HAIC Toray Anthron PU Catheter Contents HAIC Advantages

HAIC & Toray Anthron P-U Catheter 杏昌生技股份有限公司

Contents HAIC： ●Advantages of HAIC ●Paper Discussion Toray Anthron P-U Catheter： ●What is APUC？ ●Animal test ●Types of Anthron P-U Catheter ●Instructions for implantation ● ●APUC先端固定留置法 ●Regimen ●Peroration

HAIC 〈Hepatic Arterial infusion chemotherphy 〉

Advantages of HAIC Increase the local drug concentration Good response rate Prolong the survival Reduction in systemic side effects Made it possible to perform treatment on an outpatient basis

Paper Discussion HCC with PVTT Liver Metastases from Colon Cancer Liver Metastases from Gastric Cancer Liver Metastases from Breast Cancer

HCC with PVTT Dr. Tanaka

HCC with PVTT 國泰醫院

Liver Metastases from Colon Cancer Dr. Kemeny ( Memorial Sloan-Kettering Cancer Center ) ●receive 6 cycles of HAI with floxuridine and dexamethasone plus intravenous fluorouracil, with or without leucovorin(Group A), or 6 wks of similar sys alone (Group B). (p=0. 03) ●At 2 yrs, the risk ratio of B/A=2. 34.

Liver Metastases from Colon Cancer Arai, M. D.

Liver Metastases from Colon Cancer Tetsuo Taguchi, M. D. Osaka University Medical School

Liver Metastases from Gastric Cancer Tetsuo Taguchi, M. D. Osaka University Medical School

Liver Metastases from Breast cancer Tetsuo Taguchi, M. D. Osaka University Medical School

Toray Anthron P-U Catheter

What is Anthron ? Anthron is hydrophilic polymer which is ionically bound Heparin and originally developed by Toray. Anthron continues to release Heparin into blood for a long term period which prevents thrombus formation.

Raw material of this catheter ●Tube : Polyurethane ●Coating on outer surface : Anthron ●Coating on inner surface : Anthron about 8 cm from distal end. (Catheters with entire inner surface coated is under development. ) ●The surface of catheter becomes slippery after moistening, then, manipulation(操作) in blood vessel is smooth.

Heparin Release Curve from Anthron P-U Catheter 10 -2 Anthron 10 -3 10 -4 10 -5 10 -6 0 10 -1 Bz. Cl-Hep 20 40 Time (hour) 60 Eluted Heparin Amount ( units/ cm 2 min. ) 10 -1 Bz. Cl-Hep 10 -2 Anthron 10 -3 10 -4 10 -5 10 -6 0 100 200 300 Time (days) 400

Concept & Target ★Catheter for long-term inderwelling★ ★ Catheter for chemotherapy

Animal test Material & Method： ●Material: silicon catheter Anthron P-U Catheter ●Animal: Dogs(Biegle) ●Indwelling place: from femoral vein to vena cava ●Indwelling term: 6 months

Test results(1) Analysis of blood components after indwelling RBC WBC Seg-Neutrophile α 2 -globlin

Test results(2) Frequency of pulmonary embolism(n=87) Observation by optical microscopy Anthron Silicone : higher risk of PE

Test results(3) Frequency of phlebitis on indwelling place(n=87) Observation by eyes　　 Anthron Silicone Observation by optical microscopy Anthron Frequency of phlebitis where the catheter is placed Silicone

Test results(4) Frequency of thrombus formation on catheter surface Observation by SEM Anthron : lower risk of thrombus formation due to catheters indwelling Silicone

Types of Anthron P-U Catheter

Instructions for implantation

Instructions for implantation ●Check the tumor location using an angiographic catheter. If necessary, redistribute the blood circulation ●Insert a guidewire into the angiographic catheter ●The guidewire must not be removed into the

●Insert an indwelling catheter into the vessel by the Seldinger technique. ●Slide in the catheter through the guidewire until it reaches the target vessel.

●Indwell the catheter at the site to be treated, assuring the position of the end of the catheter with the radioscope. To reduce the risk of the dislocation of the catheter, coil down the catheter into the aorta. ●Cut the catheter to adjust the length appropriately

●Prepare the ST 301 C or ST 305 C manufactured by B. Braun Aesculap. ST 301 C ●Insert a lock for ST 301 C or ST 305 C over the catheter ring, over the proximal end of the catheter. ST 305 C

●Insert the exit cannula of ST 301 C or ST 305 C into the catheter, as in the following illustration. ●Fix the lock ring onto the portal.

IA Catheter 的先端固定留置法 Conventional percutaneous method CHA-coil 法 SPA-coil 法 GDA-coil法

Converntional percutaneous method RGA and GDA were embolized and the indwelling catheter was inserted to PHA

CHA-coil 法 RGA was embolized and the indwelling catheter was inserted into PHA, then CHA was embolized by coils.

SPA-coil 法 Embolization of RGA, GDA, LGA and DPA were performed before the following catheter placement. The indwelling catheter was inserted to SPA with the catheter-tip fixed employing steel coils and NBCA-Lipiodol mixture, the side hole of which was placed on the celiac artery.

GDA-coil 法 Embolization of RGA was performed before the following catheter placement. The indwelling catheter was inserted to GDA with the catheter-tip fixed employing steel coils and NBCA-Lipiodol mixture, the side hole of which was placed on CHA.

Regimen For HCC (1) High dose： 5 -FU+Ifα(for one month) IF 一 IF 二 三 IF 四 5 -FU (1600 mg/body) Response Rate： 50% 五 六 日 一 5 -FU (1600 mg/body)

For HCC (2) Low dose： 5 -FU+CDDP(for one month) 一 二 三 四 五 六 5 -FU (250 mg/body)+CDDP (10 mg/body) Response Rate： 60% 日 一

For HCC (3) EEP (for one month) Etoposido 80~90 mg/body 一 二 三 四 CDDP 70 mg/body EP 50 mg/body Response Rate： 43% 五 六 日 一 CDDP 70 mg/body EP 50 mg/body

For Metastasis WHF 5 -FU 1600 mg/body for 5 -FU 一 二 三 5 -FU 1600 mg/body for 5 -FU 四 One-time/week 五 六 日 一

Peroration HAIC + Toray Anthron P-U Catheter is the best.