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Advances in Local-Regional Therapies for HCC

Panelists:Ghassan K. Abou-Alfa, MD, Memorial Sloan Kettering Cancer Center; Richard S. Finn, MD, Geffen School of Medicine; Riccardo Lencioni, MD, Sylvester Comprehensive Cancer Center; Amit Singal, MD, UT Southwestern Medical Center
Published: Thursday, Jul 07, 2016


Transcript:

Ghassan K. Abou-Alfa, MD:
No doubt that the world of local therapy has also emerged with different approaches. What’s new?

Riccardo Lencioni, MD: Well, there are several new options. I would say in the area of ablation, we have novel forms of local therapy that use different energies. And, for instance, the new kid on the block now is irreversible electroporation—which is a non-thermal technology—so there is going to be much less risk of injury to any adjacent structures to the tumor. Of course, we’re speaking here about an investigational device. Just to make it clear, this is not currently FDA-approved for HCC or any other cancer. In the area of combination modalities, we have trials ongoing with ablation and drugs that will be released in situ during the ablation—carriers that are thermally sensitive—and therefore will be able to deliver a highly concentrated amount of drug in the ablation zone, ideally maximizing the efficacy.

Ghassan K. Abou-Alfa, MD: So, use the energy of the RFA to dissolve some membrane that will leech out some form of therapy at maximal dose.

Riccardo Lencioni, MD: Correct.

Ghassan K. Abou-Alfa, MD: Fascinating! What else?

Riccardo Lencioni, MD: That’s in the area of ablation. In the area of chemoembolization, there are several new agents and drugs that are currently being investigated. Most of the procedures are still based on drugs such as doxorubicin or cisplatin. And many new agents, potentially, have a profile that make them suitable for regional delivery.

Ghassan K. Abou-Alfa, MD: But, come on, fascinate us a little bit more. What about that virus that you can inject, the vaccinia into the tumor. What’s going on there?

Riccardo Lencioni, MD: That’s really very exciting! I would say it’s especially exciting because this would be the first local-regional therapy with a systemic effect. In short, this is an engineered virus created from the vaccinia virus that we can inject into the tumor by using imaging guidance—similar to how we would do a biopsy—and then there will be an immune effect targeting not only the injected tumor, but any other foci of disease. This is one of the big trials that is now ongoing for advanced disease. So, clearly, there are many new options under investigation. I would say that, realizing how complex the constellation of HCC is, really this is a 360º approach trying to devise more effective and safe therapies.

Ghassan K. Abou-Alfa, MD: It’s fascinating! If anything, from the perspective of the medical oncologist, what you need to know, at this point in time, is definitely that these clinical trials are ongoing. But please make sure that you see what’s around you, see what your colleagues might be doing—either at the center close by or even at your own center—sometimes in regard to engaging patients in those clinical trials. We heard about electroporation, we heard about a thermal ablation with some leeching of certain therapy within the treatment based on RFA, and we heard about the vaccinia virus—which I believe Dr. Lencioni is referring to as JX-594 over here—which is a disrupted tyrosine kinase but within vaccinia that will actually induce the killing of the cells and transfecting all other tumors being either in the liver or outside the liver. All fascinating stuff, but just make sure you that you have access to those clinical trials.

Transcript Edited for Clarity
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Transcript:

Ghassan K. Abou-Alfa, MD:
No doubt that the world of local therapy has also emerged with different approaches. What’s new?

Riccardo Lencioni, MD: Well, there are several new options. I would say in the area of ablation, we have novel forms of local therapy that use different energies. And, for instance, the new kid on the block now is irreversible electroporation—which is a non-thermal technology—so there is going to be much less risk of injury to any adjacent structures to the tumor. Of course, we’re speaking here about an investigational device. Just to make it clear, this is not currently FDA-approved for HCC or any other cancer. In the area of combination modalities, we have trials ongoing with ablation and drugs that will be released in situ during the ablation—carriers that are thermally sensitive—and therefore will be able to deliver a highly concentrated amount of drug in the ablation zone, ideally maximizing the efficacy.

Ghassan K. Abou-Alfa, MD: So, use the energy of the RFA to dissolve some membrane that will leech out some form of therapy at maximal dose.

Riccardo Lencioni, MD: Correct.

Ghassan K. Abou-Alfa, MD: Fascinating! What else?

Riccardo Lencioni, MD: That’s in the area of ablation. In the area of chemoembolization, there are several new agents and drugs that are currently being investigated. Most of the procedures are still based on drugs such as doxorubicin or cisplatin. And many new agents, potentially, have a profile that make them suitable for regional delivery.

Ghassan K. Abou-Alfa, MD: But, come on, fascinate us a little bit more. What about that virus that you can inject, the vaccinia into the tumor. What’s going on there?

Riccardo Lencioni, MD: That’s really very exciting! I would say it’s especially exciting because this would be the first local-regional therapy with a systemic effect. In short, this is an engineered virus created from the vaccinia virus that we can inject into the tumor by using imaging guidance—similar to how we would do a biopsy—and then there will be an immune effect targeting not only the injected tumor, but any other foci of disease. This is one of the big trials that is now ongoing for advanced disease. So, clearly, there are many new options under investigation. I would say that, realizing how complex the constellation of HCC is, really this is a 360º approach trying to devise more effective and safe therapies.

Ghassan K. Abou-Alfa, MD: It’s fascinating! If anything, from the perspective of the medical oncologist, what you need to know, at this point in time, is definitely that these clinical trials are ongoing. But please make sure that you see what’s around you, see what your colleagues might be doing—either at the center close by or even at your own center—sometimes in regard to engaging patients in those clinical trials. We heard about electroporation, we heard about a thermal ablation with some leeching of certain therapy within the treatment based on RFA, and we heard about the vaccinia virus—which I believe Dr. Lencioni is referring to as JX-594 over here—which is a disrupted tyrosine kinase but within vaccinia that will actually induce the killing of the cells and transfecting all other tumors being either in the liver or outside the liver. All fascinating stuff, but just make sure you that you have access to those clinical trials.

Transcript Edited for Clarity
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