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Molecular Imaging for Cancer Visualization
American College of Surgeons
Surgical Simulation Summit Chicago, IL
March 16-17, 2018
Michael Bouvet, MD Professor of Surgery
University of California San Diego San Diego VA Medical Center
MolecularImagingforCancerVisualization-Outline
• Preclinicalmousemodels• Optionsformolecularimagingoftumors• Currenttechnologyforfluorescenceguidedsurgerythatisavailableintheclinic
• Futuredirections
Primary Pancreatic Tumor
0
40
80
120
160
40 46 50 57 64
Spleen Metastasis
0
20
40
60
80
40 46 50 57 64
Bowel Metastasis
0
20
40
60
80
100
40 46 50 57 64
Omental Metastasis
0
20
40
60
80
100
40 46 50 57 64
- Bouvet M, Wang J, Nardin SR, Nassirpour R, Yang M, Baranov E, Jiang P, Moossa AR, Hoffman RM. Real-time optical imaging of primary tumor growth and multiple metastatic events in a pancreatic cancer orthotopic model. Cancer Research 62(5):1534-1540, 2002.
HumanizationofAnti-CEAAntibody(M5A)
Yazaki et al. PEDS 2004
CDR grafting onto Herceptin framework
Dr Paul Yazaki City of Hope,
Beckman Research Institute
PET Imaging Using 64Cu-M5A Anti-CEA mAb
55 yo M T3N1 rectal cancer with small lung mets and circulating CEA levels of 142. FDG-PET uptake in large primary tumor and peri-rectal nodes.
FOLFOX x 8 with reduction of primary, no change in lung mets (felt benign), and CEA normal.
Neoadjuvant chemo-radiotherapy: 54 Gy + capecitabine.
64Cu-M5A scan at 7 weeks post RT – primary and nodal uptake at 24 and 48 hours Surgical resection of primary planned
Cetuximab-IRDye800formultimodalityopticalimaging:Potentialforguidingsurgical
therapyandpathologicalanalysis
EbenRosenthal,MD
From: Bouvet M, Hoffman RM. Laparoscopic fluorescence imaging for identification and resection of pancreatic and hepatobiliary cancer. In: Kokudo N, Ishizawa T (eds.), Fluorescence Imaging: Treatment of Hepatobiliary and Pancreatic Diseases. Front Gastrointest Res. Basel, Karger, 2013, vol 31, pp. 92-99.
ParathyroidectomywithICG
• 17yofemale• Calcium11.9• PTH113• Kidneystones• Bonepain• Sestamibiscanandultrasoundwerenegative
ParathyroidectomywithICG
• 17yofemale• Calcium11.9• PTH113• Kidneystones• Bonepain• Sestamibiscanandultrasoundwerenegative
Conclusions
• Curativesurgeryisdependentonremovingallprimaryandmetastaticcancercells
• Techniquesinfluorescenceguidedsurgery(FGS)areemergingthatselectivelyilluminatecancercells
• FGSenhancestumordetection,surgicalnavigation,marginconfirmation,andinsomecasescanbecombinedwiththerapeutictechniquestoeliminatemicroscopicdisease
Acknowledgements • Bouvet lab
– John DeLong – Thinzar Helmi Lwin – Jeong Youp Park – Ho Kyoung Hwang – Siamak Amirfahkri
• Funding – NIH/NCI – American Cancer Society – VA Merit Review – Leo and Anne Albert Trust – Intuitive Surgical Research Grant
• City of Hope – John C. Williamson – Gagandeep “Gaugs” Singh – Paul Yazaki
• AntiCancer, Inc – Robert M Hoffman – Takashi Murakami – Yukihiko Hiroshima – Sang Nam Yoon
• University of Nebraska – Surinder Batra