Modulating the Tumor Immune Microenvironment with Locoregional Image-Guided Interventions

 This presentation will explain the biological rationale for locoregional image-guided immunotherapy administration, summarize the existing interventional oncology approaches to immunotherapy, and discuss emerging technological advances in biomaterials and drug delivery that could further advance the field of interventional oncology.      

Background: Cancer immunotherapy has gained significant attention in recent years and has revolutionized the modern approach to cancer therapy. However, cancer immunotherapy is still limited in its full potential due to various tumor immune-avoidance behaviors and delivery barriers, and this is seen in the low objective response rates of most cancers to immunotherapy. A novel approach to immunotherapy utilizes image-guided administration of immunotherapeutic agents directly into a tumor site; this technique offers several advantages, including avoidance of potent toxicity, bypassing the tumor immunosuppressive microenvironment, and higher therapeutic bioavailability relative to systemic drug administration.

Clinical Findings/Procedure Details: Locoregional immunotherapy has fewer systemic side effects than conventional chemotherapeutics with similar tumor reduction potential due to their targeted delivery to tumor cells. Recent preclinical studies have established the therapeutic viability of locoregional immunotherapy delivery, demonstrating significant potential to revolutionize the modern approach to cancer treatment. Existing strategies for locoregional immunotherapy include oncolytic viruses, intratumoral delivery of checkpoint inhibitors, and innate immune system activation. Engineered methods such as nanoparticle encapsulation of therapeutics, magnetic resonance targeting, and clustered regularly interspaced short palindromic repeats (CRISPR) – CRIPSR associated protein 9 (Cas9) multiplex editing systems can be combined with image-guided injections for robust and highly precise administration of cancer therapeutics.

Conclusion and/or Teaching Points: Intratumoral administration of cancer immunotherapy in particular has significant potential to alter the landscape of cancer treatment in the coming years, both independently and in conjunction with conventional treatment strategies. Many treatment-resistant or difficult-to-reach malignancies could become accessible with further advances in locoregional therapeutic administration. Moreover, the exciting developments in biomaterials and biotechnology will further enhance the precision and efficacy of locoregional immunotherapy.