New evidence supports intratumoral therapies for lung cancer

A. Christine Argento, MD, FCCP
A. Christine Argento, MD, FCCP

Intratumoral therapy is the new kid on the block for lung cancer treatment. Local injection of tumors has long been used as an adjunct for the treatment of malignant airway obstruction, but new devices and new approaches are looking to take intratumoral chemotherapy and immunotherapy into the mainstream.

The goal is to improve lung cancer outcomes while reducing the often-debilitating side effects of conventional chemo and immunotherapies, either singly or in combination.

“Lung cancer remains the highest mortality of all cancers,” said A. Christine Argento, MD, FCCP, associate professor of medicine at Johns Hopkins University. “The idea is that if you can give the same types of therapies, but in a local fashion, you can reduce tumor burden and provide relief of symptoms with minimal systemic effects because the drug is not going through the circulation but directly where it needs to go. It has higher effects exactly where you want it, in the tumor, and minimal effects elsewhere in the body.”

Dr. Argento will chair a groundbreaking session on Intratumoral Therapies for Lung Cancer: Current Evidence and Future Pathways on Wednesday, October 19, from 8:00 am – 9:00 am CT in Room 106BC. Intratumoral treatment has shown success in liver, kidney, and other organ tumors with similar promise in lung cancers.

Current technology offers two approaches to intratumoral therapy in the lung—bronchoscopic and percutaneous, Dr. Argento said. Percutaneous approaches are most often used for peripheral lung tumors near the chest wall. These peripheral tumors may have fewer bothersome symptoms than more central tumors that can impinge on airways.

Bronchoscopic approaches are more appropriate for tumors growing deeper in the lungs that are more likely to crush or otherwise obstruct larger airways. These more obstructive tumors are more often accompanied by coughing, bleeding, and other severe symptoms, which prompted early attempts at intratumoral injection.

“Going in bronchoscopically, being able to use a needle to deliver drugs exactly where you want them and shrinking the tumor can, hopefully, relieve a lot of the symptoms patients are suffering from,” Dr. Argento said. “And with these newer technologies, we can deliver it accurately.”

Early attempts were hampered by inaccurate drug delivery. Endobronchial ultrasound (EBUS) allows for highly precise, real-time visualization for needle placement and injection, she said.

Recent advances in endobronchial robotics have improved access to tumors that are more difficult to reach using conventional bronchoscopy because of airway geography or size.

“There is going to be a lot of debate around whether we inject just chemotherapy, just immunotherapy, the potential for combination therapy, maybe combinations of local and system therapies, different considerations for peripheral tumors and more central tumors, the best uses for all the technologies that are out there and in development,” Dr. Argento said. “We have seen that intratumor therapy can work; we’re trying to figure where and when it works most effectively.”

Early trials focused on the neoadjuvant setting and patients who were not good surgical candidates, but there is good potential for intratumoral approaches for less advanced disease, as well.

“We are hopeful for our patients that this works out as well as early lung trials and use in other organs suggest,” Dr. Argento said. “This is up-and-coming material that will keep you ahead of the curve in treating lung cancer. This session is going to be jaw-dropping material for just about everyone.”