> Our Work > The Work We Fund

2023 National Cancer Institute – PCF Young Investigator Award

Artificial Intelligence-Based Lesion Kinetics Assessment for the Selection of Therapeutic Targets for Focal SBRT in Patients with Oligoprogressive Metastatic Castration Resistant (mCRPC) and Biochemically Recurrent (BCR) Prostate Cancer

Krishnan Patel, MD
National Cancer Institute (NCI)

Mentors: Ravi Madan, Deborah Citrin

Description:

  • Advances in molecular imaging and radiotherapy have enabled the development of metastasis-directed radiation therapy techniques. Clinical trials have demonstrated that metastasis-directed radiation therapy can improve progression-free survival times in patients with “oligometastatic” (up to 5 metastases) prostate cancer.
  • However, studies are needed to understand whether metastasis-directed radiation therapy would benefit any patients with more advanced or wide-spread metastatic disease, and how many/which tumors would need to be radiated in these patients for benefit.
  • Krishnan Patel is studying whether patients with an oligo-progressive phenotype (in which the minority of lesions drive progression) would benefit from metastasis-directed radiation therapy to “active” lesions alone.
  • Patel and team are conducting a phase 2 clinical trial testing a whether an AI-based strategy can identify progressing lesions from PET scans, and if targeting metastasis-directed radiation therapy to only these lesions can prolong progression-free survival in patients with metastatic castration-resistant prostate cancer (mCRPC) on first-line therapy.
  • Whether immune cell-based blood biomarkers can predict which patients will benefit from this approach will be investigated.
  • The team will also analyze data from an ongoing trial to determine whether a subset of patients experiencing a biochemical recurrence (rising PSA after initial therapy) may benefit from the same AI-based target selection strategy.
  • If successful, this project will develop a new AI-based approach to optimize the use of metastasis-directed radiation therapy in patients with biochemical recurrence and mCRPC. This may serve to reduce the toxicity from metastasis-directed radiation therapy by limiting the total treatment volume, as well as allow patients with biochemical recurrence to avoid initiating ADT or delay the need for further lines of therapy in patients with mCRPC.

What this means to patients: Metastasis-directed radiation therapy is a treatment strategy that can delay disease progression in patients with a small number of metastatic tumors, but how to apply it in patients with more widespread disease is unknown. Dr. Krishnan Patel is developing an AI-based approach to identify active tumor lesions and determine whether radiation to only active lesions can prolong disease progression in patients with more advanced prostate cancer. This project will define a means by which to rationally and appropriately select lesions to treat with metastasis-directed radiation therapy, that will delay disease progression in patients with advanced prostate cancer who largely have stable disease on systemic therapy.