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

  • Hepatobiliary-Pancreas
  • Published:
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An Editorial Comment to this article was published on 17 June 2019

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.

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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

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan

    Yasunori Minami, Naoshi Nishida & Masatoshi Kudo

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  1. Yasunori Minami
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  2. Naoshi Nishida
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  3. Masatoshi Kudo
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Correspondence to Yasunori Minami.

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

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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.

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

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Minami, Y., Nishida, N. & Kudo, M. Radiofrequency ablation of liver metastasis: potential impact on immune checkpoint inhibitor therapy. Eur Radiol 29, 5045–5051 (2019). https://doi.org/10.1007/s00330-019-06189-6

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