The liver is the most common site for colorectal cancer metastasis and can affect up to a quarter of these patients. The COLLISION trial, an international, multicentre randomised phase III non-inferiority study compared thermal ablation versus surgical resection for colorectal liver metastases. The trial stopped early as they met the predefined criteria showing survival after ablation was no worse than surgery. Importantly, the study also showed fewer adverse events, which is practice changing and now puts ablation in the spotlight as a potential first line option for selected patients who may have previously been recommended surgery.

In kidney cancer, the NEST trial, a cohort embedded RCT compared cryoablation versus robotic partial nephrectomy for small kidney tumours. It has shown lower complication rates with cryoablation, shorter hospital stays and preservation of renal function, again supporting more integration of cryoablation into the management of kidney cancer.

In primary liver cancer, hepatocellular carcinoma (HCC), the EMERALD-1 RCT (Phase III randomised, placebo-controlled) was the first global trial to show an improvement in progression free survival by adding immunotherapy (Durvalumab) and anti-VEGF therapy (bevacizumab) to TACE for intermediate-stage HCC.

Bubbles, and the future of IO…

It is safe to say we have now entered a new chapter for precision medicine and for IO. In some ways we have truly entered the sci-fi era.

Do you recall those films with futuristic medical bays and pods where characters are laid down and have their injuries healed without any scalpels or incisions? Elysium is the one I particularly recall. The vision of eradicating cancer without scalpels, needles, heat or radiation, may be here sooner that you think.

Histotripsy is a novel form ultrasound-based therapy that utilises controlled acoustic cavitation to disrupt targeted tissue. Unlike conventional thermal based ultrasound therapy – known as high intensity focused ultrasound – which induces cell death through heating and coagulative necrosis, histotripsy uses a non-thermal mechanism, involving the formation and collapse of microbubbles. The action of these microbubbles destroys the targeted cells, fractionating the tissue in the focal region. This can be delivered through a device external to the body with extremely high precision, where the boundary between treated and untreated tissue is less than 100 micrometres – around the thickness of a strand of human hair.

Histotripsy also comes with potential advantages over current available ablation therapies as it can preserve sensitive structures such as nerves, blood vessels and bile ducts which would normally be damaged by the other ablation modalities.

My colleague, collaborator and mentor Professor Tze Min Wah performed the world’s first Histotripsy procedure for kidney cancer as part of the CAIN trial. The trial evaluated the technical success and safety of this therapy in treating primary kidney cancers and she will be presenting the results of this trial at the Cardiovascular and Interventional Radiology Society of Europe Annual Congress in September.

This builds upon the HOPE4LIVER trial, a prospective multicentre, first-in-human feasibility study, which found histotripsy treatment for unresectable liver tumours was successful at completely treating the tumour with minimal adverse events. We are now understanding that as Histotripsy pulverises tumours, it also preserves their antigens, effectively flagging them for the immune system. Now imagine how much more effective that could be when paired with precision immunotherapies for a coordinated strike?

I for one am very excited to be able to continue on this exciting journey, striving to integrate more IO therapies into routine clinical care so that patients everywhere can receive smarter, kinder and more effective treatments.