By Lunbao (Jerry) Huang, Pharm.D. Candidate c\/o 2013<\/p>\n
–<\/p>\n
Over the last two decades, there has been an increasing focus on hepatocellular carcinoma (HCC, most commonly known as liver cancer). \u00a0In the United States, as of 2011, there have been an estimated 26,190 new cases and 19,590 deaths\u00a0from both hepatic and\u00a0intrahepatic\u00a0bile duct\u00a0cancer.\u00a0 Defined by the National Cancer Institute (NCI) as a \u201cprimary liver cancer \u2026 that forms in the tissues of the liver,\u201d HCC is one of the four leading causes of death worldwide.1<\/sup><\/p>\n Doxil\u00ae<\/sup> (liposomal doxorubicin) is an anthracyclic, antineoplastic agent approved for the treatment of AIDS-related Kaposi sarcoma (after failure of or intolerance to prior systemic therapy), multiple myeloma (after failure of at least one prior therapy), and ovarian cancer (progressive or recurrent). \u00a0The liposomal injection formulation is pegylated and has some advantages over conventional intravenous doxorubicin hydrochloride.\u00a0 Liposomes are microscopic lipid vesicles that contain the active ingredient inside. \u00a0A liposomal drug delivery system increases doxorubicin\u2019s blood circulation time, increases the drug\u2019s half-life, decreases its volume of distribution.2,3<\/sup>\u00a0 It also enhances drug uptake by solid tumors (including the liver and spleen), and shows an impressive reduction in cardiac toxicity in contrast to conventional doxorubicin.2,3<\/sup> \u00a0Recently after Johnson & Johnson\u2019s liposomal doxorubicin was approved by the FDA for use in the United States, there have been many articles focusing on its utility in liver cancer. 4<\/sup><\/p>\n In 2002, Goldberg, et. al.<\/i> demonstrated that liposomal doxorubicin might enhance the efficacy of thermal ablation of liver cancer.4<\/sup> \u00a0Doxil\u00ae<\/sup>, when used before radiofrequency ablation (RFA), increased tumor lesion volume and surgical coagulation (which improves the focus of intense light energy used to destroy abnormal tissues).4<\/sup> \u00a0Thus, tumor destruction combined with radiofrequency ablation suggested that similar techniques have the possibility of improving clinical outcomes and efficacy in a variety of focal hepatic tumors.4<\/sup><\/p>\n In 2009 and 2011, Poon, et. al.<\/i> found benefits in using a lyso-thermosensitive version of liposomal doxorubicin (LTLD, later branded as ThermoDox\u00ae<\/sup>) in conjunction with radiofrequency ablation.5,6<\/sup>\u00a0 The mechanism was similar to Goldberg\u2019s finding of Doxil\u00ae<\/sup> with RFA.4<\/sup> When heated above 39.5 \u00b0C (103.1 \u00b0F), LTLD released high concentration doxorubicin directly into liver tumors, focusing its cytotoxic effect on the tumor and tumor margin only. \u00a0The studies concluded that the RFA\/LTLD combination could treat Child-Pugh class A-B patients with tumors up to 7 centimeters \u2013 offering a substantial increase in potentially curable patients with HCC.<\/p>\n Nanoknife angiodynamics or irreversible electroporation (IRE) is an FDA-approved surgical technique used for ablation of soft tissues in specific conditions.7<\/sup> \u00a0After placing a needle into the target (but not heating the cells above 39.5\u00b0C to 100\u00a0\u00b0C), IRE sends out short but intense electric pulses from the small electrodes placed within tumor. \u00a0\u00a0IRE irreversibly opens tumor cells and eventually kills off the tumor.\u00a0 Generally, Doxil\u00ae<\/sup> combined with IRE is a lot \u201csafer\u201d than ThermoDox\u00ae<\/sup> with RFA, mostly due to the different temperature distribution caused by nearby, cooler blood vessels \u2013 these may \u201ccancel-out\u201d the temperature required to kill the tumor cells. \u00a0IRE does not have a problem in this area – IRE with liposomal doxorubicin increases the selectivity and focus on liver tumor soft tissues more than RFA with liposomal doxorubicin. With the higher selectivity of IRE, less organ proteins are denatured.<\/p>\n In conclusion, liposomal doxorubicin in hepatocellular carcinoma, along with IRE or RFA, shows promising effects.\u00a0 However, no studies directly compare IRE with Doxil\u00ae<\/sup> versus RFA with ThermoDox.\u00ae<\/sup> \u00a0Current data is limited to a few patient cases. \u00a0Larger studies are needed to compare liposomal and conventional doxorubicin (versus placebo) in combination with IRE or RFA.<\/p>\n SOURCES:<\/span><\/b><\/p>\n By Lunbao (Jerry) Huang, Pharm.D. Candidate c\/o 2013 – Over the last two decades, there has been an increasing focus on hepatocellular carcinoma (HCC, most commonly known as liver cancer). \u00a0In the United States, as of 2011, there have been an estimated 26,190 new cases and 19,590 deaths\u00a0from both hepatic and\u00a0intrahepatic\u00a0bile duct\u00a0cancer.\u00a0 Defined by the…<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[7],"tags":[2237,343,22,40,52,419,1623,800,831,13,2227,2232,314,1647,20,67,342,407,1646,1120,832,2236,363,968,1625,45,19,184,1820,1679,453,150,1161,16,1061],"class_list":["post-319","post","type-post","status-publish","format-standard","hentry","category-clinical","tag-aids","tag-and","tag-blood","tag-cancer","tag-cardiac","tag-coagulation","tag-combination","tag-delivery","tag-doxorubicin","tag-drug","tag-ebola-virus-disease","tag-fda","tag-for","tag-formulation","tag-health","tag-hepatic","tag-hydrochloride","tag-injection","tag-intravenous","tag-lipid","tag-liposome","tag-liver","tag-of","tag-one","tag-or","tag-organ","tag-patient","tag-problem","tag-reduction","tag-short","tag-system","tag-temperature","tag-therapy","tag-treatment","tag-with"],"views":1255,"_links":{"self":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/319","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/comments?post=319"}],"version-history":[{"count":0,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/posts\/319\/revisions"}],"wp:attachment":[{"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/media?parent=319"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/categories?post=319"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/rhochistj.org\/RhoChiPost\/wp-json\/wp\/v2\/tags?post=319"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}\n