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Immunotherapy can help the immune system attack cancer cells, but it often works poorly for liver metastases, where immune responses are naturally suppressed. This study proposes a new way to deliver immune-stimulating drugs directly into liver tumors via the tumor’s blood supply, using drug carriers that slowly release the drug into the tumor over time (immunoembolization). We developed and tested several different drug carriers, including microspheres and emulsions, and showed that the immunotherapy drug is released into the tumor over days to weeks, resulting in liver tumor shrinkage in pigs. Extended-release immunoembolization has the potential to maximize immune activation in liver metastases (in situ vaccination) while reducing autoimmune side effects.

The latest publication from my lab is a new intratumoral immunotherapy delivery platform, which achieves 6 days of intratumoral drug release, from a single injection. Tumors can be “painted” with drug using a needle, and the drug stays exactly where it’s injected, maximizing immune activation in the tumor, while reducing systemic toxicity.

The immune system is like a computer, which uses chemical signals, instead of electrical signals. When the immune system sees a potential threat, it needs to integrate information from multiple sources, to decide how to respond. Making the correct decision is important for fighting infections, killing cancer cells, and avoiding autoimmune diseases.

To manipulate a computer circuit, you need to deliver time-dependent electrical signals to a specific location in the circuit. To guide the immune system into attacking cancer cells, my lab has been developing new technologies for timed local delivery of chemical signals. Spatial control is achieved by image guided delivery into tumor versus lymph node. Temporal control is achieved by programmable multi-drug release kinetics from the drug delivery implant. Different drugs can then be delivered into specific locations at specific times, to convince the immune system to attack cancer antigens.

Instead of major surgery, tumors can be treated by blocking off the artery supplying the tumor, thus starving the tumor of nutrients and oxygen. This is a common treatment for liver tumors, and this paper now shows that the same thing can be done for pancreatic tumors.

When the immune system encounters a new antigen, it needs to make a decision about whether to attack, or to ignore. Making the correct decision is important for fighting infections, killing cancer cells, and avoiding autoimmune diseases. The decision is made using time-dependent chemical signals and computations that occur at different places (tumor, lymph node, blood).

So if we think of the immune system as a computer that uses chemical signals, rather than electrical signals, how do we communicate with the immune system, to help it make the right decisions? My lab has designed a catheter that allows us to deliver time-dependent chemical signals into tumors and lymph nodes. The catheter contains a 3D printed retention mechanism to prevent migration, and it is implanted using image-guided, minimally invasive techniques. Different drugs can then be delivered into specific locations at specific times, using programmable pumps, to convince the immune system to attack cancer antigens.

That's the system we had in the 1970s (government owned the patent to government-funded research). And what happened is that the government didn't know what to do with the patents, and the inventors, who were best positioned to commercialize their invention, could not justify spending time and money to commercialize something that they didn't own. So the Bayh Dole act of 1980 allowed universities to commercialize their federally funded inventions. The result was an explosion of startups, especially in the biotech industry.

Example: John Adler received some government funding to develop Cyberknife (image-guided radiation therapy). But he couldn't get follow up funding to commercialize this revolutionary new technology. So he took out a second mortgage on his house to commercialize the invention. And now image-guided radiation therapy is a standard treatment for many types of cancer. There's no way he would have taken out that large personal loan, if he didn't own the intellectual property.

There's a large gap between a patent, and a commercially viable product. And if you showed the patent to "experts" in the field, they would likely tell you that it's worthless. Great ideas are only obvious in retrospect. The inventor has the vision, motivation, and knowledge to make their invention a reality, but they can't quit their job and get external funding, if they can't own their invention.

> Life would be simpler if only these hospitals could set aside their arrogance and just go with the recommended workflow!

This would be like asking programmers to standardize on the recommended programming language.

we would love to just use the recommended workflow, if it worked for our hospital. There are differences in the patients, doctors, local regulations, existing systems, etc between hospitals.

Patients: Top cancer hospital does a lot of clinical trials, so some of the forms require you to fill out clinical trial information for every patient. In a maternity ward, it would not be appropriate to ask about clinical trials for every patient.

Doctors: Hospitals are staffed differently. If the hospital has residents, some of the work can be delegated to residents. If not, someone else has to do it. The workflow needs to account for who is actually available to do the work.

Local regulations: Medicine is highly regulated, and each state and hospital has its own rules.

Existing systems: Hospital computer systems have been around for decades, and usually it's not possible to migrate everything to a new system, so the new system needs to integrate with the old systems that couldn't be upgraded.

In a hospital or healthcare system, all of the doctors can generally see all of the imaging, labs, and notes for all patients. The problem with "curbside consults" -- where another doctor provides an immediate opinion without seeing the patient -- is that 1. The other doctor often doesn't get the full picture without doing a full evaluation. 2. Increased malpractice risk 3. It's not billable.

I'm a doctor, and in my own experience, my first impression from just seeing the images and talking to the other doctor is sometimes completely different from my final opinion after reviewing the chart and seeing the patient.

Wait times are also a problem, because hospitals and clinics like to operate at close to 100% capacity. There are huge fixed costs in a hospital, and hospital profit margins are often <5%, so that's why they have to operate near capacity.

Interventional radiologist here. The short answer is "no." I personally perform more than 100 different types of procedures, but there are lots of variations of each procedure, and different techniques for performing the same procedure. (And you need to know what to do when something unexpected happens in the middle of a procedure)

There are thousands of CPT codes, and even more procedures, since one CPT code could describe multiple different procedures, and some procedures involve combining multiple CPT codes. There is no formal approval process for new surgical procedures, and there is no comprehensive list. New procedures are invented all the time.

Your best bet is to pick a specific area, then find a surgeon to shadow. A lot of details of surgical techniques are not written down anywhere, and you learn by working with other surgeons. There are a few books that go through the basic procedural details. For example, Zollinger's "Atlas of surgical operations" is a good reference for abdominal surgery, and Kandarpa's "Handbook of interventional radiologic procedures" is a good reference for interventional radiology procedures. "Biodesign" by Zenios is a good introduction to inventing new medical devices.