能异常，或新发心律失常。在未采用PICC的12例患者中，Ⅱ度以卜静脉炎达50％，5例采用PICC者无1发生静脉炎，所有患者无化疗相关死亡。结论：EOF，方案治疗晚期胃癌疗效较高，不良反应轻而且安全，是安全有效的晚期胃癌治疗方案，可用于一线治疗，但其疗效、TTP、生存期等资料还需扩大样本进一步验证。