"The problem is, anytime you have a human being in the equation, there's always a question of variability," he said. "What one observer calls aggressive, another may not."
Madabhushi noted that until less than a decade ago, oncologists would be cautious and prescribe both hormone therapy and chemotherapy because the severity was often hard to determine. In 2004, California-based Genomic Health introduced a test that examined gene expression. That test accurately pegged ER+ breast cancers that fell at the low and high ends of the severity scale. Women who scored low could be treated confidently with hormonal therapy alone and forgo chemotherapy.
While the test, known as Oncotype DX, became an important planning resource for oncologists and patients, it remains expensive upwards of $4,000. It also takes two weeks to produce results, which for severe cancers represents a loss of valuable treatment time.
"In 2007, an oncologist at The Cancer Institute of New Jersey, Shridar Ganesan, saw our work on prostate cancer imaging and asked if my lab could apply it to ER-positive breast cancers," said Madabhushi, who is also a member of The Cancer Institute of New Jersey. "So we applied these techniques and started to get very exciting results. We found that our image-based risk score, which we dubbed 'Ibris,' was in agreement with the Oncotype DX score almost 90 percent of the time."
Work funded by the NIH grant, made through the agency's National Institute for Biomedical Imaging and Bioengineering, will establish how well Ibris scores predict long-term patient outcomes. If successful, an Ibris test could deliver results to patients almost immediately and cut costs to patients and their insurers.
The benefits could be even more dramatic in developing countries, claims Madabhushi, where the Oncotype DX cost is prohibitive and sending samples to California can add weeks to the testing
|Contact: Carl Blesch|