With a growing interest into cancer metabolic reprogramming, new research strategies target local metabolic activity in order to improve our ability to characterize the disease. The relatively recent development of dissolution dynamic nuclear polarization can create metabolically active compounds with magnetic resonance (MR) sensitivity enhancements on the order of more than 10,000-fold. The ability to differentiate the metabolic products from the injected substrate using MR imaging or spectroscopy permits the real-time observation of in vivo metabolic pathways critical to the identification and evaluation of cancer. The basic principles of this new methodology are discussed with preclinical and clinical examples of how it can aid in the detection and staging of cancer as well as in monitoring the response to treatment.
Malignant pleural mesothelioma remains one of the deadliest cancers known to man and is still considered incurable and typically associated with a survival cited in the one year range. Peritoneal mesothelioma is less common, but is considered one the deadliest intra-abdominal cancers. Mesothelioma is, in the overwhelming majority of patients, caused by asbestos. There is usually a latency period of decades, without an upper limit, between asbestos exposure and development of the cancer. Consequently, the incidence of mesothelioma is not expected to peak in the United States until 2030. Marylander's are particularly prone to asbestos exposure and do have a significant incidence of mesothelioma due to industrial exposures (Bethlehem Steel, etc) and exposure during military service, where essentially all land, sea and air vehicles used to contain asbestos. Treatment strategies, current research and intra-Maryland collaborations to combat this terrible cancer will be discussed.
Pancreatic cancer is currently the 3rd leading cause of cancer death in the United States. Rates of pancreatic cancer are increasing. With most patients presenting with advanced disease with the vast majority of patient die with a year of diagnosis, early detection and prevention are critical to reducing the burden of this deadly disease. We will discuss ongoing strategies to identify high-risk individuals and early detection efforts.
Prostate cancer is typically diagnosed through screening tests such as the blood PSA level or a digital rectal exam, followed by a set of 12 or so biopsy cores to randomly sample the prostate for cancer. This approach has typically had the pitfall of a 30-50% rate of under-diagnosing the aggressiveness of the tumor however making reliance on risk-stratification for treatment decision-making challenging. Recent advances in prostate imaging and image guided biopsy have lead to significant improvements in this arena however. In this talk we will discuss the advances in prostate imaging, image guided biopsy of the prostate and the clinical implications of these advances.
Small Molecules for Imaging and Therapy of Prostate Cancer
Unlike most other solid tumors prostate cancer is not easily detected by clinical molecular imaging techniques, such as positron emission tomography (PET). We have developed a series of positron-emitting small molecules that target the prostate-specific membrane antigen (PSMA), which is up-regulated in prostate cancer, particularly aggressive, androgen-independent disease. The compounds developed can be worked into standard clinical workflow and one is currently in phase II/III trials. The same chemical scaffold used for imaging can also be purposed for radiopharmaceutical therapy, as will also be discussed by way of early clinical and pre-clinical examples.