Review
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World J Gastroenterol. Nov 21, 2013; 19(43): 7586-7593
Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7586
Extravascular use of drug-eluting beads: A promising approach in compartment-based tumor therapy
Simon Binder, Andrew L Lewis, J-Matthias Löhr, Michael Keese
Simon Binder, Faculty of Medicine Mannheim, University of Heidelberg, 68167 Mannheim, Germany
Andrew L Lewis, Biocompatibles UK Ltd., Department for Research and Development, Farnham GU98QL Surrey, United Kingdom
J-Matthias Löhr, Karolinska Institute, Department of Clinical Science, Intervention and Technology, 17177 Stockholm, Sweden
Michael Keese, Clinic for Vascular and Endovascular Surgery, University Hospital Frankfurt, 60590 Frankfurt am Main, Germany
Author contributions: Binder S and Keese M analyzed the data and wrote the paper; Lewis AL wrote the passage about intrapancreatic therapy; Lewis AL, Löhr JM and Keese M designed and performed the research.
Correspondence to: Michael Keese, PD, MD, Clinic for Vascular and Endovascular Surgery, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany. michael.keese@kgu.de
Telephone: +49-69-63015349 Fax: +49-69-63015336
Received: August 11, 2013
Revised: September 5, 2013
Accepted: September 16, 2013
Published online: November 21, 2013
Processing time: 128 Days and 16.3 Hours
Abstract

Intraperitoneal carcinomatosis (PC) may occur with several tumor entities. The prognosis of patients suffering from PC is usually poor. Present treatment depends on the cancer entity and includes systemic chemotherapy, radiation therapy, hormonal therapy and surgical resection. Only few patients may also benefit from hyperthermic intraperitoneal chemotherapy with a complete tumor remission. These therapies are often accompanied by severe systemic side-effects. One approach to reduce side effects is to target chemotherapeutic agents to the tumor with carrier devices. Promising experimental results have been achieved using drug-eluting beads (DEBs). A series of in vitro and in vitro experiments has been conducted to determine the suitability of their extravascular use. These encapsulation devices were able to harbor CYP2B1 producing cells and to shield them from the hosts immune system when injected intratumorally. In this way ifosfamide - which is transformed into its active metabolites by CYP2B1 - could be successfully targeted into pancreatic tumor growths. Furthermore DEBs can be used to target chemotherapeutics into the abdominal cavity for treatment of PC. If CYP2B1 producing cells are proven to be save for usage in man and if local toxic effects of chemotherapeutics can be controlled, DEBs will become promising tools in compartment-based anticancer treatment.

Keywords: Compartment based therapy; Intraperitoneal; Drug-eluting beads; Carcinomatosis; Hyperthermic intraperitoneal chemotherapy; Glioblastoma; Pancreatic cancer; CYP2B1; Ifosfamide

Core tip: Intraperitoneal carcinomatosis occurs with several tumor entities and prognosis is usually poor. Besides standard therapy, only few patients may benefit from hyperthermic intraperitoneal chemotherapy. The treatment may cause severe systemic side-effects. One different approach to target chemotherapeutic agents to the tumor employs carrier devices. Contemplable carriers are drug-eluting beads (DEBs). DEBs can be used to transfer drugs or pro-drug converting enzymes directly to the tumor. Furthermore, DEBs can successfully target chemotherapeutics into the abdominal cavity for ip treatment. When local toxic effects are controlled, DEBs are effective tools in compartment-based therapy.