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Making Molecular Imaging a Clinical Tool for Precision OncologyA Review

Educational Objective
To learn the role of molecular imaging in oncology and be aware of barriers to its clinical application.
1 Credit CME

Importance  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.

Observations  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.

Conclusions and Relevance  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.

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Article Information

Corresponding Author: David A. Mankoff, MD, PhD, Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce St, Philadelphia, PA 19104 (david.mankoff@uphs.upenn.edu).

Accepted for Publication: September 17, 2016.

Published Online: December 29, 2016. doi:10.1001/jamaoncol.2016.5084

Author Contributions: Dr Mankoff had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: All authors.

Acquisition, analysis, or interpretation of data: Mankoff.

Drafting of the manuscript: Mankoff.

Critical revision of the manuscript for important intellectual content: All authors.

Obtained funding: Mankoff.

Administrative, technical, or material support: Mankoff, Clark.

Conflict of Interest Disclosures: None reported.

Funding/Support: Manuscript writing was supported in part by grant SAC140060 from the Susan G. Komen Foundation, grant DE-SC0012476 from the Department of Energy, funding from the University of Pennsylvania Health System Breast Cancer Translational Center of Excellence, and Cancer Center Support grant P30CA016520 from the National Institutes of Health.

Role of the Funder/Sponsor: The support provided relevant research funding for the authors but did not have any influence on the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

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