What if the scan itself, combined with the right treatments, could be the key to transforming the treatment for metastatic breast cancer?

When people hear about breakthroughs in cancer treatment, they often think of drugs that target the cancer almost instantly, with “before” and “after” scans showing how one or several tumours have seemingly disappeared.
 
But what if the scan itself, combined with the right treatments, could be the key to transforming the treatment? This is just one of the questions that Dr Michael Kosmin’s RESPECT study at Paul Strickland Scanner Centre is trying to answer.
 
Dr Kosmin, whose role is co-funded by Paul Strickland Scanner Centre and the Breast Cancer Research Unit at Mount Vernon Cancer Centre, has been leading a research study that looks at how whole-body MRI scans can help patients with metastatic breast cancer which has spread to the bone.

 
Paul Strickland Scanner Centre is the global leader in whole body MRI scanning: Since 2008 we’ve helped patients with more than 6,000 whole body MRI scans, which is more than any other scanner centre in the world.
 
Currently, computed tomography (CT) scans are used to assess metastatic breast cancer, but researchers are trying to find out if whole-body MRI scans might be better at assessing how well treatments are working against disease in the bone. This is because CT scans have significant limitations in assessing how well treatments are working in the bone.
 
Dr Kosmin said: “At Paul Strickland Scanner Centre we have offered patients whole-body MRI as a matter of routine or standard care for some time, but we are the only cancer centre in the UK to do so. When using other imaging modalities such as CT, we are limited in how accurate we can be in assessing whether breast cancer that has spread to the bone is responding to treatment.” About two-thirds of patients with metastatic breast cancer eventually get metastasis to the bone, making this a major unmet need for this large patient group.
 
Accuracy and speed of identification of the effectiveness of anti-cancer treatments is important because it may allow for an earlier switch away from an ineffective treatment. Dr Kosmin said: “If a patient has been diagnosed with breast cancer that’s spread to the bone, we’d want to start treatment and see after a few months whether the treatment was working or not. The RESPECT study is designed to directly compare the information given by CT and whole-body MRI. Patients on the RESPECT study get both sets of scans (CT and MRI) every 12 weeks and we’re looking to see which of the two types of scans shows that their disease has progressed (or become worse) first, thereby allowing for an earlier change in treatment. When a treatment has stopped working, we want to identify this and change it as quickly as possible. The hypothesis of the RESPECT study is that whole-body MRI scans will show disease progression in the bone earlier than CT. We’re collecting the data necessary to show that MRI has these additional benefits.”
 
Thanks to patients who have volunteered to take part, the study is going very well. Dr Kosmin said: “We have 45 patients on the study - 42 recruited at Mount Vernon and three at the Royal Marsden Hospital, which is another site for the study. We have therefore already met our recruitment target for the RESPECT study.” Some patients who enrolled have completed their involvement, meaning their treatment has been changed as a result of the information obtained on one or both scans.
Dr Kosmin said: “We’ve got a substantial number of patients who are still on the study, meaning they’re still getting their scans every 3 months because their treatments are showing ongoing clinical benefit against their disease. As the patients reach the point where there’s evidence that their disease is worse, their treating oncologist will change their treatment and they come off the RESPECT study. We track patients on the study from the beginning of a single treatment to when it has to be changed.”
Dr Kosmin is focussing on the big picture. He said: “Ultimately we want to know what the impact on patients’ quality of life is and whether whole-body MRI scanning could extend their life. Our long- term goal will be to try to provide some very robust information and evidence so we can say not only whether whole-body MRI scanning picks up problems earlier than CT, but that by picking up these problems earlier and allowing an earlier change in treatment, this can result in real benefits to breast cancer patients .”
 
The RESPECT study is on target to complete data collection by mid-2018 and the results of the study will be published soon afterwards.