CC BY-NC-ND 4.0 · Endosc Int Open 2024; 12(10): E1085-E1091
DOI: 10.1055/a-2379-1591
Original article

Feasibility and safety of endoscopic ultrasound-guided diffusing alpha emitter radiation therapy for advanced pancreatic cancer: Preliminary data

1   Gastroenterology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
2   Medicine, McGill University Faculty of Medicine, Montreal, Canada (Ringgold ID: RIN12367)
3   McGill Centre for Translational Research in Cancer, Lady Davis Institute for Medical Research, Montreal, Canada (Ringgold ID: RIN113635)
,
Magali Lecavalier-Barsoum
4   Radiation Oncology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
2   Medicine, McGill University Faculty of Medicine, Montreal, Canada (Ringgold ID: RIN12367)
3   McGill Centre for Translational Research in Cancer, Lady Davis Institute for Medical Research, Montreal, Canada (Ringgold ID: RIN113635)
,
Kim Ma
5   Oncology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
2   Medicine, McGill University Faculty of Medicine, Montreal, Canada (Ringgold ID: RIN12367)
,
Miriam Santos Dutra
3   McGill Centre for Translational Research in Cancer, Lady Davis Institute for Medical Research, Montreal, Canada (Ringgold ID: RIN113635)
,
Youri Kaitoukov
6   Radiology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
2   Medicine, McGill University Faculty of Medicine, Montreal, Canada (Ringgold ID: RIN12367)
,
Boris Bahoric
4   Radiation Oncology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
3   McGill Centre for Translational Research in Cancer, Lady Davis Institute for Medical Research, Montreal, Canada (Ringgold ID: RIN113635)
,
Nada Tomic
7   Medical Physics Unit, McGill University, Montreal, Canada (Ringgold ID: RIN5620)
,
Francine Dinelle
8   Quality and Transformation Unit, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
,
Shirin Enger
7   Medical Physics Unit, McGill University, Montreal, Canada (Ringgold ID: RIN5620)
5   Oncology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
3   McGill Centre for Translational Research in Cancer, Lady Davis Institute for Medical Research, Montreal, Canada (Ringgold ID: RIN113635)
,
Gerald Batist
5   Oncology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
3   McGill Centre for Translational Research in Cancer, Lady Davis Institute for Medical Research, Montreal, Canada (Ringgold ID: RIN113635)
,
Stephen Yang
9   Anesthesia, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
2   Medicine, McGill University Faculty of Medicine, Montreal, Canada (Ringgold ID: RIN12367)
,
Donald Laporta
10   Adult Critical Care and Respirology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
2   Medicine, McGill University Faculty of Medicine, Montreal, Canada (Ringgold ID: RIN12367)
,
Petr Kavan
5   Oncology, Jewish General Hospital, Montreal, Canada (Ringgold ID: RIN5621)
3   McGill Centre for Translational Research in Cancer, Lady Davis Institute for Medical Research, Montreal, Canada (Ringgold ID: RIN113635)
,
Anand Sahai
11   Gastroenterology, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
,
David Roberge
12   Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada (Ringgold ID: RIN25443)
,
David Donath
12   Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montreal, Canada (Ringgold ID: RIN25443)
› Institutsangaben
Gefördert durch: MEDTEQ+ consortium and Alpha Tau Medical

Clinical Trial: Registration number (trial ID): NCT04002479, Trial registry: ClinicalTrials.gov (http://www.clinicaltrials.gov/), Type of Study: Prospective

Abstract

Background and study aims Pancreatic cancer is a devastating disease with limited locoregional treatment options. Diffusing alpha-emitter radiation therapy (Alpha DaRT), a novel cancer treatment using alpha-particle interstitial radiotherapy, may help address this challenge. The aim of this study was to evaluate the feasibility and safety of endoscopic ultrasound (EUS)-guided Alpha DaRT for advanced pancreatic cancer.

Patients and methods Patients with inoperable locally advanced or metastatic pancreatic adenocarcinoma were treated with EUS-guided Alpha DaRT insertion. The Alpha DaRT sources were delivered into pancreatic tumors using a standard EUS needle with a novel proprietary applicator. Adverse events (AEs) were assessed based on the Common Terminology Criteria for Adverse Events version 5.0. Tumor response was evaluated by imaging 4 to 6 weeks post treatment.

Results The first five patients were treated between March and September 2023. The procedure was technically successful in all cases, with Alpha DaRT sources inserted into the target tumor. Estimated gross tumor volume coverage ranged from 8% to 44%. Fourteen AEs were reported among three patients. Four were serious AEs, none of which was associated with the treatment, but rather, with disease progression or medical assistance in dying. Only two AEs (mild) were deemed possibly related to the study device. At the 35-day visit, two patients had progressive disease and three had stable disease, with one of the latter showing partial response 2 months post procedure.

Conclusions Preliminary results from this first-in-human trial indicate that EUS-guided Alpha DaRT treatment for unresectable pancreatic cancer is feasible and safe, with no device-associated serious AEs. Further investigation of this promising novel modality is underway.

Supplementary Material



Publikationsverlauf

Eingereicht: 29. Mai 2024

Angenommen nach Revision: 02. August 2024

Accepted Manuscript online:
12. August 2024

Artikel online veröffentlicht:
11. Oktober 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Siegel RL, Miller KD, Fuchs HE. et al. Cancer Statistics, 2021. CA Cancer J Clin 2021; 71: 7-33
  • 2 Jemal A, Siegel R, Ward E. et al. Cancer statistics, 2009. CA Cancer J Clin 2009; 59: 225-249
  • 3 Heinemann V, Boeck S, Hinke A. et al. Meta-analysis of randomized trials: evaluation of benefit from gemcitabine-based combination chemotherapy applied in advanced pancreatic cancer. BMC Cancer 2008; 8: 82
  • 4 Sultana A, Smith CT, Cunningham D. et al. Meta-analyses of chemotherapy for locally advanced and metastatic pancreatic cancer. J Clin Oncol 2007; 25: 2607-2615
  • 5 Bazeed AY, Day CM, Garg S. Pancreatic cancer: Challenges and opportunities in locoregional therapies. Cancers (Basel) 2022; 14: 4257
  • 6 Ahn DH, Bekaii-Saab T. The continued struggle for defining a role for radiotherapy in pancreas cancer. JAMA Oncology 2022; 8: 1257-1259
  • 7 Fegrachi S, Besselink MG, van Santvoort HC. et al. Radiofrequency ablation for unresectable locally advanced pancreatic cancer: a systematic review. HPB (Oxford) 2014; 16: 119-123
  • 8 Reyngold M, Parikh P, Crane CH. Ablative radiation therapy for locally advanced pancreatic cancer: techniques and results. Radiat Oncol 2019; 14: 95
  • 9 Gonzalo-Marin J, Vila JJ, Perez-Miranda M. Role of endoscopic ultrasound in the diagnosis of pancreatic cancer. World J Gastrointest Oncol 2014; 6: 360-368
  • 10 Sun S, Xu H, Xin J. et al. Endoscopic ultrasound-guided interstitial brachytherapy of unresectable pancreatic cancer: results of a pilot trial. Endoscopy 2006; 38: 399-403
  • 11 Jin Z, Du Y, Li Z. et al. Endoscopic ultrasonography-guided interstitial implantation of iodine 125-seeds combined with chemotherapy in the treatment of unresectable pancreatic carcinoma: a prospective pilot study. Endoscopy 2008; 40: 314-320
  • 12 Sun S, Ge N, Wang S. et al. Pilot trial of endoscopic ultrasound-guided interstitial chemoradiation of UICC-T4 pancreatic cancer. Endosc Ultrasound 2012; 1: 41-47
  • 13 Arazi L, Cooks T, Schmidt M. et al. Treatment of solid tumors by interstitial release of recoiling short-lived alpha emitters. Phys Med Biol 2007; 52: 5025-5042
  • 14 Arazi L, Cooks T, Schmidt M. et al. The treatment of solid tumors by alpha emitters released from (224)Ra-loaded sources-internal dosimetry analysis. Phys Med Biol 2010; 55: 1203-1218
  • 15 Cooks T, Arazi L, Schmidt M. et al. Growth retardation and destruction of experimental squamous cell carcinoma by interstitial radioactive wires releasing diffusing alpha-emitting atoms. Int J Cancer 2008; 122: 1657-1664
  • 16 Kelson I, Levy Y, Redmard E. Recoil implantation of alpha sources for thickness measurement of thin films. J Phys D Applied Phys 1995; 28: 100
  • 17 D'Andrea MA, VanderWalde NA, Ballo MT. et al. Feasibility and safety of diffusing alpha-emitter radiation therapy for recurrent or unresectable skin cancers. JAMA Netw Open 2023; 6: e2312824
  • 18 Popovtzer A, Rosenfeld E, Mizrachi A. et al. Initial safety and tumor control results from a "first-in-human" multicenter prospective trial evaluating a novel alpha-emitting radionuclide for the treatment of locally advanced recurrent squamous cell carcinomas of the skin and head and neck. Int J Radiat Oncol Biol Phys 2020; 106: 571-578
  • 19 Sawhney MS. Role of endoscopic ultrasound in the treatment of pancreatic neoplasms. Techniq Gastrointest Endosc 2009; 11: 44-48
  • 20 Heger G, Roy A, Dumančić M. et al. Alpha dose modeling in diffusing alpha-emitters radiation therapy-Part I: single-seed calculations in one and two dimensions. Med Phys 2023; 50: 1793-1811
  • 21 Heger G, Dumančić M, Roy A. et al. Alpha dose modeling in diffusing alpha-emitters radiation therapy. Part II: Lattice studies. Med Phys 2023; 50: 1812-1823
  • 22 Cong L, Liu Q, Zhang R. et al. Tumor size classification of the 8(th) edition of TNM staging system is superior to that of the 7(th) edition in predicting the survival outcome of pancreatic cancer patients after radical resection and adjuvant chemotherapy. Sci Rep 2018; 8: 10383
  • 23 Domankevich V, Cohen A, Efrati M. et al. Combining alpha radiation-based brachytherapy with immunomodulators promotes complete tumor regression in mice via tumor-specific long-term immune response. Cancer Immunol Immunother 2019; 68: 1949-1958