Regional Chemotherapy for triple negative breast cancer improves eligibility for surgical removal

Background: Multiple systemic treatment lines for triple negative breast cancer (TNBC) often lead to exhaustment and bone marrow supression while response rates remain unsatisfactory. There is a need for new treatment options that increase the eligibility for surgical excision of primary tumors and metastases.

Material and methods: For isolated perfusions chemotherapy, an isolated extracorporeal circuit that includes the tumor region was established with perfusion balloon catheters. Only low drug dosages were infused into the limited treatment volume. Isolated thoracic perfusion was performed for advanced primary tumors, lung metastases, and lymphatic or bone metastases in the thoracic region including the axillary. Trans-arterial chemoembolisation was performed for liver metastases.

Results: 47 patients with metastasized or recurrent TNBC were treated with intra arterial infusion and isolated perfusion chemotherapy. Serum cisplatin levels at the tumor site reached up to 95 µg/ml with only limited total dosages of 50-90 mg cisplatin due to the reduced volume. The additional stopflow technique allowed for further increased drug concentration during the first five minutes and enhanced tissue drug uptake. The local response rate was 70% (33 pts). Median overall survival rate was 12.5 months.

Conclusions: TNBC patients that suffer from unsatisfactory response or toxicity of systemic chemotherapy might benefit from isolated perfusions and intra arterial infusion techniques. Higher local drug concentrations and lower systemic concentrations increase the efficacy and decrease adverse events. A prospective clinical trial is planned to further evaluate regain of resectability.

Publication History

Article published online:
03 May 2024