# Patent

## Title
Method for therapy of liver tumors

## Abstract

A method for regional administration of preparations during the therapy of liver tumor, comprising administering a preparation into a branch of the portal vein with the simultaneous occlusion of afferent and efferent lobe vessels (branches of the portal vein proximal the place of puncture, branches of the hepatic artery and lobar hepatic vein) for 5–15 minutes.
During catalytic therapy, it is preferable to use Teraphtalum as the preparation and to administer ascorbic acid after termination of occlusion.
During photodynamic therapy, it is preferable to use photosens as the preparation and to carry out irradiation of the tumor after 10–35 minutes.
This method of administration provides for the predominant accumulation of the preparations in the target lobe (tumor carrier lobe) of the liver, their low penetration into the systemic blood flow, which makes it possible to reduce the dose of the preparation and its general toxicity.

## Background
FIELD OF THE INVENTION
The present invention relates to a method for the administration of different preparations into a liver with a tumor lesion and may be utilized in antitumor therapy.
BACKGROUND OF THE INVENTION
A method is known for administration of preparations, on the example of photodynamic therapy of liver tumors, into the hepatic artery (R. van Hillegersberg, J. P. A. Marijnissen, W. J. Kort, P. E. Zondervan, O. T. Terpstra//Interstitial photodynamic therapy in a rat liver metastasis model. Br. J. Cancer, 1992, 66, pp. 1005–1014). Photophrin was used as the preparation and irradiation was carried out 48 hours after its administration.
A drawback of the method is the spread of the preparations into the systemic blood flow, their rapid reduction in the region of damage and as a result—an increase of the general toxicity.
SUMMARY OF THE INVENTION
The object of the invention is to develop a method for administration of preparations to a target lobe (tumor carrier lobe) of the liver, ensuring their predominant accumulation in the target lobe of the liver in combination with a small spread into the systemic blood flow. This makes it possible to reduce the total amount of the introduced preparation and its toxicity.
This object is achieved by introducing a chemical preparation into a branch of the portal vein with the simultaneous occlusion of the afferent (branches of the portal vein proximal the place of puncture and branches of the hepatic artery) and efferent (lobar hepatic vein) vessels of the target lobe of the liver for 5–15 minutes. Thus, direct lengthy contact between the preparation and the target lobe of the liver, which has been eliminated from blood circulation, is accomplished. The indicated method makes it possible during catalytic therapy to introduce a second component of the binary pair—ascorbic acid (AA), immediately after removal of the occlusion with a large content of Teraphtalum (TP) in the target lobe of the liver, and during photodynamic therapy to accomplish irradiation of the tumor in early periods after the administration of a photosensitizer.


DISCLOSURE OF THE INVENTION
Practically speaking, the method is carried out in the following manner. A median laparotomy is conducted, afferent (a branch of the portal vein and hepatic artery) and efferent (a branch of the hepatic vein) vessels of the target lobe of the liver are isolated. They are taken on tourniquets. A puncture of the branch of the portal vein is made, the preparation is introduced therein, simultaneously stopping the flow of blood: the blood inflow—through branches of the portal vein (proximal to the place of puncture) and the hepatic artery, outflow—through a branch of the hepatic vein. Restoration of the blood flow is accomplished by removing clamps from the vessels 5–15 minutes after administration of the preparation.
The following data illustrate the method according to the invention. Teraphtalum (cobalt octacarboxy phthalocyanine) (TP) and Photosens (a mixture of diulfonated, trisulfonated, and tetrasulfonated derivatives of aluminum phthalocyanine) (PS) (GNTs RF “NIOPIK,” Moscow) were used as the preparations.
EXAMPLES
1. Study of the Distribution of Teraphtalum with Known Regional and Proposed Methods of Administration.
The studies were carried out on mongrel rats weighing 150 g, obtained from the N. V. Blokhin ONTs breeder and contained in the vivarium of that center.
1.1. Distribution of Teraphtalum in the Case of the Known Regional Administration.
Teraphtalum (TP) was administered once into the general trunk of the portal vein in a dose of 5 mg/kg (this was 1 mg of TP for a rat weighing 200 g). Accumulation of the preparation in the liver, lungs and its level in blood plasma were evaluated by the spectrophotometric method 5, 35 and 240 minutes after the administration.
The results are presented in Table 1. It follows from the table that the kinetics of TP in the case of the known regional administration carried a biexponential character, typical for the systemic intravenous method of administration. The preparation accumulated gradually in the liver and after only 4 hours its concentration fell. A significant amount of TP was detected in the lungs.







TABLE 1







Content of Teraphtalum in blood plasma, liver and lungs of rats with


the known regional method of administration in a dose of 5 mg/kg.











Content of Teraphtalum




(μg/g of untreated tissue)




Time for gathering material after



Place of
administration of Teraphtalum, min











No.
measurement
5
35
240





1
plasma
  92.4
  39.6
  14.4


2
liver
15
60
51


3
lungs
46
28
57









1.2. Distribution of Teraphtalum in the Case of the Proposed Method for Regional Administration.

Teraphtalum in a dose of 60 or 300 μg per rat in the form of 0.6 ml of a 0.01 and 0.05% solution was administered into a branch of the portal vein of a target lobe of the liver. The dose of TP introduced by this method is based on the possible volume of the introduced liquid in the target lobe and the allowable concentration of the TP solution which does not cause damage to the endothelium of the vessels.
Thus, the total amount of introduced TP with the proposed method of administering was 3.3 times less (at a concentration of 0.05%) and 16.5 times less (at a concentration of 0.01%) than with the known regional administration (respectively 0.3 mg, 0.06 mg and 1 mg per rat).
Accumulation of the preparation in the target lobe (subjected to occlusion), in the intact lobe of the liver (not subjected to occlusion) and also in the blood plasma were studied 5, 35 and 240 minutes after administration of the preparation by the proposed method. The results are presented in Table 2.







TABLE 2







Content of Teraphtalum in different parts of the liver and plasma of


healthy rats with the proposed regional method of administering the


preparation in a target lobe of the liver in a dose of


0.3 mg (0.6 ml, 0.01% solution).









Content of Teraphtalum (μg/g of untreated tissue)



Term of collection of material after administration


Place of
of Teraphtalum (min)










measurement
5
35
240





Target lobe of liver
30 
33 
48 


Intact lobe of liver
7
5
9


Plasma
3
—
—









It is evident from Table 2, that with the proposed method for administration of TP, a rapid accumulation of the preparation in the target lobe of the liver was observed, the difference in the level of the concentration of the preparation in the occluded and intact lobes of the liver was maintained over the whole term of observation—4 hours. The concentration of TP in the target lobe liver in the first minutes after administration by the proposed method was 2 times higher than with the known regional method (see Table 1), while the dose of the introduced TP in the proposed method was 16.5 times less.
The results of a study of the effect of the length of the period of occlusion of the afferent and abducent vessels of the target lobe of the liver on the accumulation of TP therein are presented in Table 3.







TABLE 3







Content of Teraphtalum in blood plasma and different lobes of


the liver 35 minutes after administration of the preparation in a dose of


0.3 mg (0.6 ml of a 0.01% solution) by the proposed method


depending on the length of the occlusion of the afferent and


abducent vessels of the target lobe of the liver.















Content of




Time of occlusion
Place of
Teraphtalum



No.
(min)
measurement
(μg/g)







1
5
intact lobe
7



2
15 
of liver
6



1
5
target lobe
35 



2
15 
of liver
35 



1
5
blood plasma
5



2
15 

7



—
control
intact lobe
17 





target lobe
20 





blood plasma
6










It follows from Table 3 that both with 5 and with 15 minute occlusion of the afferent and abducent vessels of the target lobe of the liver, the content of the preparation was the same in that lobe as in the intact lobe of the liver, i.e. an increase in the time of occlusion did not result in a large accumulation of TP in the target lobe of the liver. At the same time, the selective administration of TP into the lobe branch of the portal vein of the target lobe of the liver without occlusion (control) was accompanied by uniform distribution of the preparation in that lobe and in the intact lobe of the liver: the content of TP 30 minutes after administration was respectively 17 and 20 μg/g, and the level in the plasma—6 μg/g of untreated tissue.
Thus, the proposed regional (selectively-occlusive) method for administration of TP into the target lobe of the liver has advantages over the known regional method, since it ensures predominant accumulation of the preparation in the target lobe of the liver, reduces the total amount of the introduced preparation and its penetration into the systemic blood flow.
1.3. Catalytic Therapy of a Liver Tumor by the “Teraphtalum+Ascorbic Acid” (TP+AA) System when Using the Proposed Method for Administration of Preparations.
The liver tumor was modeled by inoculating into the central lobe of the liver 0.1 ml of a 20% tumoral suspension of a multipassage subcutaneous alveolar mucinous carcinoma of the liver (strain PC-1). Catalytic therapy (CT) was carried out 2 weeks after inoculation of the tumor. TP was administered by the proposed method in a volume of 0.6 ml of a 0.01% solution into a branch of the portal vein of the tumor carrier lobe of the liver with subsequent 5-minute occlusion of afferent and efferent vessels of that lobe, AA (weight ratio to TP−2.2:1) was administered immediately after termination of the occlusion in the same vessel as the TP. Rats with liver tumor, who were not given treatment, served as the control. The results were evaluated 21 days after the treatment. Measurement of the dimensions of the tumor was carried out, the volume of the tumor and the tumor growth inhibition (TGI) index calculated, and also a histological study of the tumor carrier lobe of the liver was carried out.
The volume of the tumor was calculated according to the equation (Carlsson S. R. G., Gullberg B. and Hafstron L. O.//Estimation of liver tumor volume using different formulas—an experimental study in rats. J. Cancer Res. Clin. Oncol. 105, 20–23, 1983):

Vtumor=(A×B2)×π/6

Vtumor is the volume of the tumor,
A is the maximum diameter of the tumor,
B is the minimum diameter of the tumor,
π=3.14.
The tumor growth inhibition index was calculated by the equation (Experimental evaluation of antitumor preparations in USSR and U.S.A., 1980, Moscow, Meditsina, pp. 71–106):

TGI(%)=[(TGcontrol−TGtest)/TGcontrol]×100%, where

TGI is the tumor growth inhibition,
TGtest is the volume of the tumor (mm3) in rats of the test group,
TGcontrol is the volume of the tumor (mm3) in rats of the control group.
A significant therapeutic effect was considered to be tumor growth inhibition of 50%.
The results of catalytic therapy are presented in Tables 4 and 5.







TABLE 4







Dimensions of liver tumors in rats and data on histological study pf the


tumor carrier lobe of liver before and after 21 days after administration


of Teraphtalum and ascorbic acid by the proposed method.









Dimensions of tumor










On 14th day after inoculation
On 35th day after inoculation of


No.
of tumor (prior to treatment)
tumor (21 days after treatment)





1
3 × 3
9 × 6


2
2 × 2
No tumor


3
1 × 1
3 × 4


4
1 × 1
No tumor, abscess


5
2 × 2
No tumor, abscess


6
2 × 2, 3 × 4
7 × 4


7
4 × 2
8 × 7


8
7 × 5, 3 × 3
8 × 7


Volume
46.8 ± 28.1
204.6 ± 67.8 


of


Tumor


(mm3)


M ± m





* - the difference between the arithmetical mean indexes of the volume of the tumor before and after action is not reliable, p > 0.05.






Two adjacently positioned tumor nodes were detected in a liver lobe in rats No. 6 and No. 8 on the 14th day after inoculation of the tumor.







TABLE 5







Dimensions of liver tumor in rats of control group


on the 14th and 35th (corresponding to 21 days after treatment)


days after inoculation of the tumor









Dimensions of tumor, (mm)










on 14th day
on 35th day


No.
after inoculation
after inoculation





1
5 × 4, 2 × 3
19 × 7 


2
3 × 4
7 × 3, 7 × 4


3
6 × 9, 6 × 4
5 × 12, 6 × 10, 6 × 10, 5 × 12


4
5 × 2
12 × 2, 1 × 2, 2 × 2


5
3 × 4
4 × 4, 10 × 7


6
3 × 4
4 × 5, 3 × 4, 7 × 6


7
5 × 5
20 × 13, 10 × 7


8
5 × 4
20 × 20


Volume of
86.07 ± 36.3 
1489.2 ± 760*  


tumor


(mm3)M ± m





*the difference between the arithmetical mean indexes of the volume of the tumor on 14th and 35th days after inoculation of the tumor suspension is reliable, p < 0.05.






Two adjacently positioned tumor nodes were detected in a liver lobe in rats No. 1 and No. 3 on the 14th day after inoculation of the tumor.
From 2 to 4 tumor nodes were detected in rats No. 2–7 on the 21st day after treatment (35 days after inoculation of the tumor) in a lobe of the liver.
It was determined during a comparative analysis of the results in the main and control groups (see Tables 4 and 5) that prior to treatment (14 days after inoculation of the tumor) the dimensions of the tumors were comparable and were 46.8±28.1 and 86.1±36.3 mm3, respectively (p>0.05).
In the group of animals who were given treatment in accordance with the proposed method (see Table 4), tumor carrier lobes of malignant cells were not detected in 3 out of 8 rats during a histological study, in the other 5 animals there was not a reliable increase of the tumor: 46.8±28.1 mm3 (prior to treatment) and 204.6±67.8 mm3 (after treatment), p>0.05.
In the control group (see Table 5) the size of the tumors 35 days after the inoculation was reliably greater than in the test group: 1489.2±760 mm3 and 204.6±67.8 mm3, p<0.05.
The TGI index on the 21st day after treatment (35 days after inoculation of the tumor) was 86.3% with use of the proposed method for administration of preparations of a catalytic binary pair.
II. Study of the Distribution of Photosensitizer with the Proposed Method for Administration.
A photosens (PS) (GNTs “NIOPIK,” Moscow) was used as the photosensitizer. Studies were carried out on mongrel rats weighing 150 g, obtained from the “Stolbovaya” nursery and kept in the P. A. Gertsen MNIOI vivarium. The photosens was administered in a dose of 1 mg/kg systemically intravenously (group 1) and in accordance with the proposed method (group 2). Distribution of the PS in the tissues was studied with the aid of specific fluorescence by a contact method on a “Spektr” (TOO “Klaster”) laser diagnostic installation. Normalized fluorescence (NF) was determined 5, 15, 35 minutes and 24 hours after administration of the preparation. The results are presented in Tables 6 and 7. It follows from Table 6 that with systemic intravenous administration (group 1) the PS was distributed uniformly in the central (target lobe) and upper lateral (intact) lobes of the liver. A rapid accumulation of the preparation in the skin was noted.
During the administration of the preparation by the proposed method (group 2) with subsequent occlusion, a reliable difference between the NF in the indicated lobes of the liver was noted: the content of PS in the target lobe was higher as compared with the intact lobe. Wherein, the content of PS in the skin of rats of group 2 was lower than in the animals of group 1. These differences were maintained for 35 minutes after the administration of the preparation, by 24 hours the difference leveled out, which probably was related to the removal of PS from the occluded lobe of the liver.
When PS is administered by the proposed method to rats with liver tumor, the main accumulation of PS in the tumor and the parenchyma surrounding the tumor carrier lobe of the liver in the early period after administration is also noted (see Table 7).







TABLE 6







Indexes of normalized fluorescence of photosens in different lobes of the liver


and skin of healthy rats with the proposed and systemic intravenous


administration of the preparation.









Indexes of normalized fluorescence, (c.u.)


Time of
Place of measurement (lobe of liver)












study after
Method of
Central

Right



administration
administration
(target
Upper
lateral


of preparation
of photosens
lobe)
(intact)
(intact)
Skin





 5 minutes
Proposed
141.2 ± 44.8
 55.6 ± 2.1*
76.2 ± 17.1
 6.9 ± 1.2*



Systemic
112.6 ± 6.8 
 119.5 ± 11.9
113.1 ± 8.4 
15.2 ± 0.9



intravenous


15 minutes
Proposed
157.0 ± 39.4
 70.0 ± 4.6*
76.7 ± 17.8
 10.5 ± 1.1*



Systemic
118.3 ± 8.6 
106.4 ± 8.6
111.5 ± 6.7 
19.8 ± 3.6



intravenous


35 minutes
Proposed
165.1 ± 39.7
 99.5 ± 7.9*
91.4 ± 8.9 
 11.3 ± 0.5*



Systemic
114.0 ± 5.9 
122.0 ± 4.6
106.0 ± 3.9 
21.8 ± 3.8



intravenous


24 hours
Proposed
 79.9 ± 46.3
117.5 ± 6.1
99.9 ± 7.2*
17.6 ± 2.3



Systemic
133.9 ± 3.8 
138.6 ± 9.7
134.2 ± 2.0 
18.4 ± 0.3



intravenous





*reliability of the difference of the indexes in an identical lobe of the liver and skin with systemic intravenous and the proposed methods of administration, p < 0.05.













TABLE 7







Indexes of normalized fluorescence of photosens in the tumor, the parenchyma


surrounding the liver tumor, and skin of rats with the proposed and systemic


intravenous administration of the photosensitizer in a dose of 1 mg/kg.











Indexes of normalized fluorescence, (c.u.)


Place of
Method of
Time of measurement after administration of PS












measurement
administration
5 min
15 min
35 min
24 hours





Liver tumor
Proposed
 84 ± 19
88 ± 9
113 ± 24
—



Systemic
46.1 ± 5.5
65.4 ± 7.4
70.0 ± 6.1
93.4 ± 9.3



intravenous


Parencyma
Proposed
161.5 ± 39.7
178.9 ± 15.2
148.2 ± 20.3
—


surrounding
Systemic
111.2 ± 6.4 
116.6 ± 5.2*
117.1 ± 3  
119 ± 3 


liver tumor
intravenous


Skin
Proposed
10.0 ± 1.2
 8.5 ± 0.9
10.7 ± 1.6
—



Systemic
11.2 ± 2  
14.5 ± 6  
13.2 ± 2.1
14 ± 1



intravenous





*reliability of difference of indexes of normalized fluorescence of photosens in corresponding tissues with different methods of administration of the photosens, p < 0.05.






PDT in both groups was carried out with identical parameters of irradiation: power of 200 mW/cm2, light dose of 150 J/cm2. After 3 days the animals were killed, the tumor carrier lobe of the liver was sent for histological study, which showed that in rats of group 1, 1⁄3 of the area of the tumor remained the same, while in animals of group 2, total necroses of tumor nodes was noted.
The results of PDT were studied on the 21st day after irradiation of the tumor. The test group was composed of rats who were subjected to irradiation after the administration of photosens by the proposed method. The control group was composed of animals in which after 2 weeks after inoculation of the tumor the size of the tumor was measured during laparotomy, and PDT was not carried out. The results of PDT are presented in FIG. 1.
It is evident from FIG. 1 that 2 weeks after inoculation, the size of the tumors in the control and test groups did not reliably differ, being respectively 45.6±16.5 and 76.9±29.5 mm3, p>0.05. On the 21st day the size of the tumor in the control group reliably increased to 397.04±41.7 mm3, p<0.05. A reliable increase of the size of the tumor in the test group was not noted, the area of the tumor was 57.2±25.03 mm3, p>0.05. After the PDT, tumor growth inhibition was 81.3%.
Thus, the proposed method for administration of the preparations as compared with the known method ensures their advantageous accumulation in the target lobe (tumor carrier lobe) of the liver, small penetration into the systemic blood flow, which makes it possible to reduce the dose of the preparation and its general toxicity.

## Claims

1. A method of catalytic therapy of a liver tumor comprising:
occluding afferent and efferent vessels of a target lobe of the liver for 5–15 minutes; and
administering a cobalt octacarboxy phthalocyanine preparation into a portal vein of the target lobe of the liver (tumor carrier lobe) during occlusion.

2. A method of photodynamic therapy of a liver tumor comprising:
occluding afferent and efferent vessels of a target lobe of the liver for 5–15 minutes; and
administering a preparation comprising a mixture of disulfonated, trisulfonated, and tetrasulfonated derivatives of aluminum phthalocyanine into a portal vein of the target lobe of the liver (tumor carrier lobe) during occlusion.