Abstract IA004: Molecular imaging and multi-cancer detection for precision medicine
Authors: Ferrara Katherine 
Published: January 2023

Abstract
This presentation will start with a tribute to Sanjiv Sam Gambhir. Sam is recognized as a founding father of molecular imaging and created the Molecular Imaging Program at Stanford. Molecular imaging is an interdisciplinary biomedical imaging subfield that focuses on mapping biological molecules and processes of clinical interest within living subjects. Sam also had a vision for precision health, asking us to “think about how to either prevent cancer or detect cancer very early when we have the best chance of making a difference.” He was convinced that a revolution in precision health was coming, and may have arrived, and inspired us all with his vision. Our program continues to build upon this vision. Within our molecular imaging program, 34 radiopharmaceutical INDs are in place with human studies underway spanning tumor targeting, immune cell imaging, metabolic imaging, and imaging of gene expression, among other areas. The growth of liquid biopsy techniques in cancer screening opens new opportunities to develop the molecular imaging field to provide the means to map and assess early disease. Concurrently, the field of theragnostics, radio-theragnostics in particular, is rapidly growing. Theragnostics is a unique treatment regimen in that the spatial distribution of the target protein is first imaged in each patient and, when appropriate, the targeted therapeutic isotope is injected and tracked with imaging. The needs of both early detection and theragnostics center around the selection of targets that are present in disease but not found in normal tissue. As with disease detection through blood markers, pan-cancer targets are of particular interest for molecular imaging. 18F-FDG has been widely applied to detect disease and characterize tissue metabolic activity; however, it is limited by lack of cellular specificity. Fibroblast activation protein, extracellular matrix proteins, glycolytic enzymes and immune cell markers are among the many features that can also be mapped with imaging. In particular, imaging of activated fibroblasts and CD8+ T cells are under evaluation as complementary or alternative molecular imaging approaches. Further, the emergence of spatial transcriptomics and highly multiplexed immunohistochemical methods are opening possibilities to identify targets from fine needle aspirates and core biopsies that are obtained under imaging guidance. In order to enhance the utility of imaging with positron emission tomography (PET) and computed tomography (CT), efforts are underway to reduce the radioactivity associated with these imaging studies by extending the field of view of the PET scanner, increasing CT sensitivity and efficiently using the CT x-ray spectrum via photon-counting detectors, or pairing PET with MRI. Finally, multiplexed PET imaging is technically feasible. Together, these developments are advancing molecular imaging for early multi-cancer detection and characterization of disease.
Citation Format: Katherine Ferrara. Molecular imaging and multi-cancer detection for precision medicine. [abstract]. In: Proceedings of the AACR Special Conference: Precision Prevention, Early Detection, and Interception of Cancer; 2022 Nov 17-19; Austin, TX. Philadelphia (PA): AACR; Can Prev Res 2023;16(1 Suppl): Abstract nr IA004.