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A collaboration between medical oncology and molecular imaging could open research perspectives to overcome some open clinical questions, according to Italian researchers.

A collaboration between medical oncology and molecular imaging could open research perspectives to overcome some open clinical questions, according to Italian researchers. The application of a multidisciplinary approach to clinical practice may increase the consciousness and the confidence of physicians in the right use of new therapeutic drugs, and may also contribute to a more personalized patients' management, a team from the University of Bologna defends.

In a recent editorial [1] in the European Journal of Nuclear Medicine and Molecular Imaging, Maria Pantaleo M.D. and her colleagues call attention to two areas that could benefit from a better integration between oncology and nuclear medicine: tumor biological characterization and molecular drugs development.

Some of the existing laboratory technologies already permit fine tumor analyses, such as gene expression profiling and high-resolution genome studies. These methods, in addition to the biological information obtained from traditional methods like DNA sequencing or proteomics, have "dramatically improved" the knowledge of solid tumors molecular profile, according to the researchers - but they still have limitations.

"First of all, the information coming from these analyses is derived from small tissue specimens and may not be representative of whole lesions. Secondly, the biology of neoplastic disease may be heterogeneous," the researchers explain, pointing out that, in fact, previous studies have reported differences between primary tumors and its metastases, and even between metastases themselves.

"The detection of biological abnormalities of the solid tumors seems to be a crucial point in which targeted agents can be applied to cancer care," the authors note. "An in vivo, global, non-invasive evaluation of tumor molecular background is needed." In the future, they state, the genomic background of cancers may be decoded by non-invasive imaging and this method may potentially replace the routine diagnosis in the clinical setting. "A non-invasive imaging detection of some specific therapeutic targets is a big challenge because it may revolutionize the cancer treatments approach."

Meanwhile, drugs currently available in everyday practice for many oncologists need to be analyzed for their success and limitations. New orally-available biological agents, which often have mild toxicities in comparison to chemotherapy, have improved the quality of life in cancer patients - but it's not always easy to predict and assess their activity and efficacy, as their results are often controversial.

Pantaleo and her team believe in the power of molecular imaging to overcome this obstacle: "It is well-recognized that PET/CT has the potential to improve cancer treatment assessments," their editorial remarked. As a consequence, they say, the development of new combined morphological and functional PET/CT criteria for response assessment are needed and required - using 18FDG or other PET tracers which are already available now, or new ones which will, in the future, take tumor molecular expression into consideration.

Mats Bergstrom, director of biology and lead imaging scientist for oncology at the GSK Clinical Imaging Centre in London, points out that FDG only works for some drugs and some tumors. "PET can do so much more," he says. "The beauty of PET is the versatility of chemistry. You can produce custom-made PET tracers for different tasks."

Bergstrom's research focuses on the development of tracers for oncology and neuroscience and the use of PET to describe pharmacology of drugs. He believes PET imaging will open a new era in drug development, which will move from its current model - preclinical testing followed by three phases of clinical trials - to personalized medicine - selecting the right dose and the right combination for the right patient.

"The role of PET in preclinical studies is now well-recognized, and the advantages of the acquisition of in vivo imaging are several," the authors of the paper write, citing faster evaluation of molecular pathway inhibition and faster information of prediction and assessment of the therapeutical effect. "The cooperation and multidisciplinary integration between medical oncology, nuclear medicine, radiopharmacy, biology, radiology and pathology may be a very important node for innovative and exciting perspectives in cancer research," they conclude.

[1] M. A. Pantaleo, S. Fanti, M. Nannini, S. Boschi, C. Nanni, A. Maleddu, D. Rubello and G. Biasco. 'What oncologists need and require from nuclear medicine'. Eur J Nucl Med Mol Imaging