Cancer Biology for Interventional Oncology Clinicians: An Interview With Jean-Francois Geschwind, MD

At the the 2015 Society of Interventional Radiology Annual Scientific Meeting, Jean-Francois Geschwind, MD, presented information for interventional oncology clinicians about cancer biology. Interventional Oncology 360 asked Dr. Geschwind to share a few important takeaway messages from his presentation.

Q: Can you share a couple of key points about cancer biology that IO clinicians need to know?

A: It’s a very large area that I think the interventional oncologists must be familiar with. The tumor macro environment plays a major role in how cancers actually grow and thrive, and because we affect what’s going on within the tumor macro environment I think it’s even more important for us to understand some of the key pathways, specifically angiogenesis, hypoxia and metabolism, because those three are intimately related at the molecular level. So while you may not be able to be proficient in everything you do, you should be able to at least understand some of the key concepts and the key pathways.

Q: So how have those concepts been incorporated into IO therapies?

A: Well they already are. Some of these are already in clinical trials. For example, we know that the process of chemoembolotherapy causes hypoxia and hypoxia in turn causes proangiogenesis and we are combating the effect of proangiogenesis by using systemic drugs that are approved by the FDA for that purpose. So combining our procedures with some designed molecular approaches actually may augment the impact of interventional oncology procedures. The results so far have been somewhat disappointing but nonetheless we are on the right track. It think that’s what we have to explore more and more — the combination of the local regional effect with a more systemic approach that directly deal with the tumor macro environment.

Q: There are studies under way right now?

A: Yes, there are many clinical trials combining chemoembolic therapy with antiangiogenesis and there are others coming down the pike that are still really at the preclinical stage, particularly some that are pro-drugs that are activated in hypoxic conditions, drugs like ours that also target glycolysis or metabolism and other different components or compounds that are made or about to be made available for clinical development.

Q: Anything else you think is important to say about cancer biology and what’s on the horizon?

A: Another important point is the combination of ablation. Now there’s a better understanding of what effects ablation has on the rest of the body and the notion of immunomodulation as a result of ablation. A lot of research is being done on how we can either enhance or minimize this modulatory effect. But I think it goes back to understanding some of the key pathways, especially some of those that we disrupt: if we are disruption pathways at a microbiology level, it’s the least we can do to understand what we do and how we affect them. So those to me are the key points and my session covers that. That’s what I really wanted to do, is cover that in depth so that interventional oncology clinicians learn that this is an important issue.

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Editor’s note: Dr. Geschwind is section chief of interventional radiology, director of cardiovascular and interventional radiology, and director of interventional radiology research at Johns Hopkins in Baltimore, Maryland. He is a widely published author and is also the recipient of numerous national and international awards and grants for his research in the field of liver cancer. Dr. Geschwind is a member of the editorial board of the Journal of Vascular and Interventional Radiology (JVIR), Techniques in Vascular and Interventional Radiology, and the World Journal of Gastroenterology and is the vice chair of the World Conference on Interventional Oncology (WCIO). He is a member of the Hepatobiliary Task Force of the National Cancer Institute and has been a board member of the Society of Interventional Radiology Research Foundation since 2006.