A New Way to Track Liver Cancer Treatment

Posted in Announcements

Nariman Nezami, MD; Reetu Mukherji, MD; Giuseppe Esposito, MD; Alexander Kroemer, MD, PhD, Georgetown University Medical Center and Medstar Georgetown University Hospital

Treatment Strategies

Liver cancer, specifically Hepatocellular Carcinoma (HCC), remains one of the deadliest forms of cancer worldwide. While researchers have developed several ways to fight it, the “optimal” approach for each individual patient remains unclear, as there are currently limited ways to predict how each person will respond to therapy. 

Currently, doctors use two main strategies:

• Local Therapy (TACE): A procedure where chemotherapy is delivered directly to the tumor via its blood supply. The flow of blood through the liver via the hepatic artery is then blocked, effectively “starving” and poisoning the cancer locally. As normal liver tissue gets most of its blood from the portal vein, the healthy liver is largely spared damage.
• Immunotherapy: Drugs that “unmask” the cancer, allowing the body’s own immune system—specifically CD8+ T cells (the body’s “soldier” cells)—to recognize and destroy the tumor.

Although both treatment methods help, liver tumors are notoriously good at creating an “immunosuppressive microenvironment (tumor neighborhood)”—essentially a biological fortress that puts immune cells to sleep or keeps them out entirely. Recent evidence suggests that combining these two treatments might be more effective than either alone, but we currently lack a reliable way to determine whether the treatment is actually “waking up” the immune system in real time.

The Challenge: Moving from Invasive to Non-Invasive Visualization

Right now, the only way to know what’s happening inside a tumor’s immune environment is through the use of needles—invasive biopsies (using a large “core” needle to take a physical tissue sample) or blood tests. However, a biopsy provides only a tiny “snapshot” of a single spot, and blood tests tell us that immune cells are present, but not whether they are actually getting into the tumor where they are needed. A clearer window is needed.

This Pilot Project

This research project proposes a high-tech, non-invasive solution called CD8ImmunoPET. This technology uses a specialized imaging agent (⁸⁹Zr-crefmirlimab berdoxam) that binds to a specific type of immune cell—CD8+ T cells. When a patient undergoes a PET scan, these “soldier cells” light up on the radiologist’s screen.

Instead of guessing, doctors can actually see the spatial distribution of the immune system within and around the tumor. They can see the following:

• Whether, after treatment, the T cells are 

• standing on the sidelines (outside the tumor) or
• successfully invading the tumor?
• How these dynamics change in the days immediately following a procedure like TACE.

More Detail

This study is a “feasibility” trial, meaning the primary goal is to demonstrate that this imaging technique works and provides clear data in a clinical setting. 

The team will enroll four patients: two receiving standard TACE and two starting systemic immunotherapy.

By taking scans before treatment and on Days 1 and 5 after treatment, researchers can map the “early temporal dynamics”—the immediate movement of the immune system in response to therapy. This is paired with traditional biopsies and blood draws to ensure the imaging data matches the biological reality.

Why This Matters

If the investigators can demonstrate that CD8ImmunoPET accurately tracks immune activity, it could revolutionize the treatment of liver cancer. It would allow for a personalized medicine, in which doctors can see within days—rather than months—if a therapy is working. If the “soldiers” aren’t showing up to the fight, the medical team can pivot to a different strategy immediately.

Ultimately, this multi-disciplinary effort between radiologists, oncologists, and surgeons aims to move away from a “one size fits all” approach and toward a future where we can visualize, track, and conquer liver cancer with precision.

Comparison: Traditional Monitoring vs. CD8ImmunoPET