Transarterial Chemoembolization using M1 Doxorubicin Eluting Beads for the Treatment of Chemorefractory Liver Metastases from Breast Cancer

Purpose To report the safety and efficacy of transarterial chemoembolization (TACE) using doxorubicin-eluting beads (DEB) for the treatment of chemorefractory liver metastases from breast cancer (BC).

Materials and Methods A retrospective evaluation of DEB-TACE for the treatment of chemorefractory liver metastases from BC between 2005 and 2016 was performed. Fourteen patients (median age 54, range 33–78) were included. All patients had progressed following systemic chemotherapy. DEB-TACE was performed in a lobar fashion for a total dose of 150 mg of doxorubicin. Tumor response was evaluated according to modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria. Adverse events (AE) following TACE were documented.

Results A total of 22 lobar DEB TACE administrations were performed. Two (14.2%) out of 14 patients had complete response, four (28.6%) had partial response, four (28.6%) demonstrated stable disease, and four (28.6%) experienced disease progression. Two patients experienced grade 3 hepatobiliary AE within 24 hours of the DEB-TACE in addition to progressive hyperbilirubinemia, which continued until death. These patients had infiltrative liver metastases with pseudocirrhosis or portal hypertension prior to TACE. Death occurred 3 and 6 weeks following DEB-TACE, respectively. Of the remaining patients, none experienced significant hyperbilirubinemia, and 11 experienced acute, self-limiting transaminitis following the procedure.

Conclusion DEB-TACE may be an effective therapy for chemorefractory liver metastases from BC. However, in the setting of infiltrative metastases with pseudocirrhosis or portal hypertension, DEB-TACE may result in hyperbilirubinemia, liver failure, and death. Therefore, DEB-TACE in such patients may not be safe despite relatively normal baseline liver function tests.