Interventional Oncology

Clinical Center

Investigators

Linked publications & trials

Abstract

The Center for Interventional Oncology (CIO) was established in late FY 09 at the NIH Clinical Center (CC) to develop and translate image-guided technologies for localized cancer treatments. The Center is a collaboration involving the CC and the National Cancer Institute (NCI), and to lesser extent NIBIB. The Center draws on the strengths of each partner to investigate how imaging technologies and devices can diagnose and treat localized cancers in ways that are precisely targeted and minimally or non-invasive. In doing so, CIO bridges the gap between diagnosis and therapy, and between emerging technologies and procedural medicine. Advanced imaging methods have ushered in an era of earlier detection of cancers that are frequently localized to a single organ or region, such as the liver or prostate. Interventional oncology often provides cancer patients with local or regional treatment options to augment the standard systemic or organ based cancer therapies. CIO investigators leverage the interdisciplinary, translational environment at the CC to investigate and optimize how and when to combine drugs, devices, and multimodal imaging navigation. For example, activatable drugs can be injected in a vein or artery inside a nanoscale or micron-scale vector or bubble, then deployed directly in the tumor with needles, catheters, or ultrasound using fusion imaging, augmented reality, or deep learning, to enable the physician to navigate through the body in a more standardized fashion, with real-time visualization using the latest advanced imaging technologies, such as magnetic resonance imaging (MRI), positron emission tomography (PET), computed tomography (CT), cone beam CT (CBCT), or ultrasound. Pre-procedural images are reused to guide devices delivering targeted therapy to the location of the disease, making the procedure more cost-effective because it doesn't require the imaging system to be physically present to take advantage of the prior imaging information. A prior prostate MRI, for example, can be used to help with guided biopsy or focal ablation by using a medical GPS-enabled needle and ultrasound, without requiring, occupying or tying up an MRI system during the procedure. In another example, a thin needle or light sound or electrical waves can be used to ablate tumors and enhance targeted drug delivery. Energy sources include high-intensity focused ultrasound, freezing, microwaves, laser, histotripsy, electroporation, and radiofrequency. Researchers also expand investigations into image-guided drug delivery or image-guided drug painting, where the image can be used to prescribe a particular drug to a specific region, by combining targeted, image-able-able or activate-able drugs with localized energy or heat to deploy the drug within specially engineered micro- or nano-particles. The Center provides a forum to encourage collaborations among researchers and patient-care experts in medical, surgical, urologic, and radiation oncology and interventional radiology / molecular interventions.. The CC provides an exceptional environment for this type of collaborative translational research. Other major program components include the development of new image-guided methods for personalized drug investigations (or tracking tissue responses to investigational drugs during drug discovery) and first-in-human investigations involving new micro- or nano-scale drugs and carriers, devices, image-guided robotics or augmented reality devices for enhanced automation and standardization of procedures. Targeted sequential biopsy is a powerful tool for drug discover or biomarker characterization across time and space coordinates. Education and cross-training is another important part of the program. Significant gaps exist between the various disciplines, between research efforts and patient care, and between diagnosis and treatment. The gaps may be integrated through advanced image methods for localized therapy. CIO trainees are exposed to a wide variety of disciplinary thought, which underlines the unique translational atmosphere at the NIH, where bench-to-bedside is the rule. Specific aims include: 1. Develop training and educational pathways not otherwise available in Interventional Oncology 2. Develop novel image-guided methods for smart biopsy and biomarker procurement to support targeted therapeutics 3. Support patient care using novel minimally invasive Interventional Oncology techniques, especially in the liver, kidney and prostate 4. Pursue research in novel techniques and technologies in Interventional Oncology. This program is ideally and uniquely positioned to provide an interdisciplinary environment that combines training, patient care, and translational research to accelerate progress in interventional oncology and molecularly targeted interventions. The focus is upon translational models, translational tools, and actual practical deliverables and multidisciplinary paradigms that meet specific translational milestones to address short term clinical needs. Deep learning in cancer was begun with the goal of defining pathways and toolkits to promote future integration of digital pathology, with molecular and imaging information for specific cancers and cancer interventions. CIO managed 10 preclinical protocols and 5 clinical protocols. CIO staff were awarded 2 PhDs this past fiscal year. The CIO has trained many students, residents, fellows, PhD candidates, junior faculty, visiting scientists, engineers, and collaborating scientists, who have successfully advanced in their academic careers and are practicing in interventional radiology, radiology, urology, radiation oncology, veterinary medicine, and various senior positions in academics and industry. The Woodchuck HCC model was established and characterized for IR and immunomodulatory agents. Heat vs freezing ablation was compared in terms of immune effects and immune resistance. Novel software and hardware were developed for patients. Augmented reality for smartphones and goggles was compared to standard guidance systems for IR clinic. CIO helped define the founding vision of the NCI AI Resource, as a toolkit for deep learning tasks within CCR and the data science ecosystem for cancer. Fusion guided ablation was developed and deployed for the office setting, as was prostate biopsy with needle and ultrasound totally outside of the rectum. Smartphone interventions were brought to clinic. CIO accomplished the 1st in human use of artificial intelligence and deep learning for semi-automated segmentation and registration during thermal ablation procedures, Transperineal hand-held ultrasound fusion biopsy without a frame or stepper stage was reduced to practice, to define interventions for prostate cancer that do not involve the rectum in any way. In the translational animal lab, CIO characterized molecular immune correlates for woodchuck hepatitis-induced HCC, developed a drug delivery model for drug dose painting with fusion and image-able drug eluting beads, developed and deployed immuno-beads that elute immunomodulatory agents (TLR-7 and small molecule checkpoint inhibitors) after local catheter-based delivery into woodchucks with HCC, characterized preclinical augmentation of check point inhibition with cryo in woodchuck liver cancer and cryo and RFA in mouse tumors in vivo, Multiple devices were developed including Angle-Nav MEMS clip to needle, Airwaze, BronchoMEMS, OncoNav, PercuNav, UroNav, Airwaze, and CystoNav. Augmented reality via smartphone was validated. The CIO team pivoted to COVID-19 research and rapidly assembled multi-national datasets and partnerships with 10 publications on COVID-19, data challenges, and the largest public posting of CT scans of COVID-19, and helped translate and commercialize a 3D-printed miniature ventilator and an isolation device.