About 19 in 20 colorectal cancers that have spread are invisible to standard immunotherapy. We break the tumor open with a needle and inject immune drugs, aiming to invite your immune system in. Colorectal cancer that has spread, and that standard immunotherapy cannot see.
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Most colorectal cancers keep immune cells out, so standard immunotherapy drugs have little to work on. Your pathology report calls this type MSS (microsatellite-stable). A needle breaks the tumor open by freezing or with electrical pulses and injects immune drugs into it. It works alongside your current treatment, not in place of it.
The immune drugs placed in the tumor teach the immune system to recognize this cancer, the way a vaccine does. You teach the immune system in one spot, and it goes after the same cancer in the rest of the body.
The treated tumor is the source of the vaccine, and it keeps supplying it. It is not one exposure and done. Every round of tumor cells the immune system destroys exposes new antigens, and those restart the cycle, so the response keeps spreading: broader, throughout the body, and with memory. It turns a “cold” tumor, one the immune system ignores, “hot”.
Card 06 leads back to card 02. Doctors call the widening response epitope spreading.
Colorectal cancer spreads to the liver and pelvis, often against large blood vessels. Pulsed electric fields break tumor cells open without heat, so we can treat beside the liver's main vein and artery, where a hot probe could not go. For cancer that is mostly in the liver, immune drugs can also be given through the liver's own artery, by a thin tube passed in from the groin or wrist.
An MSS tumor keeps immune cells out. Breaking it open releases its markers and danger signals, and the drugs we inject push the immune system to respond. That is the gap standard immunotherapy leaves open.
About an hour under image guidance, and most people go home the same day, about two hours later.
Treating one tumor builds immune memory against cancer elsewhere that was never treated. The cycle above is how that memory is built and kept refreshed.
Standard care. About 1 in 20 metastatic colorectal cancers are microsatellite-instability-high (MSI-high, also reported as dMMR) and respond to checkpoint blockade. The other roughly 95% are microsatellite-stable (MSS): standard care is chemotherapy with a biologic backbone, and checkpoint monotherapy has not worked in MSS disease. For liver-only or lung-only oligometastatic disease, ablation alone is an established local treatment.
Ablation alone. Local treatment of the tumor; any immune effect of ablation alone is not established.
This approach. Image-guided ablation of a tumor, combined in the same session with a multi-agent intratumoral immunotherapy injected into the ablation bed. Pulsed electric field (PEF) ablation, a non-thermal method, is used where the tumor lies against the portal vein, inferior vena cava or hepatic artery; cryoablation is used where the anatomy allows. It is built for MSS disease, the group that standard immunotherapy does not reach. For liver-dominant disease, an intra-arterial option delivers immunotherapy through the hepatic artery. In our clinical observations, lasting immune memory forms against untreated metastatic sites.
The procedure, step by step
Agents. The injected immunotherapy is a multi-agent combination. The agents and doses are set per patient by the treating physician.
The immune conversion cycle, in clinical terms. Ablation disrupts the tumor and exposes its full antigen repertoire, not a pre-selected subset. The injected immunotherapy then remodels the tumor microenvironment, priming, recruiting and activating immune cells and releasing the brakes on them. Immune-mediated lysis exposes further antigens, which re-prime the response (epitope spreading), producing a broader, polyclonal, systemic response with memory, converting a cold tumor hot. This is WCI’s stated rationale, in Dr. Goodyear’s framing, borne out in our clinical observations.
Rationale. An MSS tumor excludes T cells; without T cells inside the tumor, IV checkpoint drugs have little to act on. WCI's rationale is that breaking the tumor open releases its antigens and danger signals and that the injected agents bring immune cells into a tumor that kept them out. In our clinical observations, ablation re-seeds a T-cell response in MSS colorectal cancer.
Evidence, and its limits. In mice with colorectal tumors and no ablation, anti-CTLA-4 injected into a tumor reached about 14 times the day-7 level of IV dosing in that tumor; the untreated tumor received no more than with IV dosing, and half the dose reached the blood within an hour [1]. That is mouse data; it does not test ablation or show a distant-site effect. For the intra-arterial route, the established hepatic arterial infusion data are for chemotherapy (floxuridine pump series); the intra-arterial immunotherapy data are early and mostly in primary liver cancer, not colorectal, and no randomized trial of intra-arterial versus IV immunotherapy in colorectal liver metastases has completed. Chemotherapy results do not transfer to immunotherapy. There is no published WCI series in colorectal cancer and no randomized trial of this combination. Sources
Where your cancer is, and whether it is MSS or MSI-high, decides where we fit. Your pathology report says which. Pick the card that sounds like your diagnosis. Whether this is right for you is decided case by case, by a physician reading your records, so no list here is a verdict. If unsure, send the records.
Your colorectal cancer has spread, and one of these:
Each case is individually evaluated by the Williams Cancer Institute team.
After completing our admissions form, one of our Patient Consultants will contact you to explain the process and guide you through the next steps. Our admissions process is free of charge, including the review of your medical information and, if our medical team determines that you are a candidate, a video consultation. Treatments are generally not covered by health insurance, and WCI does not bill insurance companies.
One of our Patient Consultants will contact you to explain the admissions process, answer your general questions, and guide you through the next steps.
Your Patient Consultant will guide you on the required medical records and imaging studies, as well as how to submit them so our medical team can evaluate your case.
Once the necessary information has been received, our medical team will review your case to determine whether you may be a candidate for our treatments. If necessary, the medical team may request additional studies or information before making a decision.
If our medical team determines that you are a candidate, we will coordinate a complimentary Zoom consultation with one of our physicians. During this consultation, you will be able to discuss your case, address your medical questions, and learn about the treatment approach indicated for you.
Following your medical consultation, you will receive a personalized treatment plan that includes the corresponding costs. If you decide to proceed, the next steps will be coordinated to schedule your treatment.
Most treatments take place in Los Cabos, Mexico; in some cases our medical team may schedule a procedure in Mexico City. Rebyota is given only at our Beverly Hills, California location.
Your physician confirms the details for your case.
Your physician goes through the risks for your case before anything is decided.
Dr. Jason Williams is a board-certified radiologist who has spent his career putting needles into tumors under imaging. His first patent, in 2003, covered ablation combined with immunotherapy injected into the tumor. A physician since 2000, he opened his first ablation center in 2004 and completed his residency in 2007. He also co-founded Syncromune, whose separate investigational drug SV-102 holds FDA Fast Track status. His tumor board reviews every case.
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Most of our treatments are performed in Los Cabos, Mexico, in a private hospital setting.
Other treatment locations. In some cases our medical team may schedule a procedure in Mexico City. Rebyota is given only at our Beverly Hills, California location.
Accounts Williams Cancer Institute publishes, shared with each patient's permission. They span different cancers. Individual results vary and are not guaranteed.
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Read the full account →Complete our admissions form to get started. One of our Patient Consultants will contact you to explain the process and guide you through the next steps, including the medical information and imaging studies required for our medical team to evaluate your case.
