The LC Bead Trial; Transarterial Chemoembolization of Hepatocellular Carcinoma (HCC)With a Drug-eluting Bead

Patients will be given IV fluids and premedication with 500 mg metronidazole, 10 mg
dexamethasone, and 8 mg ondansetron to prevent infection, limit pain and nausea. The femoral
artery will be accessed and a catheter advanced into the superior mesenteric artery.
Positioning of all catheters will be confirmed by injection of radiographic contrast
material. Superior mesenteric angiography will be performed with images obtained through the
portal venous phase to confirm patency and flow direction of the portal vein and determine
the presence of aberrant supply to the right lobe of the liver by the superior mesenteric
artery. The catheter will then be advanced into the celiac artery. Celiac angiography will be
performed to determine remainder of the hepatic arterial anatomy. Selection of the tumor
bearing artery will then be performed with a microcatheter which is advanced through the
catheter in the celiac artery origin. Selection will be guided by fluoroscopy and will be at
the lobar level or peripherally in all cases. Once the feeding vessel has been selected and
confirmed by contrast injection, the physician will initiate embolization with LC Beads. Up
to two vials of LC Beads will be administered. One 2 mL vial each of 300-500 and 500-700 um
LC Beads with 37.5 mg/mL doxorubicin will be prepared. The LC Beads will be mixed with
radiographic contrast to ensure fluoroscopic visibility during injection. Under careful
fluoroscopic control, the vial of 300-500 um vial will be infused, followed by the vial of
500-700 um LC Beads. If the artery reaches stasis prior to administration of both vials, the
residual volume of LC Beads will be noted on the surgical report form. If after
administration of the DEB, there is residual antegrade flow in the feeding artery, it will be
treated with bland embolization similar to chemoembolization. After confirming that the
artery is appropriately treated, all catheters and guidewires will be removed from the
femoral artery and hemostasis obtained.

Inclusion Criteria:

- Age > 18

- Patent main portal vein with hepatopetal flow

- Bilirubin less than or equal to 2.5 mg/dl, albumin >2.8g/dl, alkaline phosphatase
<630IU/L, AST <235IU/L, ALT <265IU/L, INR <2.0, PTT <40sec., absolute neutrophil count
>1K/cumm, platelet count >100K/cumm

- No encephalopathy

- No previous biliary ductal intervention

- Child A status

- Confirmation of Hepatocellular Carcinoma (through biopsy or radiological exam)

- Unresectable HCC and ineligible for possible curative therapies

- Normal ECG with QT <480 msec within the previous 2 months

- Normal MUGA scan within the previous 2 months

- Measureable disease per the Response Evaluation Criteria in Solid Tumors (RECIST)

- Subject is competent and willing to provide written informed consent in order to
participate in the study

Exclusion Criteria:

- Thrombosis or hepatofugal flow in the main portal vein; presence of a large shunt
which in the operator's opinion precludes embolization

- Replacement of greater than 50% of the liver parenchyma by tumor

- Bilirubin greater than or equal to 2.6 mg/dl

- ECOG performance status of 2 or greater

- Previous liver directed therapy

- Previous biliary intervention (excluding cholecystectomy)

- Allergy to iodinated contrast used for angiography

- Elevated creatinine greater than or equal to 1.8 mg/dl

- Women who are pregnant or nursing

- Patients in which any of the following are contraindicated: 1)the use of doxorubicin,
2)MRI or CT scans, 3) Hepatic embolization procedures

- Patients with active bacterial or fungal infection that is deemed to be clinically
significant by the investigator

- Patients with cardiac disease, including congestive heart failure, recent myocardial
infarction, or uncontrolled arrhythmias

- Non-English speaking patients