Personalized oncology in interventional radiology

Abstract

As personalized medicine becomes more applicable to oncologic practice, image-guided biopsies will be integral for enabling predictive and pharmacodynamic molecular pathology. Interventional radiology has a key role in defining patient-specific management. Advances in diagnostic techniques, genomics, and proteomics enable a window into subcellular mechanisms driving hyperproliferation, metastatic capabilities, and tumor angiogenesis. A new era of personalized medicine has evolved whereby clinical decisions are adjusted according to a patient's molecular profile. Several mutations and key markers already have been introduced into standard oncologic practice. A broader understanding of personalized oncology will help interventionalists play a greater role in therapy selection and discovery.

Keywords: ALK; ATP; BCR-ABL; BRAF; CD-20; CML; CRC; EGFR; EML4; FDA; Food and Drug Administration; HCC; HER-2; KRAS; Kirsten rat sarcoma viral oncogene; NSCLC; PDGFR; SMKI; VEGF; VEGFR2; adenosine triphosphate; analplastic lymphoma factor; breakpoint cluster region/the Abelson tyrosine; c-KIT; chronic myelogenous leukemia; clusters of differentiation-20 (antigen of B-cells); colorectal carcinoma; echinoderm microtubule-associated protein-like 4; epidermal growth factor receptor; hepatocellular carcinoma; human epidermal growth factor receptor-2; mAb; mTOR; mammalian target of rapamycin; monoclonal antibody; non–small cell lung carcinoma; platelet-derived growth factor receptor; small molecule kinase inhibitor; tyrosine-protein kinase kit or mast/stem cell growth factor receptor; v-raf murine sarcoma viral oncogene; vascular endothelial growth factor; vascular endothelial growth factor receptor-2.

Figure 1

Targeting the hallmarks of cancer. Drugs that interfere with, or target, the hallmarks of cancer growth, progression, or resistance have been developed. (From Hanahan D, Weinberg RA. Hallmarks of cancer: the next generation. Cell 2011; 144:646–674. Copyright © 2011 Elsevier. Reprinted with permission from Elsevier.)

Figure 2

Signaling pathways of EGFR and interaction sites of various targeted therapies. (Reprinted with permission from Gazdar AF. Personalized medicine and inhibition of EGFR signaling in lung cancer. N Engl J Med 2009; 361:1018–1020. Copyright © 2011 Massachusetts Medical Society. Reprinted with permission from Massachusetts Medical Society.) (Available in color online at www.jvir.org.)

Figure 3

Molecular profiling lung cancer biopsy with potential outcomes and therapeutic regimens. (Available in color online at www.jvir.org.)

Figure 4

(a–d) Different types of tumor heterogeneity are illustrated using pancreatic tumor and its metastasis as an example. (a) Mutations during cell growth result in heterogeneity within tumor. (b) As metastases are derived from different clones of primary tumors, intermetastatic heterogeneity is observed. (c) As metastases grow, they derive various mutations resulting in intrametastatic heterogeneity. (d) Finally, differences between patients result in interpatient heterogeneity. (From Vogelstein B, Papadopoulos N, Velculescu VE, Zhou S, Diaz LA Jr, Kinzler KW. Cancer genome landscapes. Science 2013; 339:1546–1558. Copyright © 2013 The American Society for the Advancement of Science. Reprinted with permission from The American Society for the Advancement of Science.) (Available in color online at www.jvir.org.)