Increasing intra-lesional pH with the use of Bicarbonate along with Doxorubicin in trans-arterial chemoembolization of hepatocellular carcinoma: Phase 1 study

Monday, March 6, 2023

12:00 PM – 1:00 PM

Location: Phoenix Convention Center, North Ballroom 120 D

Poster Presenter(s)

Dayananda Lingegowda, MBBS,DNB

Consultant Radiologist
TATA MEDICAL CENTER

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Avik Som, MD, PhD

Integrated IR/DR Radiology Resident
MGH
BG

BHARAT GUPTA, MBBS,MD

Consultant Radiologist
TATA MEDICAL CENTER
AG

Anisha Gehani, MBBS,MD

Consultant Radiologist
TATA MEDICAL CENTER
PG

Priya Ghosh, MBBS,MD

Consultant Radiologist
TATA MEDICAL CENTER
Ss

Saugata sen, MBBS,MD

Consultant Radiologist
TATA MEDICAL CENTER

Disclosure(s):

Dayananda Lingegowda, MBBS,DNB: No financial relationships to disclose

Avik Som, MD, PhD: Boston Scientific: Consultant (); CareSignal Health: Ownership Interest ()

Purpose: Doxorubicin is a weakly basic agent and undergoes protonation below a pH of 7. This may dramatically decrease the potency of doxorubicin in an acidic micro-environment which typically occurs within hepatocellular carcinomas during the process of transarterial embolization. We hypothesise that the efficacy of TACE can be improved by improving the potency of Doxorubicin when used in combination with sodium bicarbonate by creating an alkaline environment. We propose this phase 1 trial combining the standard TACE with bicarbonate

Materials and Methods: Institutional review board approval was obtained for this trial and written comprehensive consent was obtained from all patientsTen consecutive patients who consented for the study were enrolled in the trial (august 2020-december2021). Enrolled patients underwent standard conventional TACE or DEB TACE . In each tumour feeding artery that was selectively embolized, about 25 ml of 5% bicarbonate was injected along with the standard TACE emulsion . A maximum dose of 75 ml of 5% sodium bicarbonate was used per session. Procedure toxicity, imaging response and overall survival were evaluated.

Results:
A total of ten patients were treated with Bicarbonate-TACE (M:F-8:2,mean age 59y). All patients were categorised as Child Pugh A(3 patients classified as BCLC-C due to the presence of portal venous thrombosis and rest BCLC B).Viral serology (either HCV or HBV) was positive in five out of ten patients who were enrolled. Post procedure Grade 0 toxicity was seen in 5 patients, Grade 1 toxicity was found in two patients, grade 2 toxicity in three patients and and grade 3 toxicity in one patient. All BCLC -C patients (3) developed progressive disease after initial partial response and died during the follow-up period. 4 patients underwent additional treatment either with RFA or TACE to achieve complete response on imaging. One patient underwent hepatectomy after TACE. One patient died due to covid after TACE. Two patients are alive with progrssive disease which required systemic therapy.

Conclusion: Sodium bicarbonate can be safely used intra arterially during the TACE procedure. Air pockets within the lesions are normal after sodium bicarbonate TACE.