“It is important to pursue imaging response assessment”

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Robert J Lewandowski, associate professor of Radiology, Northwestern University, Chicago, USA, who was part of the GEST 2012 US scientific programme committee, gave Interventional News a quick account of key developments from the interventional oncology sessions from the meeting in New York.

What were the key, new interesting developments in interventional oncology to emerge at GEST 2012 US?

The meeting took both a practical and a critical look at the embolic agents used in transcatheter intra-arterial cancer therapies. These therapies include arterial embolization, chemoembolization with/without drug-eluting beads, and radioembolization. There is increasing interest in combining systemic therapies with our locoregional therapies. Discussions at the meeting primarily focused on combining new anti-angiogenesis agents with intra-arterial therapies.

What are three messages that emerged from the interventional oncology sessions in terms of consensus or discussion at GEST 2012 US that you would like to share with other interventional radiologists?

  • There is a trend toward favouring smaller embolic agents for arterial embolization and chemoembolization with drug-eluting bead procedures. These smaller agents may improve response rates, but there is concern for increasing toxicities. Further studies are warranted.

  • The role of all intra-arterial therapies in the setting of portal vein tumour thrombus continues to be studied. A consensus panel favoured radioembolization in this clinical context.

  • There is promising data emerging for chemoembolization with irinotecan-loaded drug eluting beads for the treatment of patients with metastatic colorectal cancer.

 

What key questions would you like to see answered in the field of interventional oncology?

The first and most important concept is to improve the quality of our research. Phase 3 trials are important to further establish the role of interventional oncology. As such, it is exciting to see many such trials underway in radioembolization. Some companies are currently sponsoring international, multicentre, randomised phase 3 trials in both hepatocellular carcinoma and metastatic colorectal cancer.

The second important concept in interventional oncology research that is important to pursue is imaging response assessment. Standard anatomic response strategies utilise changes in size (and more recently necrosis), but these changes may take months to realise and can be misleading secondary to treatment-related effects on the adjacent hepatic parenchyma. Functional parameters (such as serum tumour markers, positron emission tomography, diffusion weighted imaging at magnetic resonance imaging) have shown promise but continue to have limitations, including lack of standardisation.

The third concept in interventional oncology research that is important to pursue is determining the appropriate application of our therapies. These studies will need to take into consideration expected treatment outcomes, safety profile, quality of life, and cost-benefit analyses in order to discern a) which patients to treat, b) when to apply our therapies within the context of multi-discipline care c) which treatment to perform when, and d) when to combine our treatment with other locoregional or systemic therapies.