Chief, Vascular and Interventional Radiology Rutgers New Jersey Medical School
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 barrierswithin the tumor microenvironmentthrough combination with techniques such as pressure-enabled drug delivery, immunotherapy, and molecular targeting.
Background: TACE and TARE arecommonly used in the treatment of hepatocellular carcinoma (HCC) and hepatic metastases. These procedures utilize selective chemotherapeutic and radiation delivery, respectively, offering advantages in increasingdelivery of therapeutics to the site of the tumor while minimizingadverse offsite effects compared to their systemic alternatives. Still, there are barriers to optimizing deliverydue to the hurdles the tumor microenvironment (TME)innately presents, including increased intratumoralpressure, immunosuppressive effects, and riskof local adverseeffects. 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 theenhanced 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 ICIsserves to supplement this effect byfurther increasing immune cell proliferation andinfiltration within tumors, effectivelyincreasing tumor response duration.
Although TACE and TARE are already selective through delivery via the desired blood vessel, this is nottumor-specific.Molecular targeting makes use ofagents 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.