(52) Comparison of Doxorubicin and Alternative Chemotherapeutics in DEB-TACE

Ankit Patel, BS – Medical Student, Northeast Ohio Medical University; Mina Makary, MD – Interventional Radiologist, Vascular and Interventional Radiology, The Ohio State University Wexner Medical Center

Purpose: Doxorubicin, an anthracycline antibiotic, is the standard for drug-eluting bead transarterial chemoembolization (DEB-TACE) due to its potent cytotoxicity and bead compatibility. However, agents such as mitomycin C, cisplatin, methotrexate, and paclitaxel are also used based on tumor histology, patient tolerance, and regional practice. This exhibit compares anthracycline-based beads versus these alternatives in DEB-TACE to guide optimized agent selection.

Material and Methods: We performed a literature review (2005 - 2025) comparing DEB-TACE protocols using anthracyclines against non-anthracycline agents, including mitomycin C, cisplatin, methotrexate, and paclitaxel. Standardized protocols loaded 100–700 µm microspheres with each drug for selective infusion into tumor-feeding hepatic arteries. We compared loading efficiency, release kinetics, intratumoral and systemic drug levels, and adverse events. Key parameters included bead stability, elution profiles, preclinical and clinical efficacy, and rates of post-embolization syndrome. Determinants of agent choice, such as tumor biology, liver function, prior systemic therapy, and institutional protocols, were analyzed to identify factors influencing the selection.

Results: Anthracycline-loaded beads exhibit reliable loading, sustained intratumoral delivery, and manageable systemic toxicity, supporting anthracyclines, in particular doxorubicin, as the benchmark for this approach. Mitomycin C delivers DNA crosslinking but shows variable elution and higher myelosuppression in some reports. Cisplatin- and methotrexate-loaded beads exhibit moderate cytotoxicity, with distinct risks of nephrotoxicity and mucositis, respectively. Paclitaxel beads offer microtubule inhibition, but they face challenges in terms of bead compatibility and uniform release. Selection generally balances pharmacodynamic potency against patient-specific tolerability and logistical considerations.

Conclusions: DEB-TACE with doxorubicin remains the cornerstone of transarterial chemotherapy due to its proven cytotoxicity and favorable pharmacokinetics. Alternative agents like mitomycin C, cisplatin, methotrexate, and paclitaxel offer unique mechanisms and toxicity profiles that may suit individual patient scenarios. Additional randomized trials are needed to establish evidence-based guidelines on agent selection, dosing, and sequencing.