title: The challenges of integrating molecular imaging into the optimization of cancer therapy.
abstract: We review novel, in vivo and tissue-based imaging technologies that monitor and optimize cancer therapeutics. Recent advances in cancer treatment centre around the development of targeted therapies and personalisation of treatment regimes to individual tumour characteristics. However, clinical outcomes have not improved as expected. Further development of the use of molecular imaging to predict or assess treatment response must address spatial heterogeneity of cancer within the body. A combination of different imaging modalities should be used to relate the effect of the drug to dosing regimen or effective drug concentration at the local site of action. Molecular imaging provides a functional and dynamic read-out of cancer therapeutics, from nanometre to whole body scale. At the whole body scale, an increase in the sensitivity and specificity of the imaging probe is required to localise (micro)metastatic foci and/or residual disease that are currently below the limit of detection. The use of image-guided endoscopic biopsy can produce tumour cells or tissues for nanoscopic analysis in a relatively patient-compliant manner, thereby linking clinical imaging to a more precise assessment of molecular mechanisms. This multimodality imaging approach (in combination with genetics/genomic information) could be used to bridge the gap between our knowledge of mechanisms underlying the processes of metastasis, tumour dormancy and routine clinical practice. Treatment regimes could therefore be individually tailored both at diagnosis and throughout treatment, through monitoring of drug pharmacodynamics providing an early read-out of response or resistance.
authors.affiliation: Richard Dimbleby Department of Cancer Research, Randall Division & Division of Cancer Studies, King's College London, Guy's Medical School Campus, London, SE1 1UL, UK. gargi.patel@kcl.ac.uk
authors.forename: G S
authors.initials: GS
authors.lastname: Patel
authors.forename: T
authors.initials: T
authors.lastname: Kiuchi
authors.forename: K
authors.initials: K
authors.lastname: Lawler
authors.forename: E
authors.initials: E
authors.lastname: Ofo
authors.forename: G O
authors.initials: GO
authors.lastname: Fruhwirth
authors.forename: M
authors.initials: M
authors.lastname: Kelleher
authors.forename: E
authors.initials: E
authors.lastname: Shamil
authors.forename: R
authors.initials: R
authors.lastname: Zhang
authors.forename: P R
authors.initials: PR
authors.lastname: Selvin
authors.forename: G
authors.initials: G
authors.lastname: Santis
authors.forename: J
authors.initials: J
authors.lastname: Spicer
authors.forename: N
authors.initials: N
authors.lastname: Woodman
authors.forename: C E
authors.initials: CE
authors.lastname: Gillett
authors.forename: P R
authors.initials: PR
authors.lastname: Barber
authors.forename: B
authors.initials: B
authors.lastname: Vojnovic
authors.forename: G
authors.initials: G
authors.lastname: Kéri
authors.forename: T
authors.initials: T
authors.lastname: Schaeffter
authors.forename: V
authors.initials: V
authors.lastname: Goh
authors.forename: M J
authors.initials: MJ
authors.lastname: O'Doherty
authors.forename: P A
authors.initials: PA
authors.lastname: Ellis
authors.forename: T
authors.initials: T
authors.lastname: Ng
mesh_terms: D014408:Biomarkers, Tumor / Q000032:analysis*; D006801:Humans; D057054:Molecular Imaging / Q000379:methods*; D009363:Neoplasm Proteins / Q000032:analysis*; D009369:Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000628:therapy*; D018511:Systems Integration
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins