Noninvasive MRI Technique Accurately Predicts Mutations in Human Brain Tumors

Investigators were able to accurately predict the specific genetic mutation that caused brain cancer in a group of patients studied utilizing magnetic resonance imaging (MRI).

"The field of cancer research has evolved to the point where the identification of the mutations that cause tumors has changed how we treat patients in a number of cancers,” said Donald O'Rourke, M.D., associate professor of neurosurgery at the University of Pennsylvania School of Medicine (Penn; Philadelphia, USA). "Potentially, we believe we have a method that uses MRI to identify a tumor mutation. Historically, tumor mutations have been identified in only one way: take the tissue out and examine it using one of two laboratory tests to see if the mutation is present. In this study we've done this identification noninvasively. To my knowledge this is the first demonstration that an MRI, or any imaging technique, can accurately predict the type of mutation of a human tumor.”

A particular MRI technique, called relative cerebral blood volume, measures blood flow to the tumor, which very highly correlates with the presence of an important mutation in glioblastoma, a type of brain cancer. The mutation occurs in the epidermal growth factor receptor (EGFR), a well known cancer-related protein that helps tumors form their necessary blood vessels. EGFRvIII, the specific mutation the Penn group studied, is the hallmark of a more aggressive form of glioblastoma.

The researchers compared MRI readings to tumor tissue samples from 97 glioblastoma patients. They discovered that patients with higher relative cerebral blood volume as measured by MRI correlates with the EGFRvIII mutation compared to those who did not have the mutation.

Glioblastoma is a variable disease, and clinicians need help to distinguish one form from another. "All of cancer research is evolving to a point where mutations can facilitate care, so a more accurate diagnosis and treatment course can be better planned by identifying the mutational status of the tumor,” remarked Dr. O'Rourke.

EGFRvIII is an area of intense interest in the field of cancer, because it is linked to more aggressive cancers. Having a noninvasive way to identity patients with the EGFRvIII mutation could allow physicians to enroll these patients into trials using drugs that specifically target this mutation. Penn is part of a multicenter trial that is doing just that.

Another implication of having a noninvasive method to track a specific patient group is for following treatment response. "Currently we identify a tumor mutation by removing a tumor, and then we select a particular treatment and evaluate the response with an MRI to see if the tumor is stable or smaller,” explained O'Rourke. "With this new method we'll be able to show whether a surrogate of the mutation is changing. EGFRvIII correlates with the elevated blood flow to the tumor and if we put a patient on an effective anti-tumor strategy, that blood flow should reduce. We'd be getting a more biological readout to therapy.”

Ongoing research is focusing on utilizing advanced MRI to characterize additional mutations in glioblastoma tumors. The researchers presented their findings the week of April 20, 2009, at the American Association for Cancer Research (AACR) 100th annual meeting.

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