Precision Imaging for Early Detection and Targeted Treatment Monitoring in Pancreatic Cancer

Overview

Specifically, in this project, the objective will be developped a model to capture imaging-based tumor heterogeneity with multiscale radiomics approach by obtaining the mirror tumor image at in vivo MRI, ex vivo MRI at histology. This imaging model giving a perfect virtual histology tumor representation will be secondary implemented on routine in vivo clinical MRI for early cancer detection and treatment monitoring. Successful completion of this proposal will lead to a comprehensive non invasive characterisation of pancreatic cancer and will be a game changer in patient management.

Detailed description

With a five-year survival rate of only 3% for the majority of patients, pancreatic cancer is a global healthcare challenge. By the time of diagnosis over half of pancreatic cancers are metastasized. The dire disease situation reflects our inability to diagnose pancreatic cancer early and to effectively treat it. Our failure to diagnose the disease early results in part from the inaccessibility of the organ, difficulties in detecting small pancreatic lesions by conventional imaging approaches, and a poor understanding of the spectrum of heterogeneity in pancreatic cancer. Single time point, single site biopsies cannot assess entire tumor while multiple biopsies at several time points are not feasible in clinical routine. Limitations of invasive sampling may be addressed with non-invasive imaging that captures morphologic and functional information about the entire tumor in space and, if repeated, in time. Radiomics has the potential for "whole tumour virtual sampling" using a single or serial non-invasive examinations in place of biopsies. By approaching images as data able to be mined, instead of merely pictures in conventional radiology, quantitative imaging allows for further information to be extracted from medical images as well as for global assessments across large patient populations. Therefore, these new quantitative approaches hold the promise of detecting pancreatic cancer characteristics that the naked eye alone cannot perceive from conventional medical imaging, opening new doors for personalized medicine in pancreatic cancer. To date, no study has evaluated the value of radiomics at macroscopic (in vivo 1.5T/3TMRI) and microscopic (ex vivo 9.4TMRI) scale for early cancer detection and targeted treatment monitoring. Specifically, in this project, the objective will be developpe a model to capture imaging-based tumor heterogeneity with multiscale radiomics approach by obtaining the mirror tumor image at in vivo MRI, ex vivo MRI at histology. This imaging model giving a perfect virtual histology tumor representation will be secondary implemented on routine in vivo clinical MRI for early cancer detection and treatment monitoring. Successful completion of this proposal will lead to a comprehensive non invasive characterisation of pancreatic cancer and will be a game changer in patient management.

Interventions

• Biological Biological/Vaccine: Blood sample and tissue sample
  During the surgery : Tissus sample : primary tumor and metastasis blood sample : 3 EDTA tubes ex vivo MRI data

Primary outcome measures

• the integration of in vivo and ex vivo MRI with histology and molecular caracteristic in order to increase the pancreatic cancer detection and therapeutic response monitoring [Time frame: The day of the surgery]

Secondary outcome measures (4)

• the imaging phenotype of tumor heterogeneity with a multi-scale radiomic approach by obtaining the image mirror tumor at the in vivo scale [Time frame: The day of the surgery]
• tumor heterogeneity in artificial intelligence-based imaging reflects and can predict underlying histology (proportion of tumor stroma and density of tumor-infiltrating lymphocytes) (tumor detection and response) and genomics, [Time frame: The day of the surgery]
• the heterogeneity of tumor biology via non-invasive imaging of different portions of the tumor, [Time frame: The day of the surgery]
• Correlate MRI results with hematological molecular biology results. [Time frame: The day of the surgery]

Eligibility criteria

Inclusion criteria

• Patient aged >18 2.
• Pathologically proven pancreatic cancer which can beneficiate of upfront surgery or delayed surgery followed by neoadjuvant chemotherapy.
• Negative pregnancy test for women of childbearing potential
• Patients affiliated to a social protection system
• Written informed consent signed before project onset.

Exclusion criteria

• presence of metastases,
• Patient who will not have surgery
• Pregnant or breastfeeding women
• Mental or psychological state, physical or legal incapacity preventing participation in the project.

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

N/A

Model

Single group

Masking

Open label

Primary purpose

Other

Study locations

France · 1 center

• NOUGARET Stephanie — Montpellier

Publications

• Nougaret S, Lakhman Y, Gourgou S, Kubik-Huch R, Derchi L, Sala E, Forstner R; European Society of Radiology (ESR) and the European Society of Urogenital Radiology (ESUR). MRI in female pelvis: an ESUR/ESR survey. Insights Imaging. 2022 Mar 28;13(1):60. doi: 10.1186/s13244-021-01152-w. PMID 35347481
• Soyer P, Revel MP, Dohan A, Vernhet-Kovacsik H, Nougaret S, Hoeffel C. Gender diversity in authorship in Diagnostic & Interventional Imaging: Where are we now? Diagn Interv Imaging. 2022 May;103(5):237-239. doi: 10.1016/j.diii.2022.02.001. Epub 2022 Feb 17. No abstract available. PMID 35183485
• Tardieu M, Lakhman Y, Khellaf L, Cardoso M, Sgarbura O, Colombo PE, Crispin-Ortuzar M, Sala E, Goze-Bac C, Nougaret S. Assessing Histology Structures by Ex Vivo MR Microscopy and Exploring the Link Between MRM-Derived Radiomic Features and Histopathology in Ovarian Cancer. Front Oncol. 2022 Jan 19;11:771848. doi: 10.3389/fonc.2021.771848. eCollection 2021. PMID 35127479
• Sadowski EA, Thomassin-Naggara I, Rockall A, Maturen KE, Forstner R, Jha P, Nougaret S, Siegelman ES, Reinhold C. O-RADS MRI Risk Stratification System: Guide for Assessing Adnexal Lesions from the ACR O-RADS Committee. Radiology. 2022 Apr;303(1):35-47. doi: 10.1148/radiol.204371. Epub 2022 Jan 18. PMID 35040672
• Shinagare AB, Sadowski EA, Park H, Brook OR, Forstner R, Wallace SK, Horowitz JM, Horowitz N, Javitt M, Jha P, Kido A, Lakhman Y, Lee SI, Manganaro L, Maturen KE, Nougaret S, Poder L, Rauch GM, Reinhold C, Sala E, Thomassin-Naggara I, Vargas HA, Venkatesan A, Nikolic O, Rockall AG. Ovarian cancer reporting lexicon for computed tomography (CT) and magnetic resonance (MR) imaging developed by the SA PMID 34846566
• Tibermacine H, Rouanet P, Sbarra M, Forghani R, Reinhold C, Nougaret S; GRECCAR Study Group. Radiomics modelling in rectal cancer to predict disease-free survival: evaluation of different approaches. Br J Surg. 2021 Oct 23;108(10):1243-1250. doi: 10.1093/bjs/znab191. PMID 34423347
• Nougaret S, Vargas HA, Sala E. BJR female genitourinary oncology special feature: introductory editorial. Br J Radiol. 2021 Sep 1;94(1125):20219003. doi: 10.1259/bjr.20219003. No abstract available. PMID 34415200
• Rouanet P, Rullier E, Lelong B, Maingon P, Tuech JJ, Pezet D, Castan F, Nougaret S; GRECCAR Study Group*. Tailored Strategy for Locally Advanced Rectal Carcinoma (GRECCAR 4): Long-term Results From a Multicenter, Randomized, Open-Label, Phase II Trial. Dis Colon Rectum. 2022 Aug 1;65(8):986-995. doi: 10.1097/DCR.0000000000002153. Epub 2022 Jul 5. PMID 34759247

Identifiers

NCT: NCT06144762 · PROICM 2023-03 PAN

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗