Breast cancer – imaging, metabolism and novel therapeutic strategies.
For most breast cancer patients, prognosis is relatively good. In Norway, more than 75% of the women are still alive more than 15 years after the time point of diagnosis.
Nevertheless, there are still several challenges that need to be solved. Some patients have advanced disease, whereas others have particularly aggressive subtypes of breast cancer.
The objective of the MR Cancer Group is to introduce advanced magnetic resonance imaging (MRI) methods into clinical practice, thereby improving diagnostic accuracy. In addition, we aim to provide a better understanding of breast cancer metabolism (which can be studied using MR spectroscopy) in order to improve risk evaluation and identify novel therapeutic strategies.
In 2012, the MR Cancer Group was awarded NOK 8.7 mill from the Norwegian Research Council, funding the translational project “Imaging the Breast Cancer Metabolome”. Here, we want to develop and implement functional and molecular MR technology to establish prognostic and predictive biomarkers for personalised diagnosis and tailored therapy in breast cancer.
The project is divided into the following three sub-packages:
Clinical imaging in breast cancer:
Multimodal MRI is a sensitive and specific method for detection of breast tumours. However, novel methods are needed to extract molecular and functional information for better description of potential risk factors. We have therefore put a significant effort into implementation of advanced diffusion-based imaging (DWI MRI) protocols and development of sophisticated statistical methods for image analysis. DWI provides information about cellularity and cell membrane architecture of the tissue, by measuring random (Brownian) motion of water molecules. An advantage is that DWI does not require the use of administered contrast medium. Furthermore, DWI can be extended to capture directionality of the diffusion through diffusion tensor imaging (DTI). This technique, commonly used within neuroimaging, is now gaining interest within breast MRI due to the complex tissue structure of the breast. This research may prove particularly valuable for real-time evaluation of neoadjuvant treatment.
Imaging and targeting metabolic pathways:
Here, we want to verify that targeting of phospholipid metabolism is a possible approach for personalised breast cancer treatment. Our long-term commitment to studies of breast cancer metabolism has helped us realise that different subtypes of breast cancer have different metabolic characteristics. Therefore, we aim to evaluate the efficacy of drugs targeting phospholipid metabolism in patient-derived disease models. Furthermore, we have developed MR technology that allows us to image metabolic characteristics in vivo. This represents a potential tool both for risk stratification and real-time therapy monitoring.
Molecular profiling for improved risk stratification:
The main aim of this sub-project is to combine metabolic data with several layers of molecular data, thereby providing more detailed prognostic and predictive information. In pilot studies, we have shown how different metabolic fingerprints are associated with survival. In a collaboration with several research groups at the University of Oslo and Oslo University hospital (OUS), we will process biopsies from more than 1000 women in order to validate these findings and hopefully discover new patterns that can guide clinical decision-making.