A new type of Nano bead, a medical magnetic bead, offers better treatment for some liver cancers. It’s called the LUMI bead and it lets doctors see in real time if the bead is delivered to the target.
Robert Freeman had retired to Florida and was enjoying life when he got the news. He had stage four liver cancer. His doctor put him on chemotherapy right away.
Freeman told Ivanhoe, “Every two weeks, I needed a blood transfusion so it felt like this isn’t working.”
His doctor wanted to try a different type of therapy. He placed Nano beads in blood vessels to block blood flow to the tumor and starve it. There was good news. The LUMI bead, a new type of Nano bead, had just been FDA-approved for embolization treatment.
Raj Narayanan, M.D., an interventional radiologist at the Sylvester Comprehensive Cancer Center explained, “It gives you positive confirmation that the particles were delivered to the location where they were intended to be delivered.”
The beads are impregnated with iodine so they light up on scans in real time, making it easy for doctors to make adjustments during the procedure.
“If we do see there is residual blood supply that hasn’t been targeted, we can go back and target it right away,” Dr. Narayanan told Ivanhoe.
It’s also easier on the body than chemo. No more blood transfusions, no hair loss and no nausea. It’s also offering Freeman and his wife a greater chance they’ll get to enjoy life together awhile longer.
“I have a lot more hope now that they can stop this enough to give me two or three years,” Freeman said.
Before the new LUMI bead, doctors would have to wait three or four weeks to figure out if the beads were in the right place based upon how the patient was responding to the treatment.
Contributors to this news report include: Cyndy McGrath, Supervising Producer; Robbi Peele, Field Producer; Milvionne Chery, Assistant Producer; Tony D’Astoli, Editor; Andrew Smith, Videographer.
BACKGROUND: The liver is the largest internal organ and it lies under a person’s ribs just beneath the right lung. Nearly 40,000 new cases of liver cancer and intrahepatic bile duct cancer will be diagnosed this year: 30,000 being men and 10,000 in women. About 27, 000 of these people will die from these cancers. Although the rates in young adults have begun to decline, liver cancer has more than tripled since 1980. More common in men than in women, liver cancer’s death rates have increased by 2.7 percent from 2003 to 2012. Sixty-three is the average age for liver cancer diagnosis, and more than 95 percent of all people diagnosed are over the age of 45. Over 700,000 people are diagnosed with liver cancer worldwide each year. With over 600,000 deaths worldwide each year, it is the leading cause of cancer deaths.
TREATMENTS: When treating liver cancer, a patient may have several doctors depending on treatment. A surgeon, radiation oncologist, medical oncologist or a gastroenterologist maybe called in during treatment. Important factors to consider when selecting the right treatment include the stage of the cancer and the health of the rest of your liver. Doctors may also recommend combining more than one treatment. Common treatments include surgery, chemotherapy and radiation.
NEW TECHNOLOGY: A new type of embolization bead offers better treatment for some liver cancers. It’s called LUMI bead and it is an option for some patients with tumors that cannot be removed by surgery. It also lets doctors see in real time if the bead is delivered to the target. The beads have iodine so they light up on scans and doctors can make adjustments during the procedure. Before, doctors would have had to wait three to four weeks to figure out if the beads were in the right place based upon how the patient was responding to the treatment. While in the blood vessels, the LUMI beads block blood flow to the tumor and starve it. The LUMI bead is easier on the body than regular chemotherapy and is FDA-approved.
(Source: Dr. Raj Narayanan)
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Raj Narayanan, M.D., an interventional radiologist at University of Miami’s Sylvester Comprehensive Cancer Care Center talks about a new therapy that is targeting some liver cancers more precisely than ever before.
Interview conducted by Ivanhoe Broadcast News in May 2016.
We’re to talk about the LUMI beads, tell me about them and how they work.
Dr. Narayanan: The LUMI bead is the newest development in the world of embolics. It’s a generation of beads which is classified as radio opaque beads. The difference between the LUMI bead and the conventional embolics is the fact that it has been impregnated with some iodine and therefore you are able to visualize it as to where the embolic was delivered. Traditionally embolization procedures are performed with embolic particles and they are mixed with a contrast agent so when we inject them we are able to see the contrast flowing through the blood vessels and where the embolics are being taken by the blood stream. But once the contrast washes out you can no longer visualize where the embolic was deposited. Now with the LUMI you have the option of visualizing the embolic even after the contrast material has washed out. You get a much better idea as to where the particles were deposited and whether the area that you wanted to treat has been adequately targeted.
How effective are these bead?
Dr. Narayanan: It’s a new product and it’s very early for us to know about the actual effectiveness of it. It has been cleared by the FDA as an embolic and traditionally any embolic once you block the blood supply it causes cell death. That’s the principle by which embolics work. Since it’s relatively new and we’re one of the earliest centers using it we will know more about the actual effectiveness of the procedure down the road. Our early results and follow ups of patients who have been treated with this technology has been promising. We are seeing responses in the areas that were treated.
You are saying that you’re able to visualize where these beads are actually going and working, what causes that, what is the attraction for these beads to go to the desired location?
Dr. Narayanan: Well the delivery system is controlled by the operator so we take micro catheters to the location where we want to deliver the particles and we deliver them. The difference is the ability to see where it’s being delivered. In the previous generation both of these embolics have been delivered by being mixed with contrast but when you have a conventional bead, you deliver the contrast, the contrast washes out.
Dr. Narayanan: Your question was how the beads get to where it’s supposed to get.
Dr. Narayanan: That’s completely technical because we’re the ones advancing the catheter to the blood vessels feeding the tumor and delivering the embolics.
I thought there was something about a blocking.
Dr. Narayanan: No, it blocks the blood vessels and then once it blocks the blood vessels you’re cutting the blood supply to the tumor and the tumor dies.
Dr. Narayanan: That’s just a delivery method.
That’s all just a delivery method.
Dr. Narayanan: The advantage is important.
Let’s talk about that. What are the advantages to these beads?
Dr. Narayanan: The technical advantages of using the radio opaque bead is the fact that now you’re able to see where the actual beads were deposited. Even without a contrast agent we use techniques called cone beam CT where we’re able to get images of the patient in different planes while they are on the angiography table. Then we’re able to see whether the particles have been deposited in the location that we want it to be. If we do see that there is residual blood supply that has not been targeted we can go back and target it right away rather than having to wait for a few weeks for the patient to come back for a follow up and then we realize that some part of it has not been treated. We able to get immediate feedback during the procedure to get a better understanding of what’s been treated and what’s still left behind and we can tailor your treatment accordingly.
This is a completely different way of treating or of using chemotherapy, is it completely different? This makes it more effective in fighting the tumor?
Dr. Narayanan: We all know where the tumor is based on imaging so we already have an idea as to where the tumor is. What we’re trying to do is go to the feeding blood vessels.
We were talking about is it more effective in fighting the tumor.
Dr. Narayanan: Yeah, we don’t know the definitive answer to that.
Can this cure the disease or is the goal just to slow the progression?
Dr. Narayanan: We treat different types of patients. One where we’re potentially trying to go for a cure and then ones where delaying the disease. The question is whether these LUMI beads can cure a disease or is it delaying the progression. Depending on the patient and the size and the location the options could be that we effectively get a cure or downstage a patient to surgery.
But it is no matter what more precise than any other—
Dr. Narayanan: Correct.
Than any other procedure you have at the moment on the market? What about the surrounding tissue and is it damaged or destroyed by these?
Dr. Narayanan: This is delivered in a very precise manner with imaging guidance and therefore there’s not much collateral injury to the surrounding structures. One of the additional advantages of the LUMI is the fact that we can visualize non-target embolization. In other words did the embolic go to another unintended location. In the past you were not able to see that, and you could only detect that from clinical signs and symptoms. Let’s say somebody blocked the blood supply to the gallbladder inadvertently, you would not know that except when you have signs and symptoms that the blood supply to the gallbladder is blocked. But now you’ll actually see the particles lining the blood supply to the gallbladder. What does this mean two things. One obviously it takes the technique to a different level, people who use this should be experienced with the anatomy and where they are delivering it so you have to be careful with the technique. But on the bright side it gives you positive conformation that the particles were delivered to the location that they were intended to be delivered.
All of those with collateral damage the simple things that we all know cancer causes or the treatment for cancer causes like losing your hair that’s no longer going to really be a problem?
Dr. Narayanan: Traditionally treating tumors by targeting the blood vessels has been around for a very long time. The procedure is called TACE trans arterial chemo embolization. Embolics were used in the mixture where chemotherapy was mixed with an oil based contrast and then finished off with some embolics to deliver a larger dose of chemo and also block the blood supply. The embolics came in to use more around 2005, 2006 when the particles were more size controlled.
Traditionally we think of liver cancer in particular as being very difficult if not impossible to treat. Is this new radio opaque bead, is this changing the prognosis of the disease or for the disease?
Dr. Narayanan: No. Basically what this gives is more information. With more information you’ll able to target it more precisely. When you traditionally had to wait three and a half weeks or four weeks for the follow up to then see what happened with your treatment now you’re getting almost real time visualization and ability to see okay, did I get it, did it go where I wanted to go, did I get adequate coverage or not. That’s all it does is giving you more information.
How many treatments are normal or typical or does that all depend on the cancer?
Dr. Narayanan: The number of treatments that a particular patient receives depends on the size of the tumor and their ability to tolerate the treatment and the response.
You said this is not a new idea but it’s a new way to visualize what’s happening and be more targeted with it. How long is this particular LUMI bead been available?
Dr. Narayanan: This is the first radio opaque bead that is commercially available and it was just launched in January as a limited launch. The University of Miami Sylvester Cancer Center was the first site to receive it after the NIH, The product was developed in collaboration with NIH. The first human patient was treated at the NIH. After the NIH the second site to treat a patient was here at the University of Miami. This product is currently approved only in the United States so there are about five to six sites in the United States that have access to the technology. It is going to be rolled out to additional sites this month, and that’s my understanding. We were one of the earliest if not within the first two of the earliest sites to actually use this technology.
How long has this radio opaque been in use?
Dr. Narayanan: The radio opaque bead currently on the market is being manufactured by a company called BTG and this is the only commercially available radio opaque bead. This product was brought in to the United States in a limited launch in January of this year and the product was developed in collaboration with the NIH. The NIH treated the first patient in January and after the NIH, Sylvester Cancer Center was the second site to treat a patient using the radio opaque technology. The product is still on a limited launch there are only six sites in the country that have been that have used this product. My understanding is that they’re going to do a wider launch of the product very soon. But it’s a new product that was just launched this year.