Saving breast cancer patients from ineffective treatment.

Chemotherapy before surgery (neoadjuvant chemotherapy) is used in patients with aggressive breast cancer to shrink the tumor and to prevent the chance of distant metastases. Unfortunately, the effect of neoadjuvant chemotherapy can only be assessed in a late phase of the therapy. Therefore, in case of an ineffective therapy, patients already suffered from the side effects of chemotherapy without any benefit. Currently, no good non-invasive method capable of assessing the efficacy of chemotherapy before the surgery is available. Although studies using Magnetic Resonance Imaging (MRI) detected changes in vascularity and cell density, no threshold value was established that could predict response to chemotherapy early after the start of treatment. The reason for this could be that parameters such as vascularity and cell density do not reflect tumor metabolism, which may be a better indicator of tumor aggressiveness and will be influenced by chemotherapy in an earlier stage than that changes in vascularity or cell density present.
Preclinical studies indicate that the phospholipid membrane metabolism –responsible for cell membrane synthesis- is changed in cancer. We have developed a unique setup, consisting of a high field MRI scanner (7 Tesla) and dedicated receiver coils, capable of assessing this aberrant metabolism in a non-invasive way directly in the patients by using 31P-Magnetic Resonance Spectroscopy (31P-MRS).

Purpose: To determine by 31P MRS early on in the course of neo-adjuvant chemotherapy whether or not a breast cancer patient responds to the chemotherapy. This enables the identification of patients that benefit from neo-adjuvant chemotherapy and prevent patients that do not respond to neo-adjuvant chemotherapy from having ineffective chemotherapy

In vivo 31P MRS at ultra high field before and after the first cycle of neoadjuvant chemotherapy can predict the response to neoadjuvant chemotherapy in breast cancer patients.

MRS/MRI:
before first cycle of NAC, 2 weeks after first cycle of NAC.
Pathological response:
after 6 cycles of NAC at surgery.

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