Imageable holmium-166 microspheres for SIRT
see what you treat, treat what you see
Next-generation microspheres for SIRT
QuiremSpheres® consists of Holmium-166 microspheres that have the same mode of action as existing Yttrium-90 based SIRT products: the microspheres emit beta radiation that kills tumor cells from close range. However, QuiremSpheres® can be visualized with SPECT and MR imaging, even in low concentrations. This is unique and cannot be done with currently available Yttrium-90 based microspheres and enables accurate verification of the delivered dose after the treatment. QuiremSpheres® comes with Q-Suite™, a proprietary software tool to calculate the absorbed dose based on the SPECT and MR images.
1. QuiremSpheres® are shipped in ready-to-use patient-specific vials. There is no need for patient-dose preperation on-site.
2. QuiremSpheres® can be visualized with high accuracy (MRI) and high sensitivity (SPECT) after the treatment to verify dose delivery.
3. QuiremSpheres® comes with Q-Suite dosimetry software, tailored for evaluating 166Ho SIRT.
4. Local product specialists will fully support you in setting-up the software, on-site imaging equipment and training of involved staff.
5. We offer you a peer-to-peer QuiremSpheres® training program, including proctoring by a SIRT clinical expert, to ensure a seamless first treatment experience.
“166Ho-radioembolisation is feasible and safe for the treatment of patients with unresectable and chemorefractory liver metastases and enables image-guided treatment.” Smits et al. Lancet Oncology 2012 http://dx.doi.org/10.1016/S1470-2045(12)70334-0
“Radioembolization with 166Ho-microspheres induced a response in salvage patients with metastatic liver malignancies.” Prince et al. Journal of Nuclear Medicine 2017 http://dx.doi.org/10.2967/jnumed.117.197194
|Beta-radiation (Emax)||1.77 MeV (48.7%)|
1.86 MeV (50.0%)
|Gamma-radiation||81 keV (6.7%)||–|
|Visible on MRI||Yes||No|
|Half-life||26.8 hours||64.1 hours|
|Material||poly(L-lactic acid)||resin (r) or glass (g)|
|Diameter||15-60 μm||20-60 μm (r) |
20-30 μm (g)
|Density||1.4 g/cm3||1.6 g/cm3 (r) |
3.3 g/cm3 (g)
QuiremSpheres® consists of biocompatible poly-L-lactic acid (PLLA) microspheres containing Holmium-166. The microspheres have a mean diameter of 30 micrometer (97% between 15 to 60 micrometer). Holmium-166 is a high-energy beta emitting isotope for therapeutic use. The maximum energy of the beta particles is 1.85 MeV (50.0%) and 1.77 MeV (48.7%). The maximum range of the emitted beta particles in tissue is 8.7 mm with a mean of 2.5 mm. In addition, Holmium-166 emits primary gamma photons (81 KeV). The half-life is 26.8 hours, which means more than 90% of the radiation is delivered within the first 4 days following the implantation procedure. At planned moment of treatment, the activity per microsphere is approximately 240-375 Bq. QuiremSpheres® is a permanent implant.
QuiremSpheres® is indicated for the treatment of unresectable liver tumours.
QuiremSpheres® is intended for implantation into hepatic tumours by delivery via the hepatic artery.
As outpatient treatment, QuiremSpheres® are injected by a microcatheter in the hepatic artery and are transported by the blood flow to the tumor(s) in the liver. The tip of the microcatheter is put in the optimal position, as determined during the pre-treatment planning phase. The full procedure takes about 60 minutes.
It is strongly recommended to use the QuiremSpheres® administration system for performing the implantation of the QuiremSpheres® microspheres.
QuiremSpheres® microspheres are contraindicated in patients who have:
- had previous external beam radiation therapy to the liver;
- ascites or are in clinical liver failure;
- inadequate liver function
- significantly abnormal synthetic and excretory liver function tests (LFTs);
- a lung dose exceeding 30 Gy in a single treatment.
- a pre-assessment angiogram that demonstrates abnormal vascular anatomy that would result in significant reflux of hepatic arterial blood to the stomach, pancreas or bowel;
- been treated with capecitabine within two months prior to treatment, or who will be treated with capecitabine at any time following treatment with QuiremSpheres®;
- complete main portal vein thrombosis;
- inadequate kidney function
- uncorrectable extrahepatic deposition. Activity in the falciform ligament, portal lymph nodes and gallbladder is accepted.
next-generation microspheres for sirt
QuiremSpheres® is safe1 and effective2 for treating unresectable liver tumors
QuiremSpheres® offer an innovative way of treating unresectable cancers in the liver by means of Selective Internal Radiotherapy (SIRT). It is the only commercially available SIRT product based on holmium-166. Holmium has unique imaging properties, allowing the physician to treat what he sees and see what he treats.
How to get started with QuiremSpheres®
in 6 simple steps
Ensure product availability in your region
Contact your local Terumo representative to inquire if QuiremSpheres®, QuiremScout® and Q-Suite are available in your region. A local QuiremSpheres® product specialist will assist you in preparing your hospital and clinical team.
Apply for a holmium license
The first step in getting your hospital ready for QuiremSpheres® is to make sure you have the appropriate licenses in place to receive and handle the isotope holmium-166. Depending on your region/country, obtaining a holmium license may take anywhere between a few weeks up to 6 months.
Attend a QuiremSpheres® workshop
Terumo and Quirem Medical organize frequent workshops at a QuiremSpheres® Center of Excellence in which you can learn from and interact with experts users of QuiremSpheres® and QuiremScout®.
On-site product training
A few weeks before the first procedure, a QuiremSpheres® product specialist will visit your hospital to train all staff involved in the QuiremScout® and/or QuiremSpheres® treatment.
Set-up imaging systems and install software
In order to use the imaging and verification possibilities of QuiremSpheres® to their fullest potential, we will support you in setting up your MR and SPECT(/CT) system(s) for imaging of QuiremSpheres®.
First patient treatment
Once all prior steps have successfully been completed, you are ready to treat the first patient with QuiremScout® and/or QuiremSpheres®. During the first treatment, an experienced QuiremSpheres® user (proctor) will support your team during the preparation and treatment procedure.
Latest news for QuiremSpheres®
On 05-09-2018 the first two patients were treated with QuiremSpheres®, the only commercially available holmium-166 based microspheres for SIRT, as part of the HORA EST HCC clinical study aiming to treat early stage HCC patients. After the University Medical Centre Utrecht, this is now the second Dutch hospital to use
On June 7th the first site of the QuiremSpheres® Observational Study, the Universitätsklinikum Carl Gustav Carus in Dresden, Germany, was opened for registration. The observational study aims to further confirm treatment safety and efficacy using QuiremSpheres® for the treatment of patients with unresectable primary liver cancer or unresectable liver metastases.
On June 21st 2018, the first patient at Universitätsklinikum Magdeburg was treated with QuiremSpheres® in Magdeburg, Germany. The multidisciplinary team led by Prof. Dr. Maciej Pech (Director), PD Dr. med. Maciej Powerski (IR), Prof. Dr. Michael Kreißl (NM physician), Dr. Oliver Großer (Physicist) and Hr. Maurice Klopfleisch (Radiopharmacist) successfully performed