Interventional Oncology

Session: Educational Exhibit Presentations - Station 7: Imaging and Interventional Oncology

What’s New with TACE and TARE: Enhancing Tumor Response by Overcoming Biophysical and Immunological Barriers

Monday, March 6, 2023

5:40 PM – 5:45 PM

Location: Phoenix Convention Center, North Ballroom 120ABC, Poster Hall

Abstract Presenter(s)

SP

Swathi Pavuluri, BS

Medical Student
Rutgers New Jersey Medical School

Disclosure(s): No financial relationships to disclose

Author/Co-author(s)

Xiaoni Zhao, MS

Medical Student
Rutgers New Jersey Medical School
HA

Hernoor Athwal, MS

Medical Student
Rutgers New Jersey Medical School
LM

Laura Marrone, BA

Medical Student
Rutgers New Jersey Medical School
Pratik A. Shukla, MD

Director and Associate Professor of Interventional Radiology
Rutgers - New Jersey Medical School
Abhishek Kumar, MD

Division Chief of Vascular and Interventional Radiology
Rutgers New Jersey Medical School

Disclosure(s):

Swathi Pavuluri, BS: No financial relationships to disclose

Pratik A. Shukla, MD: No relevant disclosure to display

Abhishek Kumar, MD: Boston Scientific: Consultant (Ongoing), Speaking and Teaching (Ongoing); NAKI Therapeuatics: Advisory Committee or Review Panel Member (Ongoing)

Learning Objectives: To discuss recent enhancements to the use of transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in overcoming biophysical and immunosuppressive barriers within the tumor microenvironment through combination with techniques such as pressure-enabled drug delivery, immunotherapy, and molecular targeting.

Background: TACE and TARE are commonly used in the treatment of hepatocellular carcinoma (HCC) and hepatic metastases. These procedures utilize selective chemotherapeutic and radiation delivery, respectively, offering advantages in increasing delivery of therapeutics to the site of the tumor while minimizing adverse offsite effects compared to their systemic alternatives. Still, there are barriers to optimizing delivery due to the hurdles the tumor microenvironment (TME) innately presents, including increased intratumoral pressure, immunosuppressive effects, and risk of local adverse effects. Recent studies have found that supplementing TARE and TACE with additional techniques such as pressure-enabled drug delivery (PEDD), immunotherapy via immune checkpoint inhibitors (ICIs), and molecular targeting may be beneficial.

Clinical Findings/Procedure Details:

PEDD makes use of an incorporated intermittently occlusive valve system in the delivery catheter to prevent backflow and thereby increase pressure of delivery at the site of the tumor. This allows it to better overcome the enhanced pressure of the TME. PEDD has thereby been demonstrated to increase both tumor penetration and pathological response.

TACE and TARE both have innate immunostimulatory mechanisms in the TME. Combinatorial therapy with ICIs serves to supplement this effect by further increasing immune cell proliferation and infiltration within tumors, effectively increasing tumor response duration.

Although TACE and TARE are already selective through delivery via the desired blood vessel, this is not tumor-specific. Molecular targeting makes use of agents that specifically bind to the tumor itself to increase tumor penetration and prevent off-target delivery.

Conclusion and/or Teaching Points: This exhibit will: 1. Discuss the mechanisms, indications, and benefits of using TACE/TARE in combination with therapies such as PEDD, immunotherapy, or molecular targeting. 2. Highlight the most recent literature evaluating the effectiveness and utility of these combinations, including relevant clinical trials and example cases with clinical and diagrammatic images.