Intra Tumoral, Targeted, Local, Cancer Immuno-chemotherapy
Summary:
Clinical studies conducted in recent years It has been shown that in "advanced lung cancers limited to the mediastinum", obstruction in the airways due to tumor location negatively affects the prognosis of the patient, whereas the elimination of airway obstruction with interventional bronchoscopy methods makes standard cancer treatments more successful and extends the lifespan of patients.
Methods that specifically affect cancer cells (without damaging normal cells) are applied as brachytherapy, photodynamic therapy, endobronchial intratumoral chemotherapies.
Endobronchial intratumoral chemotherapy, which is a new paradigm in our treatment. ” (EITK) was defined and its indications and place among bronchoscopic interventional methods were determined. The treatment effect and results are shown.
It has been shown that the EIKT effect principle is specific to cancerous cells, as it necrosises cancerous cells without damaging normal cells, as in photodynamic therapy and brachytherapy.
In addition, the potential benefits of using endobronchial intratumoral chemotherapy as a neo-adjuvant chemotherapy simultaneously or sequentially with radiotherapy, intravenous chemotherapy and other endobronchial interventional methods have been available since 1990, which we started at Istanbul University, later Gainsville, It has been shown by the research we developed together at the University of Florida, USA.
The feasibility of the treatment; We demonstrate and publish the reliability of the treatment (absence of systemic side effects), the prolongation of life of patients, and the medical results of the clinical research we have conducted since the 1990s.
Endo Bronchial Intra Tumoral Chemotherapy (EITK) Its place in cancer treatments was classified among the treatment methods for the first time at the world congress of the American Thoracic Society (ATS) held in San Francisco in 2007. The clinical trial results of the multi-center EITK, which has been initiated in the United States and Germany since this date. The data were published in 2013 and 2015 and it was stated that the treatment increased the reliability and life expectancy.
Application Technique:
EITK is a new interventional bronchoscopic treatment method that consists of injecting the cytotoxic drug used intravenously through a bronchoscope with a catheterized needle directly into the tumor tissue.
On the one hand, EITK enables the elimination of the endobronchial tumor mass causing obstruction; On the other hand, it has a specific cell-killing effect on cancer cells without harming normal cells.
The importance of local administration of EITK is that the drug is released into the tumor tissue, Local provision of high concentrations that can never be achieved intravenously; However, significant systemic side effects do not occur.
An 8-10 times higher drug concentration is achieved. When cytotoxic drugs are administered intratumorally, they pass into the peripheral blood circulation in very small amounts. For this reason, a significant systemic toxic effect never occurs in EITK.
EITK treatment Method of administration:
In EITK, the drug is administered locally into the tumor at 2 mg/mL or 4 mg/mL (cm3=0.5xLxD)
Into the tumor. The maximum dose of the injected drug is 40 mg in each session.
4 injections of the local drug are administered into the tumor at 1-week intervals. (Days 1, 8, 15, and 22)
According to the results we published in the journal "Lung Canser" in 2006: the reliability, effectiveness and clinical treatment benefits of the method, tumor melting after cisplatin injection and follow-up The successful effect of EITK along with radiotherapy has been demonstrated by extending the survival time in inoperable lung cancers.
Celikoglu F, Celikoglu SI, York AM, et al. Intratumoral administration of cisplatin through a bronchoscope followed by irradiation for treatment of inoperable non-small-cell obstructive lung cancer. Lung Cancer. 2006;5 1:225–236.
With EITK treatment, 17 of our patients, who were previously considered inoperable due to tumor melting, became operable as the tumor shrank, and the 3-year survival time increased by 65%.
Celikoglu SI, Celikoglu F, Goldberg EP. Endobronchial intratumoral chemotherapy (EITC) followed by surgery in early non-smallcell lung cancer with polypoid growth causing erroneous impression of advanced disease. Lung Cancer. 2006;54:339–346.
What are the clinical benefits of intratumoral chemotherapy:
Locally high doses without general toxic effects Reaching the dose
Shrinking the tumor tissue by rapidly killing the tumor tissue
Creating the possibility of surgical treatment after treatment in bronchial cancers that cannot be operated on at the beginning
There is no systemic effect in any patient, which can occur with classical chemotherapy. There were no side effects
Systemic Chemo Therapy can be performed simultaneously with Radio Therapy
3. EITK treatment in a case with stage Lung Cancer:
79 years old, Male patient
Complaints: Cough (for 1 month), hemoptysis, weight loss (7 kg). , weakness, syncope
Diseases he had: TB in 1970, atrial fibrillation, epilepsy, anemia,
Habit: cigarette: 30 cigarettes/year, has not smoked for 20 years,
Treatment: He is using anticoagulated, antiepileptic drugs
Right lung local obstructive breath sounds, dullness in the right lung, normotensive, ECG: Atrial Fibrillation, CRP high
Thorax Computed tomography (23.06.2017): 3 cm mass on the right, apical anterolateral. Conglomerate lymph nodes on the right in the mediastinum, pleural effusion in the right lung
Pleural fluid cytology: transudate, cytology negative, microbiology(-), TB BK(-)
Bronchoscopy (23.06.2017): The main carina opening was widened, the right main bronchus was obstructed and endo luminal infiltration, the right lower lobe bronchi was obstructed, forceps biopsy was taken, bronchial lavage was performed.
Bronchi Pathology: large cell lung cancer PET CT: Right upper lobe of the lung, densely located in the apico-anterior part of the upper lobe Malignant mass lesion with a diameter of 3 cm showing hypermetobolism, also subpleuritis in the right lung hypermetabolic nodule compatible with localized metastasis (3.7.2017)
Treatment: Simultaneously; 3 courses of systemic chemotherapy; taxol + carboplatin and
3 cycles of Endobronchial Intra Tumoral chemotherapy, (cisplatin) were applied between 13.07.2017 and 18.09.2017, 3 cycles at 3-week intervals
Below are 2-monthly treatments. Endo bronchial and radiological improvement was demonstrated in the treatment application
BRONCHOSCOPIC IMPROVEMENT: Complete improvement was achieved in endo bronchial obstruction and mucosal infiltration. 30 mg cisplatin EITK was administered for 2 months, for 3 cures, with 3-week intervals
RADIOLOGICAL IMPROVEMENT: (A) 23.06.2017 thorax CT; Right lung upper lobe 3 cm peripheral nodule, mediax CT conglomerate lymph nodes in the mediastinum and right pleural effusion, (B) 12.09.2017 thorax CT; Right lung upper lobe metastatic nodule shrunk by 50% (1.4 cm), pleural effusion almost completely resorbed Mediastinal Lymph nodes have been resorbed
Reaching high doses locally without general toxic effects
Shrinking the tumor tissue by rapidly killing it
Ability to provide surgical treatment after treatment for bronchial cancers that were initially inoperable
No patient had any systemic side effects that may occur with classical chemotherapy
Systemic Chemotherapy can be performed simultaneously with Radiotherapy
Increases survival in advanced stage lung cancers limited to the mediastinum
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