Advances and Trends in Interventional Therapies for Pancreatic and Liver Cancer Discussed at Synergy 2015

By Jennifer Ford

On November 6, 2015, the second day of the 2015 Synergy interventional oncology meeting in Miami began with a hands-on ablation workshop. The workshop was packed with attendees, many of whom were residents and fellows who earned scholarships for the meeting. Attendees were able to test devices that perform a range of ablations, including microwave ablation, cryoablation, and radiofrequency ablation. The focus in the general session turned to therapies for cancer in the liver and pancreas. Faculty presented a variety of combination therapies for pancreatic cancer, including radiation, chemotherapy, irreversible electroporation (IRE), immunotherapy, and surgery.

“In 2015, we will have 48,000 cases of pancreatic cancer in the US, and of these 40,000 will die,” said Alan S. Livingstone, MD, in his presentation on surgical options. He added that pancreatic cancer represents 3% of cancers but 7% of mortality, and it will become the second leading cause of cancer death. 

"The problem is that only 10% to 15% are surgical candidates, and currently, surgery is the only potential cure,” he said, but techniques have improved and mortality is now just 1% to 2%. The most important factor impacting mortality, Livingstone concluded, is getting an R0 resection.

In his presentation on locoregional therapy, Peter Hosein, MD, described a study of a series of patients he did at the University of Miami on locally advanced pancreatic cancer. He cautioned attendees that although pancreatic cancer may seem localized, it has metastasized already in most cases.

Robert C.G. Martin II, MD, PhD, described data that exist in the literature that support efficacy of IRE for pancreatic cancer, adding the caveat that safety and efficacy of IRE are dependent on operator experience. 

“This is not for the faint of heart,” he said. IRE has been optimized, he added, but results must be sustainable. Martin called for improved device placement techniques and further study of IRE in randomized controlled trials.

"Interventional radiology had mostly been involved in palliation for pancreatic cancer until the advent of IRE,” said Govindarajan Narayanan, MD. There are still challenges for IRE of the pancreas, he said, such as access and patient selection, but IRE can lead to resectability of the disease. Narayanan also described a device developed by Issam Kably, MD, of the University of Miami that displaces the colon so IRE can be performed without damage to neighboring organs. 

Martijn Meijerink, MD, presented results of the PANFIRE prospective trial, which investigated the safety of percutaneous IRE in the treatment of 25 patients with locally advanced pancreatic carcinoma. Results suggest prolonged progression-free survival and overall survival.

Peter Mueller, MD, discussed current trends in liver cancer. He noted that microwave ablation is a hot topic in the United States, IRE is used in challenging cases, and TACE is growing in popularity compared to percutaneous radiofrequency ablation. Riccardo Lencioni, MD, agreed that TACE is the most popular treatment for hepatocellular cancer worldwide.

“We are looking forward to more data on TACE from China and Japan, where outstanding contributions have come from in this area,” said Lencioni. 

Exhibitors hosted attendees at a wine tasting event in the exhibit hall at the conclusion of sessions, and Mueller was presented with the Synergy Honors award at the Synergy Gala.

"Always remember there's a patient on the other side of a therapy," said Mueller in his acceptance speech. 

Durig the gala, program cochair Jose Yrizarry, MD, announced that he would be stepping down as Synergy cochair, and Riccardo Lencioni, MD, would be assuming the position of Synergy cochair for 2016.

Day 3 of the meeting on Saturday, November 7, includes continued presentations on liver cancer as well as lung and metastatic colorectal cancer. Sunday’s meeting features a unique nursing symposium, which represents a partnership between Synergy and the Association for Radiologic & Imaging Nursing.