A study looking at new types of MRI scans to see how chemotherapy affects bowel cancer cells

Cancer type:

Bowel (colorectal) cancer

Colon cancer

Rectal cancer

Status:

Results

Phase:

Pilot

This study used 2 types of MRI scan to look at changes in the blood supply to cancer cells.

It was for people who had chemotherapy for bowel cancer that had spread (advanced bowel cancer).

Cancer Research UK supported this study.

This study was open for people to join between 2011 and 2013.

The trial team have submitted these results to be published in a journal.

More about this trial

Doctors can treat advanced bowel cancer with chemotherapy. They might also use targeted cancer drugs that block cancers growing new blood vessels. But these drugs don’t help everybody.

Researchers want to find out how to tell in advance whether a patient is likely to benefit from them.

Before looking at the effect of a combination of chemotherapy and a targeted drug, researchers wanted to learn more about the effect that chemotherapy alone had on cancer cells.

In this study, they used 2 types of MRI scan called dynamic contrast enhanced MRI (DCE MRI) and diffusion weighted imaging MRI (DWI MRI).

DWI MRI shows changes to cancer cells and DCE MRI can provide information about the blood supply to the cancer.

The researchers wanted to find out if any changes they saw on the scans related to how well people do after having chemotherapy.

They also took extra blood samples to see if proteins and cells in the blood (biomarkers Open a glossary item ) were linked to any changes they saw on the scans.

Summary of results

The study team found that chemotherapy does change what is seen on the MRI scan as well as the proteins and cells (biomarkers Open a glossary item

) in the blood.

About this study

20 people whose bowel cancer had spread to their liver joined this study. They were treated with the chemotherapy drugs oxaliplatin with 5FU or capecitabine.

They had DWI MRI scans and DCE MRI scans of their liver before starting chemotherapy treatment and during treatment. The study team used the scans to look at the:

structure of blood vessels surrounding the cancer
total size (volume) of cancer in the liver
numbers of cells in the cancer (cell density)

In the blood samples they looked at proteins (biomarkers) that would tell them:

if new blood vessels were growing
how many cells had undergone programmed death (apoptosis )

They also looked at the number of cancer cells that were in the blood. These are called circulating tumour cells (CTCs).

Results

Size (volume) of cancer

On day 2 of cycle 2 of treatment the size of the cancer had decreased for most of the people. And continued to decrease throughout treatment.

Blood vessels

When looking at the blood vessels the team looked at a measurement called Ktrans.

The day after the 1st chemotherapy treatment the scan showed that the Ktrans of:

5 people was considerably higher than before treatment
5 people was considerably lower than before treatment
10 people it didn’t change much

For everyone their Ktrans was higher on the day after their 2nd chemotherapy treatment (day 2 of cycle 2). And it remained high for everyone until the end of treatment (cycle 6).

The change in Ktrans was linked with the overall length of time people lived after treatment (overall survival).

The average overall survival was 10.1 months for those whose Ktrans was higher on day 2 of cycle 2 than before treatment. For those whose Ktrans had stayed the same their average overall survival was 22.1 months.

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Circulating tumour cells (CTCs)

The team found CTCs in all 20 people before treatment. The average number was 5.5 CTCs in 7.5mls of blood.

3 or more CTCs in 7.5mls of blood was considered to be high. 11 people were in this group.

The larger the size of the cancer the higher the number of CTCs in the blood before treatment.

After the 1st cycle of treatment the number of CTCs in the blood increased. This was linked to the increase in Ktrans.

Growth of new blood vessels

The team looked at several substances in the blood that showed if the cancer was growing new blood vessels.

They found that during chemotherapy the level of several substances that helped grow new blood vessels decreased. As the size of the cancer reduced so did the level of these substances. This suggests that chemotherapy does help reduce the number of new blood vessels the cancer can grow.

Programmed cell death (apoptosis)

The team used the distribution of water in the cancer (ADC) to look at programmed cell death.

They found that the average overall survival was lower for people whose cancer had an increase in the ADC on the 2nd day of cycle 2.

But because of the small numbers in the study they said it didn’t reach statistical significance Open a glossary item

The team suggested the increase in ADC might be a useful marker of whether treatment is working. But a larger study needs to be done to find this out.

Conclusion

The team concluded that changes caused by chemotherapy to the cancer does show up on the DCE MRI scan and DWI MRI scan. And that changes in the blood samples can be seen as well.

The link between an increase in the Ktrans on day 2 of cycle 2 and a shorter overall survival might be useful as a biomarker to show if treatment is working.

The findings in this study should be considered when looking at the results of biomarker studies of new anti-cancer treatments.

Where this information comes from

We have based this summary on information from the research team. The information they sent us has been reviewed by independent specialists (peer reviewed Open a glossary item

) but may not have been published in a medical journal. The figures we quote above were provided by the research team. We have not analysed the data ourselves.

Recruitment start:

01/10/2011

Recruitment end:

31/12/2013

How to join a clinical trial

Please note: In order to join a trial you will need to discuss it with your doctor, unless otherwise specified.

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Chief Investigator

Professor Gordon Jayson

Supported by

AstraZeneca
Cancer Research UK
Experimental Cancer Medicine Centre (ECMC)
National Institute for Health Research Cancer Research Network (NCRN)
The Christie NHS Foundation Trust

If you have questions about the trial please contact our cancer information nurses

Freephone 0808 800 4040

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