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Introduction <p>Interventional oncology (IO) is a key component of multidisciplinary cancer care, delivering minimally invasive therapies with safety and efficacy comparable to or surpassing conventional approaches. As IO enters a transformative era, the field must continue demonstrating value within the greater world of oncology, particularly through the study and application of surrogate endpoints.</p> Surrogate Endpoint Definitions and Validation Criteria <p>A central requirement for advancing IO is the&#xa0;rigorous evaluation of&#xa0;treatment outcomes through translational research. Surrogate endpoints, including imaging-based criteria and serum biomarkers,&#xa0;expedite&#xa0;therapeutic assessment, yet their validity as predictors of clinical benefit remains under scrutiny.</p> Regulatory and Methodological Challenges <p>Experience from prior IO studies underscores&#xa0;the complex interplay between surrogate endpoints, overall survival, and quality of life metrics. Variable regulatory acceptance, incomplete validation, and inconsistencies in endpoint definition and reporting continue to challenge their adoption.</p> Primary Liver Tumors <p>In hepatocellular carcinoma (HCC), surrogate endpoints have informed treatment evaluation; however, their predictive strength and reproducibility remain variable across studies.</p> Secondary Liver Malignancies <p>Applications in metastatic liver disease similarly rely on imaging and serum-based surrogates, though performance and reliability remain heterogeneous.</p> Limitations <p>Uncertainty persists regarding the ability of surrogate endpoints to reliably predict durable clinical outcomes, limiting their broader applicability.</p> Future Directions <p>Advancing IO will require&#xa0;the integration of modern trial methodologies, synthetic control arms, radiomics, and artificial intelligence to strengthen surrogate endpoint validation and facilitate&#xa0;broader clinical and regulatory acceptance.</p> Conclusions <p>By embracing its characteristically innovative spirit while maintaining a critical lens on data interpretation, the IO community can not only advance therapeutic development but also reinforce its indispensability in oncology. The beginning of a new quarter century brings a pivotal juncture, with an opportunity to reimagine IO’s trajectory bridging technical ingenuity with the nuanced demands of modern cancer care.</p>

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Survival and Surrogate Biomarkers in Interventional Oncology Trials: Pitfalls, Challenges, and Future Directions

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月16日

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  • Ana P. Gonzalez,
  • Adam Swersky,
  • Riad Salem

摘要

Introduction

Interventional oncology (IO) is a key component of multidisciplinary cancer care, delivering minimally invasive therapies with safety and efficacy comparable to or surpassing conventional approaches. As IO enters a transformative era, the field must continue demonstrating value within the greater world of oncology, particularly through the study and application of surrogate endpoints.

Surrogate Endpoint Definitions and Validation Criteria

A central requirement for advancing IO is the rigorous evaluation of treatment outcomes through translational research. Surrogate endpoints, including imaging-based criteria and serum biomarkers, expedite therapeutic assessment, yet their validity as predictors of clinical benefit remains under scrutiny.

Regulatory and Methodological Challenges

Experience from prior IO studies underscores the complex interplay between surrogate endpoints, overall survival, and quality of life metrics. Variable regulatory acceptance, incomplete validation, and inconsistencies in endpoint definition and reporting continue to challenge their adoption.

Primary Liver Tumors

In hepatocellular carcinoma (HCC), surrogate endpoints have informed treatment evaluation; however, their predictive strength and reproducibility remain variable across studies.

Secondary Liver Malignancies

Applications in metastatic liver disease similarly rely on imaging and serum-based surrogates, though performance and reliability remain heterogeneous.

Limitations

Uncertainty persists regarding the ability of surrogate endpoints to reliably predict durable clinical outcomes, limiting their broader applicability.

Future Directions

Advancing IO will require the integration of modern trial methodologies, synthetic control arms, radiomics, and artificial intelligence to strengthen surrogate endpoint validation and facilitate broader clinical and regulatory acceptance.

Conclusions

By embracing its characteristically innovative spirit while maintaining a critical lens on data interpretation, the IO community can not only advance therapeutic development but also reinforce its indispensability in oncology. The beginning of a new quarter century brings a pivotal juncture, with an opportunity to reimagine IO’s trajectory bridging technical ingenuity with the nuanced demands of modern cancer care.