CIO Townhall: Examining Trials, Truths, and Threats to IO

By Brenda Silva

The CIO Townhall session provided an assessment of the value placed on recent trials and data that may affect interventional oncology practices and procedures. The discussion served to underscore the importance of interventional oncology (IO), make sense of conflicting trial results, and caution against new threats that may influence treatment planning for patients.

Offering a look at the value of IO in a major cancer center, Leonard Kalman, MD, gave an overview of the Miami Cancer Institute and listed some of its benefits for oncology patients. Dr. Kalman detailed long-term facility goals that will address different types of cancer as separate areas for specialization and attention with interventional oncology as a major part of cancer management.

Next, Guest Course Director Ziv Haskal, MD, and Course Director Shaun Samuels, MD, moderated a panel discussion on how to understand confusing information reported in recent trials about IO procedures. The panel reviewed the perceived benefits of the SIRFLOX-FOXFIRE clinical trial as the largest interventional radiology (IR) clinical trial to date, which generated high-quality data. However, negative aspects were that hepatic tumor progression is not a good surrogate for overall survival, and Y-90 should not routinely be used in the first-line setting.

The panel reported on a comparison between nivolumab and sorafenib and how both drugs are tolerated and provide varied patient benefits. Recent data indicated that a large group of patients tolerated nivolumab better; however, further data need to be collected and evaluated for additional information on the different drug therapies.

Karen Brown, MD, asserted the need for strict enrollment criteria and central reading in general uses, as well as the need for new drugs in a combination of TACE+ drug options.

Speaking about individualized adaptive stereotactic body radiotherapy (SBRT) for liver tumors in patients at high risk for liver damage, Daniel Brown, MD, pointed out, “Stereotactic body radiotherapy (SBRT) is not a benign procedure, with nearly 50% of patients receiving less than the targeted dose.”

William Rilling, MD, reported on the SARAH/SIRveNIB trials, and pointed out a better tolerance for Y-90 with SIRveNIB with a better quality of life.

Rounding up the panel discussion, Daniel Sze, MD, focused on the CLOCC trial, noting, “even though over 96.5% of cases were technical successes with elimination of cancer tissue, the same patients still died from their cancers.”

Moderating the last morning session, Guest Course Director Charles Ray, MD, initiated a panel discussion on perceived threats to IO, such as immunotherapy, biologics, and genomics. The panelists focused their concerns on existing data that are being viewed as responsible for generating more interest in the newer approaches, which are becoming more influential factors in treatment decisions.

“One of the external threats to IO is the loss of procedures to other specialties, such as ablation. Another threat is having other procedures replace ours, such as EUS/ERCP and SBRT. Also, there is the threat of there being no need for procedures that we currently perform.”

Dr. Ray listed internal threats such as splintering of the IR community, as well as studies comparing IR procedures. “It becomes a case of us versus us with things like radioembolization versus chemoembolization,” he explained.

Looking at how interventional oncologists are getting involved in clinical trials, Sarah White, MD, said, “It’s so important for us to have a seat at the same table when they are constructing clinical trials because they don’t know what we do. I’m impressed with the evolution of how this is happening.”

She also commented on the evolution of palliative care, noting, “With patients who respond better with Y-90, we don’t have to give them cytotoxic therapy anymore. So it’s good to see palliative care being taken more into account now.”

Dr. Ray posed a question to the panel about the possibility of things getting easier based on how easy interventional oncologists have made them seem. Peter Littrup, MD, offered an answer that summed up the session.

“Know your strengths and know your weaknesses. There’s a benefit to what each of us does, and we need to not only identify the portion at risk for undertreatment, but also consider the patient’s quality of life as well.”