ONCOLOGY: Can you tell us the basic concept behind the glycolysis paper?
MANKOFF: We’ve studied a couple of areas—mostly in later-stage breast cancer—and what we’re finding is that, scanning people with fluorodeoxyglucose PET, or FDG-PET, we’ve identified patterns of glucose consumption that we think are predictive of response. And this suggests a couple of things—one is that serial measure of glucose metabolism with FDG-PET can give a very early readout on the success of a variety of treatments including both chemotherapy and endocrine therapy, and that it may actually be true that the pattern of glycolysis can provide some prediction for how aggressive and resistant a tumor is likely to be. We’ve been using PET scanning in breast cancer for some time now as a staging tool and also as a way to follow response to therapy for more advanced disease, but I think that some of these latest findings suggest that we may also be able to use this as a way to understand how tumors work, why some are resistant, and perhaps be able to use this as a very early predictive tool for response to treatment.
ONCOLOGY: Are there others working on targeted breast cancer approaches like this?
MANKOFF: Yes, there are a number of groups working on various aspects of this. For example there are groups at Washington University in St. Louis; in Edmonton, Canada at the BC Cancer Agency; and at Memorial Sloan-Kettering that are also working on these estrogen imaging studies. We hope to be able to put those groups together and develop a multi-center trial to test the approach. We’re using a labeled estrogen—labeled for PET imaging, to be able to look at estrogen receptors in breast cancer, and use that as an in vivo, non-invasive way to predict response to endocrine therapies. I think this is a very exciting development that’s mostly been applied to later-stage breast cancer, but may be helpful across the spectrum in those patients that are candidates for endocrine therapy.
ONCOLOGY: Finally, are there any talks at ASCO that you think will be particularly exciting or informative for your work?
MANKOFF: Yes, there are a number of groups that are beginning to talk about the testing of new imaging techniques in clinical trials. I think the practicing oncologist is very used to using clinical trials as the basis for determining therapy. We in imaging are just beginning to get used to using clinical trials as the basis for choosing appropriate imaging techniques. And we’re now seeing some of these advances in imaging techniques coming into play through a variety of organizations the American College of Radiology Imaging Network, ACRIN. There’s also a great deal of cooperation between societies, for example between ASCO and the Society for Nuclear Medicine, and there will be a session on Friday June 3rd that I’ll also be participating in that discusses how imaging clinical trials and cancer therapy clinical trials can work together, as well as some of the exciting work that’s going on in that area. I would point people in the direction of imaging clinical trial studies, papers, and sessions, in addition to in addition to what you’re used to seeing for therapy clinical trials.
ONCOLOGY: I did notice that on your website you mention translational and clinical trials specifically for imaging, and it was the first time I’d seen that.
MANKOFF: Yes. Actually in the “Trials in Progress Session” at ASCO, two of the ACRIN ongoing trials are being presented. One is the trial of fluorothiamidine-PET, or FLT-PET, to measure early response of breast cancer in the neo-adjuvant setting that is well underway. A second, very exciting, first of its kind trial, of optical imaging in locally advacened breast cancer as a way to measure response. That was an outgrowth of a consortium that was funded by the NCI to develop technology to enable that, and there is a group of centers that have built and tested that technology and are opening up a clinical trial under the auspices of ACRIN, so we’re very excited to see these new techniques—both new probes and new imaging techniques move into the field. I’d encourage folks to go and have a look at the new session entitled, I believe “Protocols in Progress.”
ONCOLOGY: Thank you for your time.
1. Linden HM, Mankoff DA. Breast cancer and hormonal stimulation: is glycolysis the first sign of response? J Nucl Med. 2010 Nov;51(11):1663-1664. PMID: 20956476