Interventional Oncology

Clinical Center

Investigators

Linked publications & trials

Abstract

The Center for Interventional Oncology (CIO) was established at the NIH Clinical Center (CC) to develop and translate image-guided multi-modality multidisciplinary technologies for localized cancer treatments. The Center is a collaboration involving CC and NCI. 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. CIO bridges the gap between diagnosis and therapy, and between emerging technologies and procedural medicine. Advanced imaging methods detect cancers earlier when often 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 vessel 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 AI-"deep learning", to enable the physician to navigate through the body in a more standardized fashion, with real-time visualization using advanced imaging technologies, such as fusion imaging of modalities or robotic navigation or augmented reality. Pre procedural images are fused 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, and can be done in an office setting. A prior prostate MRI, for example, can be used to help with guided biopsy or focal ablation in an office setting, by using a "medical GPS"-enabled ultrasound, without requiring, occupying or tying up an MRI system during the procedure or ever entering the rectum with the ultrasound or needles. In another example, a thin needle or light, sound, or electrical waves can be used to ablate tumors and enhance targeted drug delivery or immunomodulate by enhanced antigen presentation or downregulation of immunosuppressive factors. Energy sources include high-intensity focused ultrasound, freezing, microwaves, laser, histotripsy, electroporation, and radiofrequency. Investigations look 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 clinicians in medical, surgical, urologic, and radiation oncology and interventional radiology / molecular interventions. The IRP provides an exceptional environment for this type of collaborative translational research. Other major program components include the development of new image-guided biopsy for personalized 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 discovery or biomarker characterization across time and space coordinates. Education and cross-training in CIO addresses gaps between the various disciplines, 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 interdisciplinary 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. Develop novel techniques and technologies in Interventional Oncology. This program uniquely provides an interdisciplinary environment that combines training, patient care, and translational research to accelerate progress in interventional oncology and molecular-targeted interventions.The focus is upon translational models, translational tools, practical deliverables and multidisciplinary paradigms that address unmet clinical needs. Artificial intelligence / deep learning in cancer has clinical impacts, pathways and toolkits to promote integration of digital pathology, with molecular and imaging information for specific cancers and interventions. CIO manages multiple CRADAs, preclinical protocols, and clinical protocols. CIO staff were awarded advanced degrees and staff have mentored over 200 trainees (students, residents, fellows, PhD candidates, junior faculty, visiting scientists, engineers, and collaborating scientists). The Woodchuck HCC model was established and characterized for IR and immunomodulatory agents. Different ablation energies were further 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 and was used for ablation treatment planning. CIO helped define the founding vision of the NCI Al Resource, as a toolkit for deep learning tasks within CCR and the data science ecosystem for cancer, and also for MDRIC (NIBIB and ARPS-H funed) to define AI resources and tools. Fusion guided ablation was developed and deployed for the office setting, as was rectum-free 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 tested in practice. 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 image-able immunomodulatory agents (TLR-7 &and small molecule checkpoint inhibitors) after local delivery into woodchucks with HCC, characterized preclinical augmentation of check point inhibition with cryo in woodchuck liver cancer and deployed endobronchial ablation tools in swine. Multiple devices have been developed including "Angle-Nav" MEMS clip to needle, Airwaze, BronchoMEMS, OncoNav, PercuNav, UroNav, Lumi and CystoNav image stitching. Augmented reality via smartphone was validated. The CIO team had the largest public posting of COVID-19 CTs in the 1st year pandemic. A deep learning model was trained for detection of illness like Omicron with voice signal alone, and a voice web App was deployed for voice as a vital sign. Bladder and prostate cancer clinical trials are planned studying heat-deployed liposomal chemotherapy and hot saline infusions or HIFU. HIFU clinical trials started for local trans-urethral HIFU for prostate cancer. Artificial intelligence tools for image guided therapy were deployed. Super fine needle aspiration of normal lymph nodes was deployed for immuno-characterization in humans. Imageable gels and injection techniques were studied for cancer drug delivery.