Functional imaging: what evidence is there for its utility in clinical trials of targeted therapies?
N Tunariu1, S B Kaye, N M Desouza
1Section of Clinical Magnetic Resonance, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, Sutton, Surrey SM2 5PT, UK. nina.tunariu@icr.ac.uk
Abstract:
Key issues in early clinical trials of targeted agents include the determination of target inhibition, rational patient selection based on pre-treatment tumour characteristics, and assessment of tumour response in the absence of actual shrinkage. There is accumulating evidence that functional imaging using advanced techniques such as dynamic contrast enhanced (DCE)-magnetic resonance imaging (MRI), DCE-computerised tomography (CT) and DCE-ultrasound, diffusion weighted-MRI, magnetic resonance spectroscopy and positron emission tomography-CT using various labelled radioactive tracers has the potential to address all three. This article reviews this evidence with examples from trials using targeted agents with established clinical efficacy and summarises the clinical utility of the various techniques. We therefore recommend that input from specialist radiologists is sought at the early stages of trial design, in order to ensure that functional imaging is incorporated appropriately for the agent under study. There is an urgent need to strengthen the evidence base for these techniques as they evolve, and to ensure standardisation of the methodology.
Insights
Functional imaging techniques show promise in early clinical trials for targeted cancer agents. These advanced methods aid in assessing target inhibition, selecting patients, and evaluating tumor response, even without shrinkage.
Area of Science:
- Oncology
- Radiology
- Medical Imaging
Background:
- Early clinical trials for targeted agents face challenges in determining target inhibition, patient selection, and assessing tumor response without shrinkage.
- Functional imaging techniques are emerging as potential solutions to these critical issues in early-phase drug development.
Purpose of the Study:
- To review the evidence supporting the use of advanced functional imaging techniques in early clinical trials of targeted agents.
- To summarize the clinical utility of various functional imaging modalities for assessing targeted therapy efficacy.
Main Methods:
- Review of accumulating evidence from clinical trials utilizing targeted agents with established efficacy.
- Examples of functional imaging techniques discussed include dynamic contrast-enhanced (DCE)-MRI, DCE-CT, DCE-ultrasound, diffusion-weighted MRI, magnetic resonance spectroscopy, and positron emission tomography-CT.
Main Results:
- Functional imaging demonstrates potential in addressing key issues of target inhibition, patient selection, and response assessment in early trials.
- The reviewed evidence highlights the clinical utility of advanced imaging for evaluating targeted therapies.
Conclusions:
- Specialist radiologist input is recommended during early trial design to appropriately incorporate functional imaging.
- There is an urgent need to strengthen the evidence base and standardize methodologies for these evolving functional imaging techniques.
Related Concept Videos
01:14Brain Imaging
These technologies include computerized axial tomography (CAT or CT scans), positron-emission tomography (PET scans), magnetic resonance imaging (MRI), functional magnetic resonance imaging (fMRI), and Transcranial Magnetic Stimulation (TMS).
02:57Targeted Cancer Therapies
There are several types of targeted therapies against specific...