E-Newsletter - March 2024
Spotlight on New Alliance Program


By Isabelle Bedrosian, MD
Professor, Department of Breast Surgical Oncology, Division of Surgery
University of Texas MD Anderson Cancer Center

Principal Investigator and Director, Alliance Program-Based Therapy Program

Breaking New Ground:
Alliance Procedure-Based Therapy PrograM

Surgical extirpation for treatment of localized tumors has been an essential tenet of cancer care for well over a century and critical to achieving cures, especially prior to the advent of modern chemotherapeutics. However, in recent years, advances in systemic therapies, as well as advances in technology, have created new opportunities to revisit older paradigms of local regional care delivery. The high rates of complete response to medical therapies in some solid tumors has raised questions about the need for local regional therapy and whether de-escalation of surgical treatment should be considered, an unthinkable possibility in decades past, while the continued high rates of local failure following resection in other contexts challenge us to consider innovative new strategies such as localized delivery of chemotherapeutics in conjunction with surgery.

Innovation in radiation physics and computing technology has allowed more precise deployment of radiation treatment, expanding the reach of radiation treatment and allowing for re-consideration of who may potentially benefit from receipt of radiation. Advances in technology such as machine learning tools and robotics platforms, and the expanding role of interventionalist specialties in oncology care, has opened the door to exploring whether delivery of localized treatment through non-operative, percutaneous, device based approaches could provide equivalent outcomes to those traditionally achieved through open surgery.

Harnessing these innovations in order to optimize how and when localized therapies are delivered are the key mission areas of the Alliance Procedure-Based Therapy Program (PBTP), which launched in the Spring of 2023. Importantly, these mission areas cannot be accomplished without the concomitant development of imaging strategies that accurately capture both the anatomic and biologic characteristics of the disease, thus enabling appropriate tailoring of local treatment.

To meet its mission, the PBTP will focus on four areas of priority:
1) identifying the optimal approach for delivery of localized therapy through conduct of cross modality studies;
2) testing the efficacy of minimally invasive procedures, including treatments delivered through percutaneous and endoscopic approaches;
3) testing tailored approaches to local therapy within the multidisciplinary context, including de-escalation trials; and
4) developing imaging biomarkers that can inform on patient treatment.

These priorities will be realized through close collaboration and programmatic integration across the four committees of the program; Radiation Oncology and Imaging under the leadership of Jeffrey Bogart, MD, and Lawrence Schwartz, MD, respectively and two newly established committees, Interventional Oncology, co-led by Drs. Maldonado and Liddell, and Surgery, co-led by Christina Roland, MD and Chandrajit Raut, MD.

The Alliance is ideally positioned to lead the way in creating a new framework for delivery of localized therapy through development of a broad portfolio of cross disciplinary, cross modality procedure-based trials. The Alliance has had long standing engagement with the surgical community, formed through the inclusion of American College of Surgeons Oncology Group as one of the legacy cooperative groups and continued through the partnership with the American College of Surgeons (ACS) through the Alliance ACS Clinical Research Program.

Alliance surgeons and Alliance radiation oncologists have led practice changing studies in the fields of breast cancer, prostate cancer, GI malignancies, lung and brain tumors (Boughey 2023; Rosenkranz 2020; Katz 2022; Mohler 2019; Fleshman 2019; Trifiletti 2020; Palmer 2022; Cuttino 2022; Bogart 2021; Bogart 2023; Breen 2020; Lehrer 2022). In addition to providing imaging support to Alliance trials, the Alliance Imaging Committee under Dr. Schwartz’s leadership has led the way among the cooperative groups in moving forward the field of imaging science, using machine learning approaches to develop novel imaging biomarkers informative to patient treatment response and outcome (Burotto 2014; Leuva 2019; Maitland 2020; Yeh 2023). Integration of these specialties under the umbrella of the PBTP, along with the recruitment of medical interventionalists, recognizes the changing landscape of care of localized disease and will allow us to break new ground as we reimagine how procedure-based cancer therapeutics are delivered, to whom they are delivered, and when they are delivered across the spectrum of malignancies.



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