Trans-Arterial Micro-Perfusion Could Boost Systemic Chemotherapy Efficacy in Unresectable Pancreatic Cancer: With Gregory J. Tiesi, MD, FACS, FSSO; Anthony Scholer, MD, FACS, FSSO; and Eric Pletcher, MD

In this episode, Gregory J. Tiesi, MD, FACS, FSSO, hosted a discussion about the growing role for transarterial microperfusion (TAMP) as a regional therapy strategy for patients with locally advanced pancreatic ductal adenocarcinoma (PDAC). 

Dr Tiesi is the medical director of Hepatobiliary Surgery at the Hackensack Meridian Jersey Shore University Medical Center in Neptune, New Jersey. He was joined by: 

PDAC is a disease in which dense desmoplastic stroma and poor tumor vascularization often limit the effectiveness of standard systemic chemotherapy. Drs Tiesi, Scholer, and Pletcher explained that standard regimens, such as FOLFIRINOX or gemcitabine-based combinations, frequently fail to achieve adequate intratumoral drug concentrations because of these biologic barriers. TAMP aims to overcome this limitation by isolating a segment of an arterial vessel and pressure-mediated transvascular delivery, which would allow for higher local drug concentrations and reduce systemic exposure and toxicity. 

The experts noted that TAMP is currently being explored primarily in patients with locally advanced, unresectable pancreatic cancer without distant metastases, particularly those who have exhausted systemic treatment options but maintain localized disease. Early clinical studies, including the phase 1/2 RR1 trial (NCT02237157) and the observational RR2 dose-escalation study (NCT02591082), demonstrated that the procedure is technically feasible, repeatable, and associated with lower systemic toxicity compared with conventional chemotherapy. A pooled analysis of these studies suggested encouraging survival outcomes, particularly in patients who received prior chemoradiation, potentially because radiation modifies the tumor microenvironment and improves drug penetration. 

Lastly, Tiesi, Scholer and Pletcher reviewed the ongoing phase 3 TIGeR-PaC trial (NCT03257033), which is evaluating TAMP as a consolidation strategy after induction chemotherapy and radiation. Preliminary data suggest improved survival and substantially fewer serious adverse effects with TAMP vs continued systemic therapy alone. Although the experts cautioned that the approach remains investigational, they agreed that TAMP may provide meaningful local disease control and potentially expand treatment options and preserve quality of life for patients with this aggressive malignancy.