Pulmonary and Mediastinal Breast Cancer Metastases: Is TACE Safe and Feasible?

Transcatheter arterial chemoembolization (TACE) with superabsorbent polymer microspheres (SAP-MS) appears to be a well-tolerated and feasible palliative treatment for pulmonary and mediastinal metastases that result from breast cancer, researchers reported.

Patients with pulmonary and mediastinal metastases from breast cancer have limited treatment options. Although transpulmonary chemoembolization has been used to treat metastatic lung tumors, it is unable to treat mediastinal tumors. TACE remains a treatment possibility, but there have been few studies examining transcatheter treatment from bronchial and nonbronchial systemic arteries for pulmonary metastases.

To address this knowledge gap, investigators retrospectively analyzed data on 14 patients with 29 unresectable pulmonary or mediastinal breast cancer metastases. The patients underwent TACE between November 2002 and January 2015 using 50-100 μm of SAP-MS. Patients had received injections of a combination of 2-4 types of anticancer drugs prior to transcatheter arterial chemoembolization.

One month after the first TACE treatment, local tumor response and adverse events were assessed. Results indicated that 28.6% of patients responded to treatment—four patients partially responded, and 10 patients had stable disease. There was a median progression rate of tumor diameter of -12.7%.

There were no cases of hematologic toxicity of grade 3 or higher among the patients assessed. Four patients had grade 1 nausea, 4 patients had grade 1 back pain, and 1 patient had grade 1 fever. There was 1 patient who had a grade 3 maculopapular rash, but it may have been as a result of treatment with fluorouracil. “Regarding adverse events, this treatment can be considered to be tolerable,” the study’s authors wrote.

Additional TACE sessions were performed as needed. Each patient had an average of 5.5 sessions, with a total of 63 additional transcatheter arterial chemoembolization sessions performed in total on the group. After the first session, median overall survival time was 29 months. There was a 49.5% survival rate at 5 years.

The authors concluded that transcatheter arterial chemoembolization in the patient population studied is feasible and safe. “Multiple systemic arterial infusion and embolization treatments may provide significant therapeutic effects, which cannot be achieved using other treatments and therefore this approach is expected to contribute to improved prognosis of patients,” the researchers stated.

Reference

Kennoki N, Hori S, Yuki T, Hori A. Transcatheter arterial chemoembolization with spherical embolic agent in patients with pulmonary or mediastinal metastases from breast cancer. J Vasc Interv Radiol. 2017 Jul 18. pii: S1051-0443(17)30556-0. doi: 10.1016/j.jvir.2017.06.003. [Epub ahead of print].