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Delivering Immunotherapeutics Intratumorally: Safe for Treating Cancer?

Intravenous administration of chemotherapy is the conventional method of delivery. However, several issues arise with this method, including insufficient drug penetration into the tumor tissue. Intratumoral injections of immunotherapies directly into the tumor have been a possible solution to this problem, and, according to a recent study, results of which are published in JAMA Network Open, this technique has been found to be a viable option for a variety of histological conditions and target organs.

For this study, 85 patients with malignant tumors including melanoma, sarcoma, ovarian cancer, breast cancer, colon cancer, and others, were enrolled and underwent 498 encounters consisting of 327 image-guided intratumoral investigational agents injected in 67 patients. The remaining 18 patients underwent 113 image-guided injections of talimogene laherparepvec, an FDA-approved intratumoral immunotherapy for melanoma.

The researchers found that none of the side effects reported were associated with the technical component of the procedure, specifically needle insertion or biopsy, suggesting that this strategy of delivering immunotherapy to malignancies is safe. However, some patients reported serious adverse events (grade ≥3) such as dyspnea and severe flu-like symptoms within 24 hours of the injection that required hospitalization.

Further research is necessary as noted by the study authors, led by Rahul A. Sheth, MD, of the Department of Interventional Radiology at MD Anderson Cancer Center, "The optimal method for drug delivery that maximizes intratumoral drug distribution and retention remains unresolved. As with any invasive intervention, outcomes after intratumoral drug delivery depend on procedural technique. This is corroborated by the substantial difference in intratumoral drug delivery outcome observed when the same tumor in the same patient was injected with 2 different injection techniques. However, detailed and standardized guidelines for intratumoral injection methods are lacking."

For More Information

Sheth RA, Murthy R, Hong DS, et al (2020). Assessment of image-guided intratumoral delivery of immunotherapeutics in patients with cancer. JAMA Network Open, 3(7):e207911. DOI:10.1001/jamanetworkopen.2020.7911 

Image Courtesy of FNDE. Licensed under CC BY-SA 4.0.

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