Technical Feasibility and Safety of Repeated Computed Tomography–Guided Transthoracic Intratumoral Injection of Gene-Modified Cellular Immunotherapy in Metastatic NSCLC

Puja Shahrouki, MD; Jay M. Lee, MD; Jonathan Barclay, MD; Sarah N. Khan, MD; Scott Genshaft, MD; Fereidoun Abtin, MD; Steven M. Dubinett, MD; Aaron Lisberg, MD; Sherven Sharma, PhD; Edward B. Garon, MD; Robert Suh, MD

JTO Clinical and Research Reports (Nov 2021)

Technical Feasibility and Safety of Repeated Computed Tomography–Guided Transthoracic Intratumoral Injection of Gene-Modified Cellular Immunotherapy in Metastatic NSCLC

Puja Shahrouki, MD,
Jay M. Lee, MD,
Jonathan Barclay, MD,
Sarah N. Khan, MD,
Scott Genshaft, MD,
Fereidoun Abtin, MD,
Steven M. Dubinett, MD,
Aaron Lisberg, MD,
Sherven Sharma, PhD,
Edward B. Garon, MD,
Robert Suh, MD

Affiliations

Puja Shahrouki, MD: Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Jay M. Lee, MD: Division of Thoracic Surgery, Department of Surgery, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Jonathan Barclay, MD: Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Sarah N. Khan, MD: Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Scott Genshaft, MD: Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Fereidoun Abtin, MD: Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Steven M. Dubinett, MD: Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Aaron Lisberg, MD: Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Sherven Sharma, PhD: Division of Pulmonary and Critical Care Medicine, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Edward B. Garon, MD: Division of Hematology and Oncology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California
Robert Suh, MD: Department of Radiological Sciences, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, California; Corresponding author. Address for correspondence: Robert Suh, MD, Department of Radiological Sciences, University of California at Los Angeles, 757 Westwood Plaza, Suite 1638, Los Angeles, CA 90095.

Journal volume & issue: Vol. 2, no. 11
p. 100242

Abstract

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Introduction: To assess the technical feasibility and safety of repeated percutaneous computed tomography (CT)–guided transthoracic biopsies and intratumoral injections of gene-modified dendritic cells in metastatic NSCLC. Methods: A total of 15 patients with 15 NSCLC lesions measuring greater than 1.0 cm underwent two cycles of intratumoral biopsies and CCL21 dendritic cell injections separated by 7 days. All needle placements and injections were done under CT guidance. Clinical and imaging follow-up was done approximately 4 weeks after the first procedure. Safety and feasibility were determined as: (1) safety and feasibility similar to that of single-needle biopsy, and (2) an absence of serious adverse events defined as grade greater than or equal to three according to the National Cancer Institute Common Terminology Criteria for Adverse Events version 5.0. Results: A total of 30 percutaneous, transthoracic intratumoral biopsies and injections into the lung cancer were performed, two cycles (at d 0 and 7) received by each patient (311 biopsies and 96 intratumoral injections). All percutaneous cases achieved technical success with respect to needle placement for both biopsy and injection of CCL21 dendritic cells. Only minor complications were observed (grade <3), including pneumothorax (n = 10, 33%) and small postbiopsy hemorrhage (n = 2, 7%). Pneumothorax was moderate (n = 1) or trace (n = 9), with resolution of the moderate pneumothorax after manual aspiration without chest tube placement. No patient required chest tube placement. No other complications or serious adverse effects related to the biopsy or dendritic cell injection were noted. All patients were in stable condition after up to 4 hours in the recovery unit and were discharged home on the same day. No procedure-related complications were observed on imaging or clinical follow-up at 4 weeks. Conclusions: Repeated percutaneous, transthoracic CT-guided biopsies and intratumoral gene-modified cell-based immunotherapy injections into lung cancers are technically feasible, safe, and reproducible. There were no procedure-related serious (defined as grade ≥3) adverse events.

Published in JTO Clinical and Research Reports

ISSN: 2666-3643 (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/jto-clinical-and-research-reports/

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