Phosphorus-32 microparticles for locally advanced pancreatic cancer: how and when?

Figures & data

Table 1. First clinical applications of ³²P-particles in pancreas carcinoma.

Author	Year/Country	Study	n. of patients	Safety	Results	Comment
Bhutani et al. [11]	USA/2019	Open-label, Single-Arm Pilot Study	9	1 grade IV toxicity 23 grade III toxicity neutropenia, anemia, and thrombocytopenia	LDCR at week 16 was 88%, with PR or SD reported in 7/8 patients	The procedure for ^32P-microparticles’ implantation resulted feasible and relatively safe
Ross et al. [12]	UK/2022	Single-arm pilot study	50 (ITT) 42 (PP)	41 TEAEs in 16 (38.1%) patients were deemed possibly or probably related to ^32P-microparticles, with 167 (15.1%) classified as grade ≥ III	LDCR was 82% and 90.5% for the ITT and PP patients, with 10 downstaged becoming amenable for surgery	The integrated regimen with ^32P-microparticles and chemotherapy was relatively safe and led to surgical resection the 20% of treated patients
Nadu et al [14]	Australia/2022	Prospective, singe center	12	No significant peri-procedural complications	Reduction in tumor volume and metabolic activity in all cases, 5 of which underwent surgery	The integrated regimen combining ^32P-microparticles and chemotherapy is safe and results in an improved tumor resection rate

LDCR: local disease control rate; ITT: intention-to-treat population; PP: population treated with ³²P-microparticles; treatment-emergent adverse events.

Figure 1. Schematic representation of EUS-guided administration of ³²P-microparticles (left side). In published studies, microparticles’ biodistribution has been assessed by bremsstrahlung SPECT/CT at 4 h and 7 days’ post implantation, while tumor response has been evaluated at 16 weeks by CT and 12 weeks by ¹⁸F-FDG PET/CT (right side). Figure created with BIorender.com.

Bhutani MS, Klapman JB, Tuli R, et al. OncoPaC-1: an open-label, single-arm Pilot study of phosphorus-32 microparticles brachytherapy in combination with gemcitabine ± nab-paclitaxel in unresectable locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys. 2019;105(1):E236–E237. doi: 10.1016/j.ijrobp.2019.06.2010

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Ross PJ, Wasan HS, Croagh D, et al. Results of a single-arm pilot study of 32P microparticles in unresectable locally advanced pancreatic adenocarcinoma with gemcitabine/nab-paclitaxel or FOLFIRINOX chemotherapy. ESMO Open. 2022;7(1):100356. doi: 10.1016/j.esmoop.2021.100356

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Naidu J, Bartholomeusz D, Zobel J, et al. Combined chemotherapy and endoscopic ultrasound-guided intratumoral 32P implantation for locally advanced pancreatic adenocarcinoma: a pilot study. Endoscopy. 2022;54(1):75–80. doi: 10.1055/a-1353-0941

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