Precise imaging for precision medicine

In Roche pRED, our scientists are working at the cutting edge of imaging science, with one objective in mind: to develop and deploy new tools to “see” the effects of new drugs in patients

Cancer is a complex disease that begins when abnormal cells in any part of the body start to grow out of control, forming tumors that behave almost like new organs with their own immune cells and blood vessels. While growing, tumors can in addition make themselves “invisible” to the body by suppressing immune responses that would have been directed against them.

However, they can’t hide from the scientists at Roche, who are able to visualize tumors with cutting-edge imaging technologies – both in radiology and molecular pathology. The researchers are developing ways to visualize tumors in action at the level of the whole body right down to that of individual cells.

Globally, the Roche Group develops diagnostic technologies to find and characterize cancers while it simultaneously develops targeted therapeutics to treat them. This combination of diagnostics and pharmaceutical research allows Roche to take a unique, comprehensive approach to personalised healthcare (PHC, also known as precision medicine).

What you can’t see can hurt you

In many cancers and other serious illnesses, signs and symptoms of the disease often do not become apparent until the illness reaches an advanced and more difficult stage. For centuries, doctors and patients alike were completely unable to do anything about this. This changed dramatically, however, with the advent of medical imaging, starting with the discovery of X-rays in 1895. Wilhelm Röntgen’s grainy image of his wife’s hand launched a revolution in the way diseases were diagnosed and treatments evaluated. Imaging’s medical value has grown in importance ever since with advances in technology like computed tomography (CT), ultrasound, magnetic resonance imaging (MRI) and positron emission tomography (PET).

In Roche pRED, our scientists are working at the cutting edge of imaging science, with one objective in mind: to develop and deploy new tools to “see” the effect of new drugs in patients. The data gathered could inform drug development decisions and treatment options for patients, ultimately leading to improved outcomes.

In early clinical trials, imaging evaluation is often the main endpoint to assess drug efficacy, making it critical for identifying patients who do or do not respond to treatment. Based on radiological imaging evidence, patients may continue on a treatment.  Alternatively, they can be withdrawn from clinical studies and offered alternative therapies to avoid giving them ineffective therapy and exposing them to possible treatment-related adverse events.

Today, Roche pRED is additionally using imaging to assess how much drug is reaching the tumor compared to other tissues, making it possible to evaluate its potential at a very early stage. This is done by tagging a drug with a tracer and performing an imaging scan to “see” where the drug goes once administered to the patient. This allows researchers to explore how the route (intravenous, subcutaneous or other forms), frequency and dosing of the drug can be adjusted to optimize delivery and effectiveness.

With the advent of immunotherapy – which aims to develop an immune response against cancer – it is vitally important to adapt and develop tools to evaluate drug response. Imaging scientists at Roche pRED are working in collaboration with Roche Diagnostics and academic groups to develop innovative new ways of assessing the efficacy of this new class of treatments. Being able to visualize the activation and proliferation of immune cells induced by anti-cancer drugs will provide an even more complete picture of how immunotherapies can benefit patients.

Our imaging technologies allow Roche to define the right drug, at the right dose, schedule and time for the patient – ultimately providing personalized, precision medicine at its best

Looking inside tumors to see their weaknesses

Going a step further, recent advances in molecular pathology technologies are enabling doctors to see inside tumors, showing how cancer cells and various immune cells are organized and impact disease progression. Today, it is now possible to visualize the organization of cancer cells inside tumors, and even the presence and distribution of specific molecules within those cells. This allows researchers to identify specific drug targets and characterize the effect of new therapies on cancer cells.

To this aim, small samples of tumors are taken (biopsies) and analyzed under dedicated microscopes. New technologies developed in collaboration between Roche Diagnostics and Roche Pharma enable researchers to tag several different cell types with colored dyes and then to identify the “good” and “bad” cells within the biopsy.

Images from a biopsy showing the density of specific immune cells in a tumor sample

These dedicated microscopes generate very complex images. Until recently, only highly trained specialists were able to analyze and interpret them, but recent advances are opening a new era in medicine. Roche researchers from pRED and Roche Tissue Diagnostics have created a specialized software suite to manage, analyze and understand these images. Today, Roche pRED scientists can decipher these complex pictures with image recognition software piloted by medical pathologists. For example, they can now clearly identify when immune cells enter a tumor.

From the macro- to the micro-scopic

When combined, images of the whole body together with detailed microscopic analysis of the tumor provide Roche pRED physicians and scientists with a comprehensive picture of disease states and underlying mechanisms. Overall, this helps build our understanding of the biology of cancer, confirming how new drugs work and how they could be combined to fight cancer. This is particularly important in cancer immunotherapies, where researchers try to train a patient’s own immune system to eliminate tumors.

Imaging scientists and pathologists in pRED work in tandem to contribute to an improved understanding of cancer, benefiting patients and the scientific community by constantly exchanging data. These technologies allow Roche to define the right drug, at the right dose, schedule and time for the patient – ultimately providing personalized, precision medicine at its best.

Tags: Science