pancreatic cancer: chemoembolization using a double ...€¦ · • 54, 000 cases of pancreatic...
TRANSCRIPT
![Page 1: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/1.jpg)
Pancreatic Cancer: ChemoembolizationUsing A Double Balloon Catheter
Jacob Cynamon, MDMontefiore Medical Center/ AECOM
Division of VIR
2016
![Page 2: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/2.jpg)
Disclosures
• Post Market Registry Investigator
![Page 3: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/3.jpg)
• 54, 000 cases of pancreatic adenocarcinoma per year in US
• Only potential cure: resection
Pancreatic Cancer Stages:
• Primary reason Locally Advanced Pancreatic Cancer (LAPC) not resectable:tumor involvement of celiac axis and SMA; can not get clean margin with resection
• Systemic gemcitabine is only guideline driven treatment with Class 1 evidence benefit; other treatmentregimen extrapolated from studies of patients with stage 4 disease
• Therefore, LAPC patients undergo a potpourri of treatment options: systemic gemcitabine, combinationchemo, chemo-radiation, research protocol, etc.
Adenocarcinoma of the Pancreas
Stage 2Not spread to vessels or lymph nodes)
Stage 3(Spread to vessels and/or lymph nodes, but not
other parts of body)
Stage 4
Spread to other parts of the body
15% - “Resectable” 35% LAPC 50% Metastatic
![Page 4: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/4.jpg)
Can TACE Benefit these patients?Several studies, including meta analysis with
the use of gemcitabine, have shown promise
Opportunities:
Familiar Anatomy
Challenges: can not identify orengage tumor feeder vessels
![Page 5: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/5.jpg)
0
10
20
30
40
50
60
70
0:00
:00
0:00
:45
0:01
:00
0:01
:15
0:01
:30
0:01
:45
0:02
:00
0:02
:15
0:02
:30
0:02
:45
0:03
:00
0:03
:15
0:03
:30
0:03
:45
0:04
:00
0:04
:15
0:04
:30
0:04
:45
0:05
:00
Pre
ssu
re(m
mH
G)
Time
Pressure over Time
catheter insplenic artery
first balloon up
second balloon up
start infusion
Potential Solution:
![Page 6: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/6.jpg)
![Page 7: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/7.jpg)
RenovoCath Balloons
SMA
Common Hepatic ArteryTumor Head
Common Hepatic Artery
SMA
RenovoCath Balloons
![Page 8: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/8.jpg)
66 y/o MPancreatic CA
Post Systemic ChemoContinued growth
![Page 9: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/9.jpg)
4 Treatments: Hepatic, SMA, Hepatic, SMA
![Page 10: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/10.jpg)
Infuse 100-120 cc at 6cc/Min
![Page 11: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/11.jpg)
![Page 12: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/12.jpg)
• 6 Fr Guiding Sheath must be advanced into Celiac or SMA
• RenovoRx Catheter is compatible with 0.014 wire
• Acute angled SMA may be difficult to access with routine techniques
• Working length 76-86 cm. (RA access is not feasible)
• Morph Catheter can be extremely helpful
Technical Considerations when using RenovoCath
![Page 13: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/13.jpg)
![Page 14: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/14.jpg)
Use of a Morph Catheter
![Page 15: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/15.jpg)
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 50 100 150 200 250 300 350 400 450
Surv
ival
(%)
Days post Initial Diagnosis
Clinical Response with RenovoCath TACE vs. Historical ControlAdenocarcinoma of the Pancreas
RenovoCath completing 8 treatments – Average 5.75g/m2 of Gemcitabine (n=9)
RenovoCath greater than 2 treatments – Average 4.4g/m2 of Gemcitabine (n=15)
Systemic Intravenous Gemcitabine – Average 6.8g/m2 (n=44) *
37% Survival*
51% survival
65% survival
† Jiang X, Galettix P, Links M et al. Population pharmacokinetics of gemcitabine and its metabolite in patients withcancer: effect of oxaliplatin and infusion rate. British Journal of Clinical Pharmacology; 65:326-333*Chauffert B, Mornex F, Bonnetain F et al. Phase III trial comparing intensive induction chemoradiotherapy. AnnOncol 2008; 19:1592-9
![Page 16: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/16.jpg)
A Multi-Center, Post-Marketing, Prospective, Observational StudyFollowing Treatment with Intra-Arterial Delivery ofChemotherapeutic Agents Using the RenovoCath Catheter
• Up to 10 US centers
• Up to 100 patients
• Launched January 2016
• 5 centers recruiting
• Additional centers in process
16
Post-Market Registry
![Page 17: Pancreatic Cancer: Chemoembolization Using A Double ...€¦ · • 54, 000 cases of pancreatic adenocarcinoma per year in US • Only potential cure: resection Pancreatic Cancer](https://reader033.vdocuments.us/reader033/viewer/2022042314/5f02511b7e708231d403ab54/html5/thumbnails/17.jpg)
Conclusions
• Intra-arterial gemcitabine can be given to patients with pancreaticcancer using localized delivery via RenovoCath Catheter withacceptable safety profile
• There is less Systemic side effects of gemcitabine as assessed byhematologic markers, using RenovoCath localized delivery
• There appears to be survival benefits in patients receiving localizedgemcitabine especially if they complete a full course of therapy
• Post Market registry data will be extremely important for theadaptation of this mode of therapy