Is it really molecular guided surgery (or just EPR effect)? Understanding and overcoming the effects of cancer physiology on tumor contrast (Conference Presentation)

Abstract

Molecular guided surgery—employing injectable fluorescent imaging agents targeted to cancer-specific biomolecules—is advancing rapidly. However, cancer physiology, specifically blood flow, vascular permeability, and lymphatic drainage can significantly influence and even dominate how imaging agents are taken up and retained in cancerous tissue. Moreover, each of these physiological parameters can vary extensively from tumor-type to tumor-type, from patient-to-patient, and even within an individual’s cancer, making it impossible to know if tumor contrast is achieved through molecular targeting or enhanced permeability and retention (EPR) effect. Alternatively, if there is no contrast, there is no guarantee that the tissue is non-cancerous, only that there was no accumulation of imaging agent, which could be attributable to low blood flow or vascular permeability. This talk will explore the potential effects of cancer physiology on imaging agent uptake and retention in cancerous tissue and discuss methods such as paired-agent imaging, which work to account for tumor physiology variability to achieve true molecular guided surgery.