Molecular Imaging as a Clinical Tool for Precision Oncology Interview with

David A Mankoff, MD, PhD

Dr. David Mankoff

David A Mankoff, MD, PhD
Gerd Muehllehner Professor of Radiology
Attending Physician
University of Pennsylvania Health System
PET Center Director
Vice-Chair of Research, Department of Radiology
University of Pennsylvania What is the background for this study? What are the main findings?

Response: This review was designed to describe the current status of molecular imaging, especially positron emission tomography (PET) as a clinical tool for helping to direct precision oncology.

We found that while there had been a number of promising methods tested in small, single research studies, the number of new molecular imaging tests translated to the clinic was small. In addition, the application of molecular methods as tools for therapeutic decision making (versus use for disease detections and staging) was even smaller. We noted that some recently published studies, including a few large multi-center trials, indicated the considerable potential of new molecular imaging tests to identify therapeutic targets for cancer treatment, to evaluate early response to targeted cancer therapy, and to predict downstream outcomes such as progression free survival. We made some observations and recommendations in the review for directing these potentially powerful imaging tools towards use as biomarkers for precision oncology. What should readers take away from this report?

Response: We suggested a number of approaches to accelerate the translation of clinically relevant molecular imaging methods to the clinic:

1. Focusing efforts on those molecular imaging methods for which clinical application is most compelling. One priority, for example, are those clinical scenarios where imaging can help direct the effective use of cancer drugs that are highly toxic and/or expensive. In such cases, the added expense and time of the imaging tests can be easily offset by limiting patient exposure to treatments unlikely to be effective.

2. Changing the way both oncologists and imagers think about molecular imaging. Oncologists should more broadly consider imaging biomarkers to help guide therapeutic decision making, and imagers need to interpret molecular imaging studies not only in light of cancer detection and staging, but as clinical tests carrying quantitative information to help guide treatment. Both groups must work together on prospective studies designed to validate new molecular imaging methods as markers for directing cancer treatment and support clinical use for this purpose.

3. The cancer community, including funding agencies and payers, need to support a framework for integrating appropriate molecular imaging tests in clinical practice that includes networks to support imaging biomarker clinical trials, better training in the use of molecular imaging as a cancer biomarker for both imagers and oncologists, and a system for reimbursement of new molecular imaging tests that recognizes proven patient impact and cost savings from imaging tests that guide patients to more effective treatments. What recommendations do you have for future research as a result of this study?

Response:  Decisions to translate new molecular imaging should consider the clinical use case as a key factor in deciding whether to take direct new methods to the clinic. As noted above, a collaborative framework is essential for translating new molecular imaging tests to the clinic and making them clinically useful procedures and not simply interesting research tools.

 No disclosures outside of those sited in the article.


Mankoff DA, Farwell MD, Clark AS, Pryma DA. Making Molecular Imaging a Clinical Tool for Precision OncologyA Review. JAMA Oncol. Published online December 29, 2016. doi:10.1001/jamaoncol.2016.5084

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on December 29, 2016 by Marie Benz MD FAAD