The treatment breaks the tumor open with electrical pulses, exposing what your immune system needs to see, then delivers immunotherapy right there, and can also send it through the liver's own artery. For liver cancer, or cancer that has spread to the liver, when options narrow.
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Whether the cancer started in your liver or spread there, a needle can usually reach it. Under CT guidance, a WCI physician places a thin needle into the tumor and breaks its cells open with pulsed electric fields, releasing the tumor's own antigens: the markers the immune system uses to recognize cancer. In the same session, immune drugs go into that exact spot. 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.
Ablation means treating a tumor through a needle, where it sits, instead of cutting it out. Liver tumors often sit against the portal vein or a bile duct. Heat can damage those, and flowing blood carries it away. Pulsed electric fields break tumor cells open without heat, so we can treat where a hot probe would be dangerous. Across 26 studies of a closely related technique (IRE) in the liver, 86% of treated tumors were completely ablated.
Many liver cancers carry marks from hepatitis B or C that the immune system should see but does not. Breaking the tumor open releases those marks, so the immune system finally has something to see. The drugs we inject into that spot are chosen to wake it up: some release its brakes, others press the accelerator.
The liver has its own blood supply. Where the cancer is mainly in the liver, we can thread a thin catheter into that artery and infuse immune drugs so they concentrate in the liver, while the needle treats the main tumors in the same session.
Once the immune system has been alerted at one tumor and kept re-primed by the cycle above, it goes after the same cancer elsewhere in the body, and it remembers it. Doctors call this an abscopal effect.
Standard care. Early hepatocellular carcinoma (HCC, BCLC stage 0–A) is treated with resection, transplant or ablation with curative intent. Intermediate disease (BCLC B) is treated with transarterial chemoembolization (TACE). Advanced disease (BCLC C) is treated first line with atezolizumab plus bevacizumab or durvalumab plus tremelimumab, then with tyrosine kinase inhibitors. For cancers that have spread to the liver from elsewhere, ablation has an established role, most clearly for colorectal and neuroendocrine metastases.
What ablation alone and TACE do. Both are local treatments. Ablation treats the tumor where it sits; TACE delivers chemotherapy-loaded beads through the hepatic artery with limited immune engagement. Neither is designed to act on disease elsewhere.
What is done here. Image-guided ablation of a liver tumor, usually with pulsed electric field (PEF) ablation, which uses electrical pulses rather than heat, followed in the same session by injection of a combination of immune-active agents into the ablated tumor. The rationale: many liver cancers, especially those driven by chronic hepatitis B or C, carry viral antigens the immune system could recognize but does not; ablation exposes tumor antigens, and the injected agents are intended to drive an immune response to them. The liver's own arterial supply also allows an intra-arterial route, infusing immune agents through the hepatic artery so that they concentrate in the liver. This combination is offered under physician review. In our clinical observations, treating a liver tumor produces an immune effect on disease outside the liver.
Case review. Triphasic CT or liver MRI, PET, biomarker reports (hepatitis B and C status, AFP, PIVKA-II where available, mutation profile) and liver bloodwork for the Child-Pugh score are read by the Williams Cancer Institute team.
Protocol design. The intratumoral combination is chosen for the cancer's origin (HCC or metastasis), Child-Pugh status and treatment history.
Guidance and ablation. CT-guided percutaneous access. PEF ablation is non-thermal and is given in cycles, across one or more sessions; cryoablation or microwave ablation is used where appropriate.
Intratumoral immunotherapy. Through the same access, a multi-agent combination is injected into the ablation bed.
Intra-arterial option for liver-dominant disease. A catheter is advanced, usually from the groin or wrist, into the hepatic artery and immune agents are infused into the liver's blood supply. It can be combined with intratumoral injection of the dominant tumors in the same session.
Setting and time. Most procedures are outpatient under conscious sedation; general anesthesia or an overnight stay is rarely required. About an hour for a needle procedure and about two hours' recovery.
Follow-up. AFP and imaging at 6 to 8 weeks. Repeat procedures as indicated; the number of treatments is decided with the patient's physician. The home hepatology, interventional radiology and oncology teams are kept informed.
Agents. Agents used in the published liver series [1]: checkpoint inhibitors (ipilimumab, nivolumab), CpG, CD40 and OX40 agonists, anti-CD47 and PV-10. The combination varied between patients.
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.
Evidence. WCI's own peer-reviewed series is a retrospective, uncontrolled report of three patients with advanced HCC (BCLC B, C and D) treated with PEF ablation plus intratumoral immunotherapy [1]. In that series two of the three patients received PEF (the first was treated before the device was available). Adverse events were transient ascites in one patient; transient severe lactic acidosis and acute kidney injury in another. One patient responded at the injected site but progressed at untreated sites. Follow-up ranged from about 6.5 months to 3.5 years, and the intratumoral agents differed between patients, so no effect can be attributed to any one of them. The published abstract states that all treated tumors responded favorably and reports no treatment-related complications; the adverse events and the progression at untreated sites are described in the full text and the record. The series shows that the procedure can be done and what can happen; it is not evidence of a response rate.
The pharmacological case for the intratumoral route comes from a mouse study: in mice with colorectal tumors and no ablation, anti-CTLA-4 injected into a tumor reached about 14 times the day-7 level of intravenous dosing in that tumor, the untreated tumor received no more than with intravenous dosing, and half the dose reached the blood within an hour [2]. That is mouse data in colorectal cancer; it does not test ablation and does not support a distant-site effect.
Non-thermal ablation in the liver has a body of evidence for classical irreversible electroporation: a meta-analysis of 26 studies (807 patients, 1,115 lesions) reported complete ablation in 86% (95% CI 81–90%) with complications in 23%, mostly minor [3]. Classical irreversible electroporation, the Aliya PEF system used here, and nanosecond PEF are related but not interchangeable, and outcomes do not transfer between devices. Systemic checkpoint blockade combined with ablation in HCC has been tested with intravenous tremelimumab plus transarterial chemoembolization or radiofrequency ablation (the abstract says "chemoablation"), with 5 of 19 evaluable patients showing a confirmed partial response [4]; that trial used an intravenous, not an intratumoral, drug. For the intra-arterial route, the evidence WCI's record cites is for hepatic arterial infusion chemotherapy combined with intravenous checkpoint inhibitor and a tyrosine kinase inhibitor; it is chemotherapy-plus-immunotherapy infusion, not immunotherapy alone, and none of it is WCI's data. No prospective trial combining PEF ablation with intratumoral immunotherapy in HCC is registered.
One patient's course from our records, with the scans exactly as recorded. Not every patient will have the same result.
Multifocal hepatocellular carcinoma, large right-lobe mass with satellite nodules.
Complete response on MRI; no evidence of disease reported
IV immunotherapy had not controlled it. Three short sessions followed.
A large liver cancer with smaller tumors around it, which IV (drip) immunotherapy had not controlled. Over four weeks there were three sessions: each broke the tumor open with electrical pulses through a needle and injected immunotherapy into it. About two years and five months later an MRI showed an eight-centimeter cavity where the tumor had been, with no sign of live tumor. Later MRI found no evidence of disease, and the patient was back at work about four months after treatment.
A large liver tumor. About two and a half years later, a cavity that no longer enhances.
About two years and five months after the first treatment, an MRI showed a well-defined 8 × 8 cm cavity with no enhancement where the tumor had been. The record reports a later MRI with no evidence of disease, and notes the patient returned to work about four months after treatment.
At the site of the prior 11.9 × 10.8 cm heterogeneous enhancing right-lobe mass there is now a well-defined, uniformly signal-void (non-enhancing) cavity measuring 8 × 8 cm, markedly smaller than the index lesion. Subsequent testing reported no evidence of disease (NED).
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Where the cancer started, how much of the liver it involves, and how well the rest of your liver works decide where we fit. Find the card closest to what you have been told. If you are unsure, send your records: a physician decides case by case, from your scans and bloodwork.
Usually a tumor a needle can reach safely, plus 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.
Like any procedure on the liver, this carries risks, including bleeding, fluid build-up in the abdomen (ascites) and, rarely, strain on the liver or kidneys. If drugs are given through the liver's artery, access is through the groin or wrist and you lie flat for a while afterwards. 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.
