New Combination Therapies in Interventional Oncology: An Interview With Afshin Gangi, MD, PhD

Afshin Gangi, MD, PhD, is professor of interventional radiology and chief of interventional radiology at the University Hospital Strasbourg, in Strasbourg, France. He is also a professor at King’s College in London, and a member of the Interventional Oncology 360 editorial board. At the 2015 Synergy interventional oncology meeting, IO360 spoke with Dr. Gangi about his specific practice interests. 

Gangi: I am really interested in interventional oncology. I cover all of interventional radiology but my field of interest has been cancer in particular since I was a resident. In Strasbourg, we have facilities including 5 treatment rooms: 3 angio rooms, 1 multimodality CT-fluoroscopy-ultrasound room, and 1 dedicated MR interventional room. All of these facilities are built in an OR environment, so we can combine our techniques with surgery. It means we give patients the best specialists for their specific disease.  

This combination of treatments is very unique to our center and has produced great collaboration and multidisciplinary teamwork. Surgeons and oncologists that come to our facility feel at home, but considering the multimodalities involved, radiologists are the only ones able to occupy this room the whole day. It makes sense for them. Many of our colleagues in other specialties enjoy sharing the space but they don’t want to control it. They want radiologists to take care of it but be able to come inside and work with us. 

IO360: How have you seen interventional oncology evolve since you started treating cancer patients?

Gangi: When I began doing interventional oncology, like everyone else, we did biopsies. Because I came from a clinical field of oncology and pulmonology, I felt that we were not doing enough for pain management. My first interest was in treating pain using neurolysis and treating pain for bone metastases. That was the beginning of my work. Today, if you look at what we are doing outside of the technology we have (CT, MR, angio, PET CT), I think we are becoming really excellent clinicians. It means that our colleagues are considering us more and more as clinicians. That’s essential. At the beginning, we were the technicians but today we are becoming part of the team. On tumor boards they’re considering us as clinicians and we are proposing treatment. This is the most important evolution I’ve seen, and it’s something I’m happy about. 

IO360: How about the future? What therapies have you seen growing in popularity and what do you think could happen in the future with different IO therapies?

Gangi: I think first of all the growth of ablations that happened in the early 90s was a big development for us. Then came TACE and embolization, which have given us very broad treatment options for patients. Now interventional oncology is becoming the fourth pillar of cancer care. It is important to have more clinicians, interventional oncologists who are clinicians, and to have a very clear curriculum. We must also report our findings and use quality control. Radiotherapy is a good example for quality control. Managing treatment, calculating the dose, follow-up of the patient, analyzing the results — these are all very important. 

Personally, I am very interested in MR interventions, which are becoming extremely popular. PET interventions are also becoming very popular. We are treating things today we thought we were not able to treat in the past. At King’s College in London we are working focused ultrasound. This is not just for tumor ablation, although that is great, but it’s also important to drug delivery. I believe drug delivery will become more and more important, considering the proliferation of delivery systems and materials like liposomes. Interventional radiologists need to be involved in focused ultrasound drug delivery with chemists and oncologists. If we miss this train it’ll be very difficult to catch the next one. 

What we are doing today is great, but it is already the past. We have to look forward to see the next step, imagine, be creative, even if sometimes we fail. The moment we stand still, it’s done, we are finished. How can we do it better? This works for a lot of different specialists, physicists, engineers, chemists. We are now clinicians, oncologists really believe in us. They are counting on us. As I said, we are working really closely with them. The next step for us is drug delivery, focused ultrasound, MR intervention, PET intervention, to further push the boundaries of interventional oncology. 

IO360: So maybe not only technological advances, but also new combinations of therapies?

Gangi: Absolutely. The combination of treatments is essential. At the beginning, interventional radiology was a threat to surgeons and radiotherapists, even sometimes oncologists. But today, everything is essential, and we have to use every weapon we have in the fight against cancer. This is not an easy enemy we are fighting. You cannot fight it with just one system. We have to pull together for the benefit of the patient. I like to use the analogy of an orchestra, where each specialty is one instrument. We can be very good at our instrument. I could be the best violinist ever, but if I’m not playing at the right moment in the orchestra, it could be catastrophic. All of us should play in the orchestra at the right time, sometimes together, sometimes alone. And there must be one conductor who is synchronizing us. If patients have three or four different doctors taking care of them at the same time, they are lost. You need one conductor who is synchronizing the treatment. 

Suggested citation: Ford J. New combination therapies in interventional oncology: an interview with Afshin Gangi, MD, PhD. Intervent Oncol 360. 2016;4(1):E7-E9.