Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
Division of Hematology/Oncology, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia.
JAMA Oncol. 2017 May 1;3(5):695-701. doi: 10.1001/jamaoncol.2016.5084.
Individualized cancer treatment, tailored to a particular patient and the tumor's biological features (precision oncology), requires a detailed knowledge of tumor biology. Biological characterization is typically performed on biopsy material, but this approach can present challenges for widespread and/or heterogeneous disease and for performing serial assays to infer changes in response to therapy. Molecular imaging is a complementary approach that provides noninvasive and quantitative measures of the in vivo biology of the full disease burden and is well suited to serial assay.
Molecular imaging can provide unique information to guide precision oncology that includes measuring the regional expression of therapeutic targets, measuring drug pharmacokinetics, measuring therapy pharmacodynamics, and providing a marker of therapeutic efficacy that is highly indicative of outcome. Thus far, most trials of novel molecular imaging in oncology have been small, single-center trials. Only a few methods have progressed to multicenter trials and even fewer have become part of clinical practice.
Molecular imaging holds great promise for precision oncology, complementing tissue-based markers to guide more effective, less toxic, and more cost-effective cancer treatments. Beyond logistical and technical challenges, moving new imaging tests from the laboratory to the clinic requires a compelling use case that will benefit patients and/or improve cost-effectiveness, and it requires the collaboration of imagers, oncologists, and industry to reach its true clinical potential.
个体化癌症治疗，针对特定患者和肿瘤的生物学特征（精准肿瘤学），需要详细了解肿瘤生物学。生物学特征通常在活检材料上进行，但这种方法对于广泛存在和/或异质性疾病以及进行连续检测以推断对治疗的反应变化具有挑战性。分子成像则是一种互补方法，它提供了对整个疾病负担的体内生物学的非侵入性和定量测量，非常适合连续检测。
分子成像可以提供独特的信息来指导精准肿瘤学，包括测量治疗靶点的局部表达、测量药物药代动力学、测量治疗药效学，以及提供一个高度提示疗效的治疗效果标志物。到目前为止，大多数新型分子成像在肿瘤学中的临床试验规模较小，都是单中心试验。只有少数方法进展到多中心试验，更少的方法成为临床实践的一部分。
分子成像为精准肿瘤学提供了巨大的潜力，补充了基于组织的标志物，以指导更有效、毒性更小、更具成本效益的癌症治疗。除了后勤和技术挑战外，将新的成像测试从实验室推向临床还需要一个有说服力的用例，使患者受益和/或提高成本效益，这需要成像师、肿瘤学家和行业的合作，以发挥其真正的临床潜力。
