Ep. 564 Pressure-Enabled Drug Delivery in HCC & Metastatic Liver Lesions with Dr. Zach Berman

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Aug 12, 2025

Dr. Zachary Berman, an interventional radiologist at UC San Diego, offers insights into pressure-enabled drug delivery for liver cancers. He explains how manipulating blood flow in tumors can optimize drug delivery, showcasing the innovative TriNav catheter's design. The discussion delves into real-world applications, including case studies of complex tumors like neuroendocrine lesions and segmental HCC. Additionally, they cover advancements in pressure-directed embolotherapy and the exciting potential future developments in enhancing treatment effectiveness.

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INSIGHT

Tumor Vasculature Is Disorganized And Fragile

Tumor arteries form haphazardly and often lack normal smooth muscle or neural innervation.
This irregular architecture and intratumoral pressure limit uniform drug and device delivery into tumors.

INSIGHT

Central Necrosis Hinders Complete Tumor Kill

Large tumors commonly develop a necrotic central core with few arteries feeding it.
That central underperfusion leaves viable cells that survive standard therapies and can cause recurrence.

ANECDOTE

Onyx Case Converted Me To Pressure Methods

In one overnight case Berman compared balloon occlusion versus end-hole on the same ruptured HCC and saw a dramatic difference in cast quality.
That Onyx experience convinced him that pressure-directed approaches markedly improve tumor filling.

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Can you manipulate blood flow in the tumor microenvironment to optimize drug delivery? In this episode of the BackTable Podcast, interventional oncologist Dr. Zachary Berman (UC San Diego) joins host Dr. Christopher Beck to discuss real-world applications of pressure-enabled drug delivery in locoregional liver-directed therapies like TACE and Y90.
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This podcast is supported by:
TriSalus Life Sciences
http://trinavinfusion.com/
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SYNPOSIS
The conversation begins with an overview of the tumor microvascular environment, focusing on the abnormal nature of the new vessels that feed tumors. They then discuss the genesis of pressure-enabled drug delivery and the theory behind its efficacy. Dr. Berman explains the TriNav catheter’s micro-valve design, its anti-reflux properties, and how these features enhance tumor drug delivery. He walks through his own procedure technique, comparing and contrasting it to standard embolization, and details the utility of pressure-enabled drug delivery in lobar radioembolization and larger tumors. They also explore the benefits of both balloon occlusion and microvalve catheters.
Real-world cases—including neuroendocrine tumors, segmental HCC, and more—illustrate the thought process around when to use specialized technologies. The episode wraps up with a discussion of the future implications for this technology in other pathologies, cost considerations, and the potential for enhancing drug delivery with innovative approaches.
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TIMESTAMPS
00:00 - Introduction
01:39 - The Tumor Microenvironment
06:59 - Pressure-Enabled Drug Delivery Explained
09:37 - Technical Aspects of Pressure-Enabled Catheters
21:48 - Case 1: Grade 3 Neuroendocrine Tumor
34:06 - Case 2: Hepatocellular Carcinoma with Tumor and Vein
36:01 - Case 3: TACE for Segmental HCC in Decompensated Cirrhosis
38:58 - Case 4: Large Heterogenous Cholangiocarcinoma
40:40 - Case 5: Lobar Neuroendocrine Tumor
42:38 - Case 6: Segmental HCC with Central Necrosis
47:52 - Best Practices and Technical Considerations
57:52 - Future Directions in Pressure-Directed Embolotherapy
59:48 - Conclusion and Final Thoughts
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RESOURCES
JVIR 2024 Jaroch et al.:
https://pubmed.ncbi.nlm.nih.gov/38969336/