Technical Feasibility and Safety of Repeated CT-guided Trans-thoracic Intratumoral Injection of Gene Modified Cellular Immunotherapy in Metastatic Non-Small Cell Lung Cancer

ABSTRACT Purpose To assess the technical feasibility and safety of repeated percutaneous computed tomographic (CT)-guided transthoracic biopsies and intratumoral injections of gene-modified dendritic cells in metastatic non-small cell lung cancer. Materials and Methods Fifteen patients with 15 non-small cell lung cancer lesions measuring greater than 1.0 cm underwent two cycles of intratumoral biopsies and CCL21 dendritic cell injections separated by 7 days. All needle placements and injections were done under CT-guidance. Clinical and imaging follow-up was done approximately 4 weeks after the first procedure. Safety and feasibility were determined as (a) safety and feasibility similar to that of single-needle biopsy and (b) an absence of serious defined as grade ≥ 3 according to the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results A total of 30 percutaneous, transthoracic intratumoral biopsies and injections into the lung cancer were performed, two cycles (at day 0 and 7) received by each patient (311 biopsies and 96 intratumoral injections). All percutaneous cases achieved technical success with respect to needle placement for both biopsy and injection of CCL21 dendritic cells. Only minor complications were observed (grade Conclusions Repeated percutaneous, transthoracic CT-guided biopsies and intratumoral gene modified cell based immunotherapy injections into lung cancers are technically feasible, safe, and reproducible. There were no procedure-related serious (defined as grade ≥ 3) adverse events.