Setting the audiences sights on the horizon at the 2023 Global Embolization Oncology Symposium (GEST, 18–21 May, New York City, USA) yesterday, Daniel Sze (Stanford University, Stanford, USA), editor in chief of the Journal of Vascular and Interventional Radiology, gave his predictions on what the interventional oncology (IO) space will look like in five years. His forecast identified the important research changing the landscape of IO, the developments that have brought us to present day, and the current areas with unmet medical needs that are receiving the most investment.
Opening his presentation with the words of Søren Kierkegaard: “Life can only be understood by looking backward; but it must be lived looking forward”, Sze began by describing recently published research articles with important implications for future practice which have been selected for editor’s awards by the Journal of Vascular and Interventional Radiology.
Delving into the content of these research papers, Sze discovered dialysis access to be the most prevalent topic to appear among award-winning papers, because of large, prospective, randomized, industry-sponsored trials. Of the most frequently awarded research within IO, Sze identified papers that explored the interactions between locoregional therapies and the immune system or immunotherapy, a topic more frequently awarded than trans-arterial radio-embolization (TARE), trans arterial chemoembolization (TACE), and ablation research publications.
Reflecting on changes that have occurred in the last five years, Sze outlined the treatments carried out now that were not performed, or as much, five years ago. Compiling a list of six treatments, Sze included musculoskeletal ablation and stabilisation, ablative dose TARE, pressure-augmented TACE, thyroid ablation, genomics biopsy and venous deprivation. Applying a set of probing questions for each, Sze interrogated the procedures respectively, asking—“why not use the concept of FLR?” for ablative dose TARE, “what is the pressure endpoint?” when performing pressure-augmented TACE, and “how can we block accelerated tumour growth without blocking hepatocyte growth?” in venous deprivation.
Pivoting to the next segment of his presentation, Sze addressed the unmet medical needs which are receiving the most investment today. First, he described new ablative technologies such as sonication, being explored by HistoSonics with their Edison histotripsy system. Additionally, Sze included the Galvanize Aliya pulsed-electric-field technology and Erik Cressman’s (MD Anderson Cancer Center, Houston, USA) development of thermochemical ablation.
Continuing, Sze outlined new anatomical targets that are receiving greater investment, such as bronchial and pulmonary TACE and renal, prostate and intracranial TARE. Alongside, these he noted new radionuclides that have received contemporary attention, for example radio-opaque TARE from ABK Biomedical and holmium-166 TARE developed by Quirem Medical, among others. Finally, Sze highlighted new immunotherapies and combination treatments that have received investment to help meet unmet medical needs, citing the large variety of non-PDL and non-CTLA4 immunotherapies in development. He foresees increased involvement of IR with in-situ vaccination, since practitioners in the field are uniquely qualified in drug delivery and local tumour environment modulation.
Casting an eye to the future, Sze concluded his presentation by stating that “five years is not a long time”, emphasising that physicians should be looking ahead not just 5 but also 15 and 50 years to identify ways that IR can lead the fight against cancer, and possibly for patients in earlier stages rather than salvage settings. Wrapping up his most salient premonitions for future practice, Sze predicted that in five years, interventional radiologists should expect to be performing incrementally improved ablation, TACE and TARE, combining locoregional therapies “more rationally” with immunotherapy, increasingly informed by tumour genetics, and most importantly, continuing the pursuit of the elusive abscopal response, the holy grail of IO.