Q&A With Ripal Gandhi, MD, Course Codirector of the Symposium on Clinical Interventional Oncology

Ripal Gandhi, MD, is an interventional radiologist and interventional oncologist at Miami Cardiovascular Institute, which is also associated with Miami Cancer Institute at Baptist Hospital in Miami, Florida. He was a course co-director of the 2016 The Symposium on Clinical Interventional Oncology (CIO). Interventional Oncology 360 spoke with Dr. Gandhi about the meeting and current data supporting interventional oncology therapies.

IO360: How has CIO grown over the years? Any plans for new and interesting types of sessions for the future?

Gandhi: The meeting continues to grow every year. I think it's different from a lot of the other meetings. I try to make a lot of the sessions practical. One session was a “year in review” on different topics related to interventional oncology: the most recent literature, anything new that happened over the last year. We typically have tumor board sessions, and we did this year as well. The tumor board sessions tend to be very popular with attendees. We get good feedback on the operator sessions as well. Finally there is a “tips and tricks” session where experts in the field share practical knowledge that you might not come across in textbooks or journals. In terms of further expansion, I think something we would definitely consider but we haven't made any definitive plans about is having more sessions on yttrium-90 radioembolization.

IO360: What are some of the stand-out studies in interventional oncology at the moment?

Gandhi: First is the SIRFLOX trial, which is probably one of the most important studies in interventional oncology right now. The SIRFLOX study was designed to assess the efficacy and safety of combining FOLFOX chemotherapy (± bev) with SIRT using yttrium-90 resin microspheres as first-line treatment of patients with liver metastases from metastatic colorectal cancer. There's a lot of great discussion. There was a whole section dedicated to the SIRFLOX trial. I think it's hard to know exactly how to manage some of these patients, but the outcome of the discussion was that clearly there is an improvement in liver progression-free survival with utilization of SIR-Spheres in conjunction with systemic chemotherapy when treating first-line patients with metastatic colorectal cancer. What we don't know at this point is whether there is an improvement in overall survival, and the data won't be available until 2017. But there's a lot of great discussion. The other topic that was definitely of interest to me and I think was of interest to the attendees was the radiopaque LUMI beads, which were just released by BTG. Brad Wood, MD, from the National Institutes of Health did some of the first cases and spoke about them at the meeting. I think this has a lot of promise and potential for being a game changer in treatment of patients with hypervascular tumors, given the ability to actually see these beads on subsequent imaging. This might allow for more effective treatment. Another important point about data is that we obviously have to have a very firm knowledge of our own procedures and our own clinical data, but to really function well on an interdisciplinary tumor board, we have to understand and have more than a superficial knowledge of the surgical oncology, medical oncology, and radiation oncology literature. That is really imperative for all of us.

IO360: One of the things we hear time and again at interventional oncology meetings is that interventional radiologists need to spread the word about interventional oncology. What are some ways you think that might occur?

Gandhi: I think the most important thing in further advancing our field is clinical research. We really need well-conducted multicenter, ideally randomized clinical trials, where we're really looking at clinical outcomes and ultimately overall survival for some of these treatment modalities that we are providing. That's not always easy to accomplish, but it’s important to improving our role in some areas that are not well established and hopefully increasing the number of patients who will benefit.

IO360: What are your personal areas of interest in terms of IO therapies?

Gandhi: One of my personal interests is utilization of robotics for endovascular procedures and specifically for interventional oncology in general. One of the limitations that we've had prior to robotic catheters is that some of them are just too big for microcatheterization work, but Hansen Medical has recently received FDA approval for their robotic microcatheters, so this is a scenario that I definitely want to delve into in further detail. This is certainly an area where I would like to see if it provides additional benefit in interventional oncology procedures. Is it helpful in navigating to sites of tumor vascularization? Does it decrease radiation exposure? Does it decrease contrast utilization? Does it provide any additional benefit over endocatheterization? That still remains to be seen but it is definitely an area of interest to us at our institute.