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Jules Bordet Instituut Free University Brussels (ULB) Patrick Flamen, MD, PhD.

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Presentation on theme: "Jules Bordet Instituut Free University Brussels (ULB) Patrick Flamen, MD, PhD."— Presentation transcript:

1 Jules Bordet Instituut Free University Brussels (ULB) Patrick Flamen, MD, PhD

2 Integrated Molecular Imaging in Oncology using PET-CT (radiolabeled peptides) and MRI (DCE-MRI and MRS). Molecular Imaging: What ? Why ? How ? Positron Emission Tomography Functional MRI Integration imaging information (PET-MRI) translational and clinical research activities Clinical team (nuc med / functional radiology) Radiolabeled biomarkers (peptides) Ga68-labeling

3 The Ultimate Goal of Molecular Imaging Patient tailored medicine To adapt the treatment to the patient specific characteristics »From : one treatment for all »To: one patient one treatment This requires the knowledge of the underlying molecular defects of the cancer

4 Networking > ULB (équipe cyclotron Erasme) > Européen (Munich / Amsterdam) +++ Multidisciplinarité +++

5 X-rays CT MRI PETSPECT Nuclear Medicine Echography Radiology Spectrum of Medical imaging STRUCTURAL / MORPHOLOGICAL METABOLIC / MOLECULAR

6 Imagerie Métabolique Caractérisation Métabolique du Nodule Pulmonaire adenocarcinomafibronecrotic nodule CT PET

7 PET-CT the new standard Nuclear Oncology

8 PET/CT with FDG CT anatomy PET metabolism Fusion

9 Rectal Cancer Staging

10 Baseline PET-CT PET-CT after 2 weeks chemo A B chimiothérapie Treatment Response Assessment

11 Functional MRI : brain tumor - (B) difusion-weighted imaging - (D&E) MR spectrometry

12 Structural Imaging Metabolic Imaging Functional Imaging Molecular Imaging Anatomy; morphology; density Perfusion; blood flow; contractility Glucose ; amino acids consumption Receptor expression; enzymatic activity gene expression; DNA CT MRI PET

13 Integrated Imaging PET-CT Metabolic / Molecular + Structural MULTIMODALITY IMAGING PET-MRI Metabolic / Molecular / Functional MULTIFUNCTIONAL IMAGING

14 WHY ? Patient tailored medicine To adapt the treatment to the patient specific characteristics Early treatment response assessment Predicting treatment response

15 Ithier Project Study Aim Early treatment response assessment

16 Pre-Treatment 2 Months Post 43 HU 30 HU Imaging response to Imatinib

17 Imaging Response to Glivec Time to treatment failure (PD on CT) n=21 P < 0.001 PET responders PET non-responders Dr. S. Stroobants et al. (Eur J Cancer 2003) PFS according PET response 8 days after start of treatment Stroobants et al. Eur J Cancer 2003

18 Functional Imaging to Evaluate Response to Lapatinib baselinelapatinibat surgery Cristofanilli M, et al. Breast Cancer Res Treat. 2006;100 Supp 1:S5

19 Functional MRI for Early Response measurement M Lemort, Bordet, 2008

20 V Huyge, 2008 ASCO

21 Du et al. J Clin Oncol. 2007 Aug 10;25(23):3440-7 Assessment of response adjuvant chemotherapy in Metastatic breast cancer

22 V Huyge, 2008 ASCO Bone Metastatic Breast Cancer

23 PET responders PET non responders PET response is related to treatment outcome V Huyge, 2008 ASCO

24 Ithier Project Study Aim Predicting response to a targeted treatment By means of the identification the molecular target of the drug Examples: her2/neu breast cancer receptor imaging »predicting Herceptine treatment »Radiolabeled trastuzumab (Zirconium-89 ? ) Hormone receptor imaging »predicting response to anti-hormonal treatment

25 FDG-PET/CT pré-traitement; Récidive de lymphome. FDG-PET/CT 6 mois après traitement par radioimmunothérapie avec anticorps marqués à lY90; rémission complète. immuno-PET/CT; dosimétrie avec anticorps marqués au Zr89 pré- traitment. K Muylle, 2008, Lugano FDG-PET immuno-PET FDG response-PET

26 Ga68–labeled markers PET-CT for Molecular Imaging example: Ga68-DOTA-octreotide > neuro-endocrine tumors (staging) > breast cancer (related to ER expression) > prostate cancer Ithier 2008

27 GENERATOR PRODUCED PET TRACERS Ge68-Ga68 generator Biosynthesis Ga68-DOTA-Toc (octreotide) Labeling SSR subtypes 2-5


29 Retroperitoneal metastatic LN

30 11 mm largest diameter Retroperitoneal metastatic LN

31 Biosynthesis Module coupled to the Ga68-generator Automated production Laptop directed Quality Controll GMP Ithier Project 2008 : Ga68-radiolabeled proteins for molecular cancer imaging

32 Thanks

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