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An innovative method for treating liver cancer sets the stage to test on prostate and brain cancers

Researchers have discovered a minimally invasive, pain-free form of radiation that is significantly boosting survival rates

An innovative method for treating liver cancer sets the stage to test on prostate and brain cancers

Everyone knows radiation kills tumors. If patients could tolerate more radiation, the treatment could be more effective in many cases. Yet traditional radiation, which broadly exposes both tumors and normal tissue to the therapy, can also cause serious side effects, including vomiting, hair loss, and memory impairment.

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But what if a treatment could minimize those side effects? TheraSphere Y-90 Glass Microspheres, first approved for the treatment of hepatocellular carcinoma (HCC), the most common type of liver cancer, is doing just that. This minimally invasive form of radiation targets blood flow that normally feeds tumors. “We essentially have taken one of the cancer’s biggest strengths and used that against it,” says Peter Pattison, president of interventional oncology, peripheral interventions, at Boston Scientific, the medical device company based in Marlborough, Mass., that manufactures TheraSphere.

By making a quarter-inch incision in a patient’s groin or wrist, interventional radiologists thread a catheter into an artery, directly accessing the liver tumor. Once there, they push a cloud of irradiated microbeads into the blood flow with extreme precision. “It’s like a river,” Pattison says. “The beads don’t know where they’re going, but they just follow the flow, lodge in the tumor, and deliver a very high dose of radiation over the course of about two weeks.” After that, the beads become inert—radiation never spreads. The tumor becomes necrotic and gets metabolized by the body.

An earlier therapy targeting blood flow, called chemoembolization, kills the whole blood vessel to destroy the tumor but can be extremely painful. Dr. Riad Salem, chief of interventional radiology at Northwestern Memorial Hospital, knows too well the anguish of trying to deliver that cure, but treatment with TheraSphere works differently. “It was a huge revelation to me, when I performed my first TheraSphere infusion, that it did not cause pain. The patients didn’t feel anything. Some of them asked, ‘Have you even done anything?’ ”

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This remarkable innovation received FDA approval for the treatment of HCC earlier this year, and a recent clinical trial showed positive results for patients with metastatic colorectal cancer to the liver. Now, the Boston Scientific team is exploring how TheraSphere might be used to treat other types of tumors. It has received FDA “breakthrough device designation” for the treatment of brain tumors, specifically glioma or glioblastoma, with the goal of creating a faster pathway for patient access in the future. Meanwhile, the team is also investigating safety and efficacy of the therapy for cancer in the prostate.

ONCE-IN-A-GENERATION TECHNOLOGY

The road to FDA approval can be long, and it can sometimes take many years for the development of new technology to accurately measure safety and efficacy for truly groundbreaking advancements. Ultimately, FDA approval for the therapy was based on results of the LEGACY clinical trial, which demonstrated an 84% survival rate at three years out for patients treated with TheraSphere alone. In liver cancer, the gold standard of cure is a liver transplant, but often surgery is impossible because the tumors are too big or too close to blood vessels or arteries. Because TheraSphere was so effective at reducing tumor size, it made some patients eligible for surgery or liver transplant, which boosted the three-year survival rate to 93%.

“As physicians, we’re always looking for the next big thing,” Salem says. “Certainly, when we saw this in 2000, this seemed like the next big thing. Persistence pays off, and now, some 20 years and 70,000 patients later, with FDA approval and large, randomized, phase-three trials showing positive effect, it’s confirming what we suspected: It is once-in-a-generation technology.”

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Pattison compares it to “one of those 20-year ‘overnight sensations’ you see in the music industry.” One cancer survivor even named her child after her interventional radiologist. As more physicians—and their patients—gain access to the therapy, its fan base is sure to grow.

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