MR spectroscopy facilitates, targets, tracks treatment in gliomas

Using a novel imaging method, a Massachusetts General Hospital (MGH) research team is investigating the mechanisms behind a potential targeted treatment for a subtype of the deadly brains tumors called gliomas. In their report published in Nature Communications, the researchers describe using magnetic resonance spectroscopy (MRS) imaging - which reflects metabolic rather than structural aspects of tissues - to determine whether treatment with an investigational IDH1 inhibitor reduced levels of a tumor-associated metabolite in patients with IDH1-mutated gliomas participating in a clinical trial.

"Gliomas are aggressive, primary brain tumors that lack effective treatments, and patients invariably succumb to the disease," says lead author Ovidiu Andronesi, MD, PhD, of the MGH-based Martinos Center for Biomedical Imaging, lead author of the paper. "There is a desperate need for progress in glioma treatment, and IDH mutations, which occur commonly in these tumors, offer a pathway for targeted therapy. With the new metabolic imaging method that we developed to probe treatment effects, we showed that a novel IDH1 inhibitor can quickly reduce levels of the oncometabolite 2HG in patients with this mutation. This type of methodology has the potential to accelerate clinical trials and translation of targeted therapies, such as mutant IDH inhibitors, and makes the concept of precision oncology feasible in glioma patients."

While patients with gliomas characterized by mutations in the isocitrate dehydrogenase (IDH) enzyme tend to live three to five times longer, with better response to chemo- and radiation therapy, than do patients whose tumors do not carry IDH mutations, the mutations themselves may initiate and drive the growth of the tumor. IDH mutant tumors produce elevated levels of 2-hydroxyglutarate (2HG), which is believed to contribute to tumor initiation by interfering with gene expression control. While it is unclear whether reducing 2HG level would reverse the process in patients, it could be used as a biomarker for diagnosis and monitoring of IDH mutant tumors.