Can a New PET Imaging Technique More Quickly Predict Response to Ongoing Cancer Treatment?
National Cancer Institute–Funded Clinical Trial Looks at Novel Technique for Detecting Tumor Growth in Patients With Esophageal and Lung Cancer
Apr 28, 2011
Can a simple imaging test help predict the success of cancer treatment, even before the treatment is complete? To begin to answer this question, a new National Cancer Institute–funded clinical trial is using a novel PET (positron emission tomography) imaging technique that could improve the early detection of tumor growth during treatment for esophageal and lung cancer.
Led by Dr. Clifford Chao at NewYork-Presbyterian Hospital, Columbia University Medical Center and Weill Cornell Medical College, the ongoing pilot employs PET scans with a radioactive tracer molecule called FLT (fluoro-L-thymidine), or FLT-PET. The study, one of the first in the United States to use this technique for esophageal and lung cancer, represents a continuation of more than 10 years of research by Dr. Chao and others and builds on evidence that FLT-PET may be more effective than the traditional method using FDG (fluorodeoxyglucose), or FDG-PET.
"Every cancer is slightly different, and response to chemotherapy and radiotherapy is not always predicable. Our goal is to develop a quicker and more effective way to see how a treatment is working while the patient is undergoing the therapy," says Dr. Chao, radiation oncologist-in-chief at NewYork-Presbyterian Hospital, chairman of the Department of Radiation Oncology at Columbia University College of Physicians and Surgeons and chief of the Division of Radiation Oncology at Weill Cornell Medical College. "Today, we have to wait six to eight weeks. Our hope is that FLT-PET will shorten this time significantly."
If shown successful, Dr. Chao says, FLT-PET could "allow us to better tailor treatment to meet the specific needs of individual patients, limiting their exposure to chemo and radiation, and more quickly make any necessary adjustments to their treatment plan."
The approach is designed to visualize big changes in tumor growth. This works for cancers like esophageal and lung cancer that are treated with radiation and chemotherapy prior to surgery, Dr. Chao explains. It is not intended for breast cancer or other cancers in which surgery is the first course of action, followed by radiation to the surgical margins and chemotherapy to kill any miniscule amounts of cancer remaining.
The new study is recruiting 100 patients with esophageal or lung cancer. They will receive FLT-PET prior to radiation and chemotherapy, then again three weeks later, along with several other routine diagnostic procedures. With FLT-PET, the patient is injected with the FLT tracer and then given a PET scan. The PET machine creates a three-dimensional image of the tumor area based on the distribution of the tracer. Investigators will compare and evaluate the FLT-PET results to standard pathological assessment based on surgical specimens.
Investigators will determine whether the experimental method is more effective than the standard PET technique. The traditional FDG tracer is an analog for sugar and shows how sugar is metabolized in the patient's body. By contrast, FLT is an analog for an organic compound called pyrimidine, which is the building block of DNA synthesis. Dr. Chao explains that the latter approach is much more sensitive and better able pick up on cancer cell activity. He cites early non-clinical studies showing that FLT is able to detect significant changes in tumor proliferation as soon as one day after treatment.
In addition to Dr. Chao, study co-investigators include Drs. Masanori Ichise, Joshua R. Sonett, Mark B. Stoopler, Halmos Balazs, Ryan J. Burri, Simon K. Cheng, Ying Wei and Peter Esser from Columbia University Medical Center; and Drs. Nasser Altorki, Brendon Stiles, Subroto Paul, Paul Lee, Jeffrey Port, Stanley Goldsmith, Joseph Osborne, Bryan Schneider and Bhupesh Parashar — from NewYork-Presbyterian/Weill Cornell.
NewYork-Presbyterian Hospital, based in New York City, is the nation's largest not-for-profit, non-sectarian hospital, with 2,353 beds. The Hospital has more than 2 million inpatient and outpatient visits in a year, including more than 220,000 visits to its emergency departments — more than any other area hospital. NewYork-Presbyterian provides state-of-the-art inpatient, ambulatory and preventive care in all areas of medicine at five major centers: NewYork-Presbyterian Hospital/Weill Cornell Medical Center, NewYork-Presbyterian Hospital/Columbia University Medical Center, NewYork-Presbyterian/Morgan Stanley Children's Hospital, NewYork-Presbyterian/The Allen Hospital and NewYork-Presbyterian Hospital/Westchester Division. One of the most comprehensive health care institutions in the world, the Hospital is committed to excellence in patient care, research, education and community service. NewYork-Presbyterian is the #1 hospital in the New York metropolitan area and is consistently ranked among the best academic medical institutions in the nation, according to U.S.News & World Report. The Hospital has academic affiliations with two of the nation's leading medical colleges: Weill Cornell Medical College and Columbia University College of Physicians and Surgeons.
Weill Cornell Medical College
Weill Cornell Medical College, Cornell University's medical school located in New York City, is committed to excellence in research, teaching, patient care and the advancement of the art and science of medicine, locally, nationally and globally. Physicians and scientists of Weill Cornell Medical College are engaged in cutting-edge research from bench to bedside, aimed at unlocking mysteries of the human body in health and sickness and toward developing new treatments and prevention strategies. In its commitment to global health and education, Weill Cornell has a strong presence in places such as Qatar, Tanzania, Haiti, Brazil, Austria and Turkey. Through the historic Weill Cornell Medical College in Qatar, the Medical College is the first in the U.S. to offer its M.D. degree overseas. Weill Cornell is the birthplace of many medical advances — including the development of the Pap test for cervical cancer, the synthesis of penicillin, the first successful embryo-biopsy pregnancy and birth in the U.S., the first clinical trial of gene therapy for Parkinson's disease, and most recently, the world's first successful use of deep brain stimulation to treat a minimally conscious brain-injured patient. Weill Cornell Medical College is affiliated with NewYork-Presbyterian Hospital, where its faculty provides comprehensive patient care at NewYork-Presbyterian Hospital/Weill Cornell Medical Center. The Medical College is also affiliated with the Methodist Hospital in Houston, making Weill Cornell one of only two medical colleges in the country affiliated with two U.S.News & World Report Honor Roll hospitals. For more information, visit Weill Cornell Medical College.
Columbia University Medical Center
Columbia University Medical Center provides international leadership in basic, pre-clinical and clinical research, in medical and health sciences education, and in patient care. The Medical Center trains future leaders and includes the dedicated work of many physicians, scientists, public health professionals, dentists, and nurses at the College of Physicians & Surgeons, the Mailman School of Public Health, the College of Dental Medicine, the School of Nursing, the biomedical departments of the Graduate School of Arts and Sciences, and allied research centers and institutions. Established in 1767, Columbia's College of Physicians and Surgeons was the first institution in the country to grant the M.D. degree and is now among the most selective medical schools in the country. Columbia University Medical Center is home to the largest medical research enterprise in New York City and state and one of the largest in the United States. For more information, please visit www.cumc.columbia.edu.
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