Andrew Holden (Auckland City Hospital; University of Auckland, Auckland, New Zealand) speaks to Interventional News ahead of this year’s Charing Cross Symposium (CX), which is being held online 19–22 April. In 2021, the conference will focus on controversies within the vascular and endovascular space. paclitaxel
What can delegates expect from this year’s meeting in terms of understanding the paclitaxel controversy?
This year, we are focusing on controversies. While 2020 was clearly the year of the pandemic, those of us who are endovascular specialists remember 2019 as being the year of the paclitaxel controversy, provoked by a meta-analysis that was published just a month or so before the start of 2019 [in the Journal of the American Heart Association (JAHA) by Konstantinos Katsanos (University of Patras, Patras, Greece) et al]. While it is very import to take reports on safety very seriously, many of us were concerned for patients who, subsequent to this meta-analysis, were not receiving some of the profound benefits of paclitaxel-based anti-restenotic therapies in the lower limb arteries, drug-coated balloons and drug-eluting stents. Clearly, these paclitaxel eluting devices have shown superior patency with lower reintervention rates compared to standard treatment, sustained for many years. Because of that controversy, the use of these devices significantly decreased and there has been real interest in trying to assess if the paclitaxel safety issue was real or due to some other factors, such as trial design, trial patient numbers, and length of follow-up. With that in mind, there has been a huge effort to re-evaluate the data in terms of randomised controlled trials and real-world data, and I am delighted to say that a new meta-analysis with updated five-year data, sheds new light on the paclitaxel mortality issue.
If the paclitaxel mortality issue proves to be incorrect, we need to think about how we integrate paclitaxel into our current practice, and how the regulators in particular deal with this issue. This is important for the global vascular community, because paclitaxel-based products are such a vital component of offering state-of-the-art care for our lower-limb arterial occlusive patients.
I really look forward to joining you in the controversies sections at Charing Cross 2021.