At the 2014 Symposium on Clinical Interventional Oncology (CIO), Dr. Dan Brown, presented information about therapies for neuroendocrine tumors. Interventional Oncology 360 interviewed Dr. Brown about the interventional oncology therapies provided at Vanderbilt University as well as his CIO presentation.
Q: How did you become involved in the interventional oncology specialty?
A: I’m director of a formal division of interventional oncology at Vanderbilt University. It’s a standalone division rather than a subdivision of interventional radiology. I first started treating cancer patients in 1999 when I was on the faculty at Mallinckrodt Institute of Radiology. It was a niche-based practice and I was able to start developing referrals and treating patients, and I found it very gratifying. As the field grew, I networked with like-minded specialists and gained additional training to build up a practice.
Q: What kinds of IO therapies are provided at Vanderbilt?
A: We have a wide array of therapies. We do intra-arterial therapies, including SIR Spheres and Theraspheres, conventional chemoembolization, and drug-eluting beads. We do thermal ablation, including radiofrequency and cryoablation. We’re on the way to getting a microwave ablation system in place. We also have a high-intensity focused ultrasound system available for research purposes.
Q: Could you share some details about the presentation you gave on neuroendocrine tumors?
A: A number of interesting publications came out in the last year on surgical and intra-arterial therapy of neuroendocrine tumors. Treatment is very effective even in patients with extrahepatic disease. However, careful attention needs to be paid to the Ki67 value. A value of >20% indicates it’s going to be a more aggressive process. Also, you don’t need to treat every patient who shows up. You want to make sure there’s enough of a disease burden so that the embolic agent primarily goes into the tumor rather than into the normal liver tissue.
Q: What are some of the points that you shared on transarterial chemoembolization at the CIO meeting?
A: I gave a talk on ethiodol chemoebolization with the subtitle “It’s Not Dead Yet.” Dr. Lencioni presented the GIDEON data, which shows that the United States is rapidly adopting drug-eluting beads. I think that drug-eluting beads are effective, but there are patients who do well with ethiodol chemoembolization as well. However, ongoing drug shortages are certainly a source of frustration.
Q: What are some of the most exciting developments happening now in interventional oncology?
A: I think in the next couple of years outcomes from trials on intra-arterial therapies will direct a lot of what we do. We have a pretty good idea of what we can get with HCC but for metastatic disease there’s much less data. The SIRFLOX trial will come out hopefully this year, and other trials combining systemic and locoregional therapies for diseases like colorectal cancer could open avenues to treating cancers like breast cancer and other metastatic disease processes.
Q: Would you like to share any other important points on what’s coming in the future?
A: I think we are getting more critical in how we look at data, bringing patients in by performance status or subgroup instead of just a wide swath of patients or all-comers types of studies. I think as we get more data and larger studies, patient outcomes will improve.
