Developing technologies and methodologies to improve monitoring of therapeutic response in cancer patients and support clinical decision making 

 

Despite the vast array of therapies to treat cancer, a significant limitation of current treatment approaches is the ability to understand how well a patient is responding to their treatment. Typically, a patient will undergo blood tests and routine imaging scans to determine whether their treatment is working. These currently have significant limitations in terms of cost, impact on patients’ lives, and efficacy – providing only an indication of the patient’s status at that snapshot in time, and measuring relatively crude tumour-specific markers in terms of underlying biological response. Tumour biopsies can be performed, but there are feasibility and patient acceptability challenges with taking these routinely. Key challenges for the clinician are to understand how well the therapy is working and how to make decisions to change or stop therapy. By actively measuring treatment response, clinicians will be able to change to another treatment as soon as they know the current one is not working effectively.

 

The successful development and clinical application of therapy monitoring technologies requires multidisciplinary research spanning discovery science, translational research and clinical trials. There is a need for new approaches to monitor responses to therapy more accurately and more frequently, and with lower impact on patients’ lives (i.e. less invasively and reducing hospital visits). Novel methods are needed to understand mechanisms of action and resistance of treatment with innovative assays to be able to predict response and resistance to treatment at the point of diagnosis. The goal is to develop low-cost therapy monitoring technologies that provide a real-time readout of therapeutic response, which can be implemented in a healthcare setting to inform treatment decision making.

     

    Determining the mechanism of action of cancer therapeutics

    Cancer therapy encompasses a range of treatment modalities including surgery, radiotherapy, chemotherapy, targeted drug therapies and immunotherapy/ biological therapies. Multidisciplinary research opportunities exist to understand the mode of action of these different therapeutics in cancer patients, which include:

    • Therapeutic delivery, distribution and side effects
    • The mechanism of action of the therapy on the tumour
    • Measuring therapeutic response and the emergence of resistance
    • Determining follow on treatment after the emergence of resistance


    Towards continuous monitoring of treatment response

    Therapy monitoring in the clinic is significantly limited by the biological information provided from blood tests and imaging that is only routinely undertaken at the start and end of a course of treatment. These approaches only allow a snap-shot of the tumour response at set time points and therefore limit the ability to make real-time decisions, in particular when a treatment has become ineffective for the patient.

     

    Non-invasive visualisation of therapy response

     

    The ability to non-invasively provide functional information about tumour response and systemic changes are a clear benefit of imaging-based solutions. Routine imaging present similar challenges to blood tests in that they can only present snapshots of the tumour in time. Most functional imaging requires multiple patient visits to build a longitudinal picture of tumour response, which is not feasible with existing costly technologies such as MRI and PET. Additionally, routine imaging typically only uses crude measurements, such as change in size to determine tumour response, with a lack of functional characterisation of the tumour which can limit clinical decision making. Innovating imaging technology to facilitate a more continuous, higher quality and automated readout of therapy response is a core focus of the Centre.

    Man going into CT scanner

    If you have any questions relating to the Therapy Monitoring Technologies theme please contact Jamie Meredith (j.meredith@imperial.ac.uk)