Editor’s Note: Selective Internal Radiation Therapy (SIRT) is a validated treatment for liver cancer, yet the influence of the immune microenvironment on treatment response and survival remains unclear. At the 18th International Liver Cancer Association (ILCA) Annual Conference, a recent study shed light on the complex relationship between the immune microenvironment in liver cancer patients prior to SIRT and its impact on treatment response and survival. Oncology Frontier invited Dr. Lin Zhang, from the Hepatobiliary Interventional Radiology Department at Beijing Tsinghua Changgung Hospital, to provide an expert analysis. With a detailed breakdown of the data and expert interpretation, this study offers valuable insights into the role of the local immune state in liver cancer treatment, paving the way for personalized and combination therapy strategies.

Dr. Lin Zhang：

In the pursuit of effective liver cancer treatments, Yttrium-90 (90Y) selective internal radiation therapy (SIRT) has emerged as an innovative approach. However, the relationship between clinical outcomes and the local tumor microenvironment has gained significant attention in recent years. This study focuses on the local immune state of liver cancer patients before undergoing 90Y treatment and its impact on treatment efficacy. By gathering clinical and biological data from patients diagnosed across multiple European hospitals, researchers could evaluate treatment response and patient survival. While 90Y treatment has garnered international recognition, the complexity and patient-to-patient variability of liver cancer mean its efficacy can vary widely among individuals.

Upon closer analysis of this study’s data, we observed the crucial role of the preoperative local immune state in determining the effectiveness of 90Y treatment. Liver cancer patients present with various immune profiles, but only tumors with immune cell infiltration typically respond well to immunotherapy. Interestingly, this study found that patients with pro-inflammatory immune cell infiltration within their tumors may not respond as well to 90Y treatment as other patients. This finding underscores the need to consider the local immune state of liver cancer tumors when devising SIRT treatment plans.

Certain key data points from the study are particularly notable. Although a substantial number of liver cancer patients were included, the response rate was not optimal. Particularly among patients at stages A and B, only a subset achieved complete or partial response, while many experienced disease progression. Furthermore, the median survival time of 15.9 months highlights the need for continued innovation in SIRT technology. Additionally, exploring combination treatments will be a future research priority.

In investigating the impact of immune state on 90Y treatment efficacy, the researchers performed a deeper analysis of differential gene expression, dividing patients into distinct groups based on their immune profiles. C1 patients showed a more pronounced local immune response, yet their survival rate was markedly lower than C2 patients. This discovery provides new insights into how the local immune state affects 90Y treatment outcomes.

Reflecting on this study, I envision several future directions for 90Y therapy in clinical research and practice. First, further exploration is required into the specific mechanisms between immune state and 90Y efficacy to provide patients with more precise treatment options. Second, personalized treatment plans should be tailored to each patient’s unique immune profile, maximizing efficacy and minimizing side effects. Finally, the importance of combination therapies cannot be overstated. For certain patients, pre-treatment with immunotherapy may enhance the effects of 90Y, improving survival outcomes.

In conclusion, this study illuminates the complex interplay between liver cancer SIRT and the patient’s immune state, providing valuable insights for future research and clinical practice. With continued advancements in 90Y technology and an increasing understanding of the immune environment, I am optimistic that we can achieve significant breakthroughs in liver cancer treatment.

Dr. Lin Zhang

• Chief of Hepatobiliary Interventional Radiology, Tsinghua University-affiliated Beijing Tsinghua Changgung Hospital
• Recognized expert in liver cancer treatment, focusing on interventional radiology and immunotherapy