WCD2016 Special Feature: A novel, personalized way of looking at cancer treatment

Hybrid molecular imaging is opening new doors for cancer researchers and physicians

BY SYAMIL ZAHARI

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n conjunction with World Cancer Day 2016, AMOR Media visited Associate Professor Fathinul Fikri Ahmad Saad, director of Universiti Putra Malaysia’s Centre for Diagnostic Nuclear Imaging, to solicit his thoughts on hybrid imaging technology, on the role of cancer advocates and on developing a research culture.

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Q: What is hybrid imaging?

A: Oncologic imaging is a cancer-based imaging, which is looking at how the cancer can be diagnosed on imaging background, so that the biopsies and the clinical assessment of a patient can lead to final diagnosis.

Of course, imaging – we’re talking about the conventional imaging like CT scan and MRI – would help one way or another, but this particular oncology imaging looks at how cancer can be imaged on the molecular basis. So hybrid imaging, by combining two conventional methods such as PET-CT [Positron Emission Tomography in combination with Computed Tomography], can give us a better understanding of cancer.

For example, when we talk about the cancer, we can only know its size from CT – which is only structural imaging. Without the functional component, it would not be complete. We need both information – structural and functional – to understand the programming in cancer so that we can provide the appropriate treatment for patients.

The functional information can work in many ways. One of those is looking at the glucose metabolism required by the cancer, for instance. We label this group to the PET traces – an example is fluorine 18. So we now have fluorine 18 FDG as the glucose analog which becomes a radiopharmacy compound for this particular targeted image analysis of hybrid imaging.

The hybrid imaging technology, which puts structural and functional together, brings about a personalized medicine. Personalized medicine era is how we work out targeted treatments now. By looking at the hybrid imaging modality, we look into specific targeted treatment in the personalized medicine.

Q: How has hybrid imaging technology advanced and where is it going in the future?

A: Hybrid imaging technology started off very slow in Southeast Asia, but it has been normal common standard practice across the world as the first line investigation for cancer. In Southeast Asia, in particular Malaysia, we are starting to understand how hybrid imaging can actually benefit patients.

If you look at the statistics, if you look at the reports that most researchers across the world have already come up with, the hybrid imaging has actually changed management in 40% of the patients as compared to conventional imaging because of the assumptional information that we can derive.

I have published over 30 publications in this area and we’ve started to convince physicians and surgeons treating patients with cancers to utilise hybrid imaging in vast majority of patients in Malaysia. So I think hybrid imaging has started to grow better now in this part of the world.

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We [UPM] are the first academic centre in Malaysia has installed the PET-CT. There are 11 centres in Malaysia that have installed this PET-CT for molecular imaging modality: there are three of them in the northern state of Penang, six in Klang Valley, and in the southern parts there are two.

I think we have good distribution of the access of these fantastic imaging modalities for patients. However the perceptions by physicians, on how they are going to utilise it, is still at the infancy state. That’s where the researcher comes into the picture. So with more research, we will be able to convince physicians as we bring new ways in how people treat the cancers.

Q: How will this technology help researchers then?

A: Researchers will have to come to another level of looking at how cancer cells behave, and putting proof together in the functional and the structural coupling imaging – the hybrid molecular imaging.

We can now bring to researchers better insights of the cancer. This, of course, potentially brings a better management protocol or treatment to the patient and improves prognosis and life span of patients by having more innovation and exploration of new drugs.

Speaking of drugs, we are doing a lot of pre-clinical works by testing new drugs using hybrid imaging modalities. You can actually go far beyond what cancer is now. So it’s a lot of potential in the near future in hybrid molecular imaging.

Q: What are the current challenges of research work?

A: When we talk about research, we are talking about fundamental research. Without fundamental research, it will take years to yield the results which can be utilised and can be beneficial to patients but can actually come into problems with funding authorities.

Funding for research is very limited because the commercialization of product is the one of the main aim of the country. So we face this problem, unlike in the Western countries where fundamental research is given priority and given concerns for people in oncology and in cancers.

We are working towards actually having the insurance, the medical and government authority to actually subsidise funding. Most research is on the fundamental, but what we have now is all the research are in applied medicine. Applied medicine means that something has been innovated before – we are just giving a new breath to that particular technology to find better answers. But there is no new way of doing it unless with fundamental research.

Fundamental research is needed so that we can actually optimize the answers especially in looking at new types of drugs to target rather than merely doing chemotherapy, for example. In cancer, we can reduce the toxicities of the drug so physicians can look at targeted treatments, which will be less toxic and can actually extend the lifespan of their patients.

In other words, it’s a better prognosis looking at fundamental research in patients in the long run. These are the challenges, due to the perceptions in the developing countries, because of the shortage of fund, and all that.

Q: How can cancer advocates and organizations help researchers do a better job in developing research? How can cancer researchers reach out into a wider audience?

A: I think what cancer organizations can do is become strongholds in patient welfare and then convince higher authorities to look into opportunities and into problems that researchers have.

Currently there’s so much gap in academics and economics. The NGOs and all these bodies must step up to the government and in fact become one of the important elements to the government: advisory.

In Australia, for example, every year before the government’s budget announcement, they would have meetings with all the NGOs. The ministers and specific government policymakers would listen to the challenges researchers have. And these cancer advocates will also try to persuade the government to come up with a very good fund for the researchers.

I think the problem that most of the researchers in oncology is that, in our Malaysian peer groups, the perceptions have yet to come to the research culture.

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The research culture, the pivotal point where a nation is inclined into researching new innovations, is yet to come up to par in this country. We don’t have the right research culture to actually be motivated and to easily share everything that we’ve come up with. Even if it is shared, it will not be utilised or accepted as it is.

We need the authorities to come in, to intervene. There is a very wide gap of understanding between the authority and the researchers. When we have a research culture, we all would be talking on the same level, so the nation would progress very rapidly and research would actually come to a standard of practise.

We are actually polishing up new breeds of researchers, and maybe then we can have a better perception and better understanding, to easily be accepted and be commercialised. By filling the gap between what we have found on the research and what can we commercialise, the standard of the practise can actually lead to the commercialisation very fast. Then the perceptions – of the user or the community or the client – will be easier. This is when it becomes a research culture.

When everyone has the right research culture, then the spread of research, in terms of networking and in terms of intervention from the government, would be much easier. We just need time to get the right research culture among all the researchers.

Associate Prof Dr Fathinul Fikri Ahmad Saad is also the organizing chairman of the International Translational Molecular Medicine Conference and Aero-Space Medicine and Physiology showcase (iCT-MIPs16), which aims to bring the most promising experimental therapies to the clinic after extensive testing in experimental, set to commence in Malaysia on April 15th-16th, 2016.

Registration fee for iCT-MIPs16, which is inclusive of a full two-day conference (two breakmeals and two lunch meals) and 6% GST, can reach upwards to USD450 (RM1,850) for non-members. AN OFFER OF USD200 FEE IS CURRENTLY BEING OFFERED FOR INTERESTED ATTENDEES REGISTERING WITH CODE ‘PISCOMED’.

The iCT-MIPs16 will be held at the upscale Sama-Sama Hotel near Kuala Lumpur International Airport in Sepang, Malaysia, and is organized in collaboration with Malaysian Palm Oil Board (MPOB), Ministry of Science Technology and Innovation (MOSTI) and Research Institute of Aviation (ANGKASA), with Siemens Healthcare Malaysia as the event’s main sponsor. Registration remains open until 15 March 2016. Visit http://www.ictmips16.comfor more information.

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