SIR 2024
Interventional Oncology
Johannes du Pisanie, Jr., MD (he/him/his)
Integrated Interventional Radiology Resident
UNC School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Haneyeh Shahbazian, MD (she/her/hers)
Research Fellow
University of North Carolina
Financial relationships: Full list of relationships is listed on the CME information page.
David Mauro, MD
Division Chief
UNC
Financial relationships: Full list of relationships is listed on the CME information page.
Alexander Villalobos, MD
Interventional Radiology Resident
Emory University School of Medicine
Disclosure information not submitted.
Hyeon Yu, MD, FSIR (he/him/his)
Professor
University of North Carolina at Chapel Hill School of Medicine
Financial relationships: Full list of relationships is listed on the CME information page.
Nima Kokabi, MD
Associate Professor of Radiology
University of North Carolina - Chapel Hill
Financial relationships: Full list of relationships is listed on the CME information page.
< !1. Describe the hepatocellular carcinoma (HCC) tumor microenvironment (TME) immunogenomic classification. 2. Describe the impact of common immunotherapies on the HCC TME. 3. Describe the impact of yttrium-90 trans-arterial radioembolization (Y90-TARE) on the HCC TME. 4.Describe the potential synergies between immunotherapies and Y90-TARE in HCC treatment and review current combination therapy trials and their results.
Background:
Most patients with HCC are diagnosed with locally advanced disease which is ineligible for curative surgical management {1}. Immunotherapy is increasingly used in patients with advanced HCC. However, commonly HCC tumors are not responsive to immunotherapy in part due to an immune-tolerant peri-tumoral microenvironment (TME) {2}. This phenomenon has prompted exploration of combining immune and locoregional therapies, namely immune checkpoint inhibitors (ICI) with yttrium-90 trans-arterial radioembolization (Y90-TARE), to help mitigate this resistance through potential synergistic effects {3,4,5}. Combination therapy is an active area of research with many phase 1 and 2 clinical trials currently underway. Understanding the complex interactions between Y90-TARE, ICIs, and the HCC TME is essential to an interventional radiologist’s comprehension of the theory, methodology, and results of combination Y90-TARE / immunotherapy trials. This presentation aims to act as a primer for IR’s to better navigate this exciting area of research.
Clinical Findings/Procedure Details: This presentation will review current HCC TME classification systems and their treatment implications. The changes ICI’s and Y90-TARE exert upon the HCC TME composition of immune cells, non-immune cells, surface proteins, and or cytokines and the potential impact on treatment outcomes will be discussed. The rationale behind combination treatment of HCC with Y90-TARE and certain immunotherapies will be presented. Finally, current phase 1 and 2 clinical trials assessing ICI’s and Y90-TARE combination therapy safety and efficacy will also be discussed. P</span>ictorial representations of key concepts to aid in their understanding will also be presented.
Conclusion and/or Teaching Points: