Randomized Embolization Trial for NeuroEndocrine Tumor Metastases To The Liver

Inclusion Criteria:

   - Participants 18 years and older;

   - Biopsy-proven neuroendocrine tumor.

   - Measurable metastasis to liver with at least one dimension ≥ 1.0 cm.

   - Tumor burden dominant in the liver AND liver tumor burden less than or equal to 70% of
   the total liver volume by visual estimate.

   - Not a candidate for surgical resection based on unresectability, anatomy, anesthesia
   risk, patient preference.

   - Symptoms uncontrolled by somatostatin analogues OR morphologically progressive tumor
   by RECIST 1.1 criteria in the liver OR baseline tumor burden >25% of the liver volume.

   - There must be no plans for the patient to receive other concomitant therapy while on
   this protocol treatment (other than somatostatin analogs or bone-strengthening
   agents).

   - Performance status 0-2 on Zubrod/ECOG Performance Scale;

   - Serum creatinine < 2.0 mg/dL;

   - Serum Bilirubin ≤ 2.0 mg/dL

   - Serum albumin ≥ 3.0 g/dL

   - Platelet count > 50 thousands/uL (corrected if needed)

   - INR ≤ 1.5 (corrected if needed)

   - All patients must be informed of the investigational nature of this study and must
   sign a study specific informed consent in accordance with institutional and federal
   guidelines prior to study entry.

Exclusion Criteria:

   - Pregnant or lactating women may not participate due to the embryotoxic effects of
   protocol treatment. Women/men of reproductive potential may not participate unless
   they have agreed to use an effective contraceptive method.

   - Prior hepatic arterial therapy or hepatic radiation therapy. Prior surgical resection
   or ablation of liver metastases is acceptable. Patients must be at least one month
   beyond prior chemotherapy, PRRT, ablation or surgery, and have recovered from all
   therapy-associated toxicities.

   - Active infection (Symptomatic bacterial and fungal infection - newly diagnosed and/or
   requiring treatment);

   - Choledochoenteric anastomosis; transpapillary biliary stent, or sphincterotomy of
   duodenal papilla

   - Absolute contraindication to intravenous iodinated contrast (Hx of significant
   previous contrast reaction, not mitigated by appropriate pre-medication).

   - Contraindications to arteriography and selective visceral catheterization:

      1. severe allergy or intolerance to contrast media, narcotics, sedatives, or
      atropine.

      2. bleeding diathesis not correctable by usual forms of therapy.

      3. severe peripheral vascular disease precluding catheterization.

   - Contraindications to hepatic artery embolization:

      1. portal vein occlusion without hepatopedal collateral flow demonstrated by
      angiography; or portal hypertension with hepatofugal flow.

      2. hepatic encephalopathy.