in 10 YEARS


WHAT COMES NEXT?


I see a resurgence of IR involvement in neuro IR as the next generation of


IRs complete IR residency and resume cerebral angiography— particularly if they include carotid stenting and stroke therapy in their skillset or complete neurointerventional radiology fellowships after their residencies. This would reinvigorate radiology involvement in neurointerventional radiology.


— MARTIN RADVANY, MD, FSIR


• The Emerald-1 trial (NCT03778957) is a three-arm study of 710 patients randomized to TACE combined with durvalumab and bevacizumab vs. TACE and durvalumab vs. TACE alone.


• Leap-012 (NCT04246177) is another study looking at 950 patients randomized to two groups: TACE with pembrolizumab and lenvatinib vs. TACE alone.


• Checkmate-74W (NCT04340193) studies 765 patients randomized to TACE with nivolumab and ipilimumab vs. TACE and nivolumab vs. TACE alone.


• Lastly the TACE-3 study (NCT04268888) involves 522 patients stratified to TACE and nivolumab vs. TACE alone.


Primary endpoints for all these trials include overall survival.


Conclusion Just as immunotherapy’s combination with targeted therapy has radically changed the treatment paradigm in patients with advanced stage HCC, positive results of any one of the four combination trials of TACE and immunotherapy could shift the paradigm for treatment of intermediate- stage HCC patients.


Practicing interventional radiologists must heed the call to recruit, enroll and treat patients in immunotherapy trials to answer the question of TACE and immunotherapy for intermediate-stage HCC. If not, investigators in other disciplines may ask, “Are locoregional therapies like TACE or SIRT really needed at all in intermediate- stage HCC, or can advanced-stage treatments like immunotherapy and antiangiogenics/TKIs be more successful


1993 1994 1995


The balloon-expandable coronary stent used today is created.


Vascular and interventional radiology is recognized by American Board of Medical Specialties (ABMS) as a subspecialty of diagnostic radiology.


1996


than TACE or SIRT alone in intermediate- stage HCC patients?”


The results of these trials and the answer to these questions remains unknown, but one thing is clear: Breakthroughs in the understanding of how locoregional therapies affect the TIME will shape future trials that define systemic, locoregional and combination therapies for intermediate-stage HCC patients for years to come.


References


1. Sung, H et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of incidence and mortality worldwide for 36 cancers in 185 countries. Ca Cancer J Clin 2021;0:1–41.


2. Galle, PR et al,. EASL Clinical practice guidelines: Management of hepatocellular carcinoma. Jour Hep. 2018;69(1)182–236.


3. Llovet, J and the SHARP Investigators Study Group. Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008 Jul 24;359(4):378–90.


4. Finn, RS et al and the IMbrave150 Investigators. Atezolizumab plus bevacizumab in unresectable hepatocellular carcinoma. N Engl J Med. 2020 May 14;382(20):1894–1905.


5. Meyer, T et al. Sorafenib in combination with transarterial chemoembolisation in patients with unresectable hepatocellular carcinoma (TACE 2): A randomised placebo- controlled, double-blind, phase 3 trial. Lancet Gastroenterol Hepatol. 2(8): 565–575.


6. Pinter M et al. Hepatocellular carcinoma: A phase II randomized controlled double-blind trial of transarterial chemoembolization in combination with biweekly intravenous administration of bevacizumab or a placebo. Radiology. 2015 Dec;277(3):903–12.


7. Lee, HL et al. Inflammatory cytokines and change of Th1/Th2 balance as prognostic indicators for hepatocellular carcinoma in patients treated with transarterial chemoembolization. Sci Rep 2019;9:3260.


8. Liao Y, et al. Increased circulating Th17 cells after transarterial chemoembolization correlate with improved survival in Stage III hepatocellular carcinoma: A prospective study. PLoS ONE 2013;8(4): e60444.


1997


1998


Intra-arterial delivery of tumor-killing viruses and gene therapy vectors to the liver is introduced.


14 IRQ | SPRING 2021 SUPPLEMENT


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20