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Radiofrequency ablation of liver metastasis: potential impact on immune checkpoint inhibitor therapy

  • Yasunori MinamiEmail author
  • Naoshi Nishida
  • Masatoshi Kudo
Hepatobiliary-Pancreas

Abstract

Percutaneous radiofrequency ablation (RFA), a generally accepted alternative therapy for patients with liver metastases, is a minimally invasive approach with a favorable safety profile and a lower rate of major complications. The use of RFA or combined RFA plus resection can produce total tumor clearance in patients with unresectable liver metastases. However, the relatively high rate of local tumor progression has prevented the widespread use of RFA. Furthermore, its efficacy is controversial because there have been no comparisons for its effect on overall survival compared with standard options such as systemic chemotherapy. Meanwhile, immunotherapy has become a major research focus for oncology based on the recent successes reported for immune checkpoint inhibitors for melanoma, non-small cell lung cancer, gastric cancer, and other cancers. Immune checkpoints negatively regulate T cell function, and inhibition prevents the blockade of the immune system by cancer cells to prevent their destruction. Unfortunately, only some patients (< 25%) respond to immuno-oncology drugs, whereas other patients acquire resistance. However, RFA can induce massive necrotic cell death which might activate immunity and the presentation of cryptic antigens to induce tumor-specific T cell response. Because RFA can induce the rapid release of large amounts of tumor antigens, it can potentially stimulate transient immune responses to much tumor antigens. Combination therapies have induced synergistic enhancement of anticancer immune response in preclinical studies, indicating great promise for the future of oncologic treatment.

Key Points

• Only some patients respond to immuno-oncology drugs.

• RFA causes the release of large amounts of cellular debris, a source of tumor antigens that elicit immune responses against tumors.

• Combination RFA for liver metastases and immune checkpoint inhibitor therapies might synergistically enhance antitumor immunity.

Keywords

Ablation techniques Immunotherapy Liver Neoplasm metastases 

Abbreviations

APCs

Antigen-presenting cells

CI

Confidence interval

CTLA-4

Cytotoxic T lymphocyte–associated protein 4

DC

Dendritic cell

FDA

Food and Drug Administration

HR

Hazard ratio

IFN

Interferon

IL

Interleukin

MHC

Major histocompatibility complex

OS

Overall survival

PD-1

Programmed cell death-1

PD-L1

Programmed cell death ligand-1

RFA

Radiofrequency ablation

TAA

Tumor-associated antigen

Teff

Effector T cell

Treg

Regulatory T cell

Notes

Funding

The authors state that this work has not received any funding.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Prof. Masatoshi Kudo.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because it is a review of literature.

Ethical approval

Approval from the institutional animal care committee was not required because it is a review of literature.

Methodology

• Performed at one institution

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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Yasunori Minami
    • 1
    Email author
  • Naoshi Nishida
    • 1
  • Masatoshi Kudo
    • 1
  1. 1.Department of Gastroenterology and HepatologyKindai University Faculty of MedicineOsaka-SayamaJapan

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