Intratumor Injections in Interventional Oncology

Osman Ahmed, MD, University of Chicago, Illinois, discusses the new area of cancer therapy, intratumor injections. This method may allow for a higher therapeutic index with less toxicities from immunotherapies for patients with cancers.

As Dr Ahmed explains, with these therapies interventional radiologists will be responsible for directly injecting these agents into the tumor. This technique is “already in our skill set” and, as he notes, “no other specialty will be able to sort of reach some of these tumors.”

Transcript:

Hi everyone, I'm at the CIO meeting, my name is Osman Ahmed, I'm an interventional radiologist at the University of Chicago. One of the few things I was invited to speak about was intratumor injections, which is a sort of hot or new area of cancer therapy.

As we all probably know, immunotherapies have become very popular lately for their ability to sort of effectively treat a lot of cancers. With that said, there are some limitations of systemic immunotherapies, including a low therapeutic index — meaning a lot of tumors are “immunologically cold,” so it's hard for these therapies to penetrate the tumor. In addition to that, there's toxicities related to sort of the systemic IV administration of these drugs as well. So there's been a lot of interest now to try to inject these therapies directly into the tumor, to try to help make these tumors produce their own vaccine, basically immunologically wake them up so that there's more antigen presenting cells and sort of make this more effective.

One of the advantages of direct tumor injection would be you can achieve higher therapeutic index, because you can inject much higher concentrations of these agents. And there's a wide variety of agents currently being studied including oncolytic viruses and immune cells and things like that. It's a really exciting time. Most of these are in clinical trials and we expect probably in the near future for some of these to hopefully start coming onto the market.

With that said what is the role of IR for this? The role of IR is going to be very critical because we are going to be tasked with the job of injecting these therapies directly into the tumor and so we'll obviously need to have the technical expertise to do that, but we are all trained to sort of do that already. These direct intratumor injections are already in our skill set. We're already doing biopsies, we're already placing needles in tumors for ablation, things like that. That won't be very different, other than there may be challenging tumors that we have to get needles into, and so obviously our technical skill will come into play because no other specialty will be able to sort of reach some of these tumors. The good thing about this is this is an existing skill we already have.

But what we'll have to adapt to is fitting into the workflow and the logistical challenges of administering these therapies, and then also trying to standardize these injections to make sure that we get consistent results for these patients as well.

It's an exciting time and I believe that probably over the next few years we're going to start getting results from many of these trials and we'll start seeing this much more commonly.