New MRI technique predicts treatment response for neuroendocrine cancer patients

Supplementary content information

Two magnetic resonance images. The left shows the baseline level of arterial fraction, while the right shows the levels of arterial fraction post-treatment. The right image shows a decrease in fraction when compared to the left image.

Royal Marsden

A new study carried out at the Cancer Research UK and EPSRC Cancer Imaging Centre at The Institute of Cancer Research (IRC) and The Royal Marsden Hospital, has shown that a specialist type of MRI can be used to predict which patients will respond to a targeted radiotherapy and monitor response to treatment.

The work, which is reported in the journal Radiology, may help to ensure that patients with advanced neuroendocrine cancers - cancers arising from hormone-producing cells, often in the lungs or gastrointestinal tract - receive the most effective treatment.

The founder of Apple, Steve Jobs, succumbed to this type of cancer in October 2011, after being diagnosed in 2003 with a pancreatic neuroendocrine tumour. The disease later spread to his liver, leading to his death.

The outlook for patients with neuroendocrine tumours that have spread to the liver is poor, with only 20 to 30 per cent surviving for five years or longer. For many patients surgery isn’t possible and some patients don’t respond to chemotherapy. Peptide receptor targeted therapy, a type of radiotherapy which enables radiation treatment to be directed to tumours, avoiding damage to non-cancer cells, offers an important alternative. However, until now doctors have not had a satisfactory way to predict which patients are likely to benefit from treatment or assess whether patients are responding.

In the paper, Dr Dow-Mu Koh, Professor Martin Leach and colleagues at the Institute of Cancer Research (ICR) and The Royal Marsden have shown that dynamic contrast enhanced (DCE-)MRI can be used to monitor and predict response to peptide receptor therapy. DCE - MRI is a new technique which is particularly effective at measuring blood vessels. As neuroendocrine tumours have a large blood supply, the research team reasoned that they would be able to measure when treatments were working by looking at the reduction in the blood supply as a proxy for the effect on tumours.

Researchers scanned 20 patients with neuroendocrine liver metastases before treatment and two months after receiving radiopeptide therapy. Rapid and repeated imaging was performed over the tumour area after injection of an intravenous contrast agent. By tracking the time course of the contrast material through the tumour tissue, it is possible to measure the tumour blood supply. By comparing these measurements before and after treatment, the team was able to map whether there had been any reduction in tumour blood supply after treatment.

Professor Leach says: Radiopeptide therapy is an important treatment option for patients whose cancer has spread. This test may help to doctors to make decisions about which patients to offer this targeted therapy, and whether to stop treatment if patients aren’t responding, avoiding side-effects for those who won’t benefit.

Dr Koh says: We were able to reliably map patients’ livers using a completely non-invasive technique. Importantly, this type of MRI can be carried out on standard equipment, which is already available in hospitals around the country. The next step is to carry out larger studies involving other hospitals, to fully investigate this technique.

Notes for editors

The use of dynamic contrast-enhanced magnetic resonance imaging to monitor and predict radio labelled octreotide therapy response in patients with neuroendocrine tumour liver metastases with first author Dr Keiko Miyazaki from The Institute of Cancer Research is published in Radiology.

The Institute of Cancer Research

The ICR is one of the world’s most influential cancer research institutes. For more information visit The ICR website.

The Royal Marsden NHS Foundation Trust

The Royal Marsden opened its doors in 1851 as the world’s first hospital dedicated to cancer diagnosis, treatment, research and education.