BackTable Tumor Board

In the past five years, the use of immunotherapeutic agents for advanced cancers has emerged as a promising alternative to tyrosine kinase inhibitors and chemotherapy, making it an exciting time to be practicing oncology. In this episode, Dr. Tyler Sandow interviews oncology experts about the landscape of advanced hepatocellular carcinoma (HCC) and the current state of immunotherapy treatments. He is joined by medical oncologists Dr. Jonathan Mizrah, Dr. Lingling Du, and Dr. Adam Burgoyne, as well as interventional oncologist Dr. Zachary Berman.Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125737---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISDrs. Burgoyne and Mizrahi provide a primer on immunotherapy and explain how they communicate the principles of this treatment to their patients. Dr. Du discusses the Imbrave clinical trial and how recent studies have shown improved overall survival when immunotherapeutic agents are used, especially when multiple agents targeting various pathways are employed. When choosing between different regimens, the doctors consider factors such as the patient's underlying liver function, symptom burden, and prior treatments.Importantly, the doctors also discuss contraindications to immunotherapy, including a history of organ transplant, autoimmune disease, and poor performance status—all of which put patients at high risk for deterioration with this treatment. The treatment of patients with poor liver function remains controversial, as underlying cirrhosis may prevent the recovery of liver function. Dr. Berman outlines recent clinical trials studying the effects of transarterial chemoembolization (TACE) combined with immunotherapy. Finally, the doctors discuss the future of HCC treatment and the benefits of continued innovation in both interventional and medical oncology.---TIMESTAMPS00:00 - Introduction to Immunotherapy04:32 - Notable Clinical Trials13:39 - HCC Etiology and Immunotherapy Outcomes18:43 - Contraindications for Immunotherapy23:05 - Adverse Effects from Treatment25:14 - Combination Therapy36:22 - Considerations for Immunotherapy Dosing40:26 - The Future of HCC Treatment---RESOURCESAtezolizumab plus Bevacizumab in Unresectable Hepatocellular Carcinoma, IMbrave150 Trial (Finn et al, 2020):https://pubmed.ncbi.nlm.nih.gov/32402160/Tremelimumab plus Durvalumab in Unresectable Hepatocellular Carcinoma, HIMALAYA Trial (Abou-Alfa et al, 2022):https://evidence.nejm.org/doi/full/10.1056/EVIDoa2100070Nivolumab versus sorafenib in advanced hepatocellular carcinoma (CheckMate 459): a randomised, multicentre, open-label, phase 3 trial (Yau, 2022):https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(21)00604-5/abstractNivolumab (NIVO) plus ipilimumab (IPI) vs lenvatinib (LEN) or sorafenib (SOR) as first-line treatment for unresectable hepatocellular carcinoma (uHCC): First results from CheckMate 9DW (Galle, 2024):https://ascopubs.org/doi/10.1200/JCO.2024.42.17_suppl.LBA4008Randomized Phase 3 LEAP-012 Study: Transarterial Chemoembolization With or Without Lenvatinib Plus Pembrolizumab for Intermediate-Stage Hepatocellular Carcinoma Not Amenable to Curative Treatment (Llovet, 2022):https://pubmed.ncbi.nlm.nih.gov/35119481/EMERALD-1: A phase 3, randomized, placebo-controlled study of transarterial chemoembolization combined with durvalumab with or without bevacizumab in participants with unresectable hepatocellular carcinoma eligible for embolization (Lencioni, 2024):https://ascopubs.org/doi/10.1200/JCO.2024.42.3_suppl.LBA432CME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Of all the topics covered during interventional radiology training, dosimetry education is often delayed until after IRs enter clinical practice. In this episode, Drs. Tyler Sandow and Sabeen Dhand host a roundtable discussion with experts on the dosimetry fundamentals that all Y90 operators should understand. They are joined by interventional radiologists Drs. Zachary Berman, Kirema Garcia-Reyes, and Siddharth Padia, who provide their expert insights.Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125736---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISThe group agrees that dosimetry is not a one-size-fits-all approach. Dosing strategies depend on factors such as tumor size, perfusion territory, underlying liver function, the choice between glass versus resin spheres, and treatment intent. These considerations are illustrated with real-life case examples. The doctors also explore voxel-based dosimetry, a method for calculating the amount of radiation absorbed by different parts of the tumor. They stress the importance of learning how to perform accurate dosage calculations.Finally, the conversation touches on data from major Y90 trials, current guidelines, and the evolving perspective on Y90 as a potential curative treatment, rather than merely a bridging therapy.---TIMESTAMPS00:00 - Introduction01:59 - Dosimetry Education During Training05:46 - Benefit of Individualized Dosing11:01 - Complications from High Doses15:19 - Dosage Calculation Cases22:51 - Duration of Response to Y9025:00 - Dosing Based on Treatment Intent29:11 - Challenging Case Example42:31 - Voxel-Based Dosimetry45:15 - Using Dosimetry Software---RESOURCESLEGACY Trial (Salem et al, 2021):https://pmc.ncbi.nlm.nih.gov/articles/PMC8596669/Voxel-based tumor dose correlates to complete pathologic necrosis after transarterial radioembolization for hepatocellular carcinoma (Pianka et al, 2024):https://pubmed.ncbi.nlm.nih.gov/38913189/RAPY90D Trial (Kappadath et al, 2023):https://jnm.snmjournals.org/content/64/supplement_1/P268Clinical, dosimetric, and reporting considerations for Y-90 glass microspheres in hepatocellular carcinoma: updated 2022 recommendations from an international multidisciplinary working group (Salem et al, 2023):https://pubmed.ncbi.nlm.nih.gov/36114872/International recommendations for personalised selective internal radiation therapy of primary and metastatic liver diseases with yttrium-90 resin microspheres (Levillain, 2021):https://link.springer.com/article/10.1007/s00259-020-05163-5)CME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf

Welcome to the first episode of BackTable Tumor Board, and our first recording session at our new in-person studio! Guest host Dr. Tyler Sandow (interventional radiologist) leads a multidisciplinary discussion about patient care coordination in hepatocellular carcinoma (HCC) diagnosis and treatment, with insights from his colleagues at Ochsner Health– Dr. Steven Young (hepatologist), Dr. Jonathan Mizrahi (medical oncologist), and Deondra Bonds-Adams (patient navigator).Physicians, nurses, nurse practitioners, and physician assistants can follow this link to earn CME / CE credits for completing an accredited learning activity related to this discussion:https://www.cmeuniversity.com/course/take/125735---This podcast is supported by an educational grant from AstraZeneca Pharmaceuticals and Boston Scientific.---SYNPOSISThe team speaks on the value of having multiple specialties weigh in on treatment conversations that are tailored to each patient’s medical history and risk factors, such as underlying cirrhosis and portal hypertension. Deondra highlights the importance of assessing the patient’s understanding of their disease and the role of physician extenders and schedulers in patient education. Dr. Young discusses the value of outreach clinics and streamlining the transplant evaluation process. Finally, Dr. Mizrahi gives advice on building referral networks and establishing early contact with transplant centers.---TIMESTAMPS00:00 - Introduction00:46 - Multidisciplinary Tumor Board06:00 - Patient Experience in Treatment Pathways10:10 - Barriers to Treatment16:03 - Benefits of IR Clinic19:33 - HCC Screening and Risk Factors24:08 - Building Referral Networks30:34 - Strategies for Effective Scheduling35:43 - The Future of HCC Treatment---RESOURCESCME Accreditation Information:https://f7cae4ec-b69e-490d-9e0f-19b16a6f146d.usrfiles.com/ugd/f7cae4_a7c37ea3cd1b4d3fa53d5edf8dfe255b.pdf