Inspired by sci-fi, radiologist forges new frontiers in cancer diagnostics

June 4, 2019 | by Maxine Nunes

Ammar Chaudhry Ammar Chaudhry, M.D.
When Ammar Chaudhry, M.D., was a child, his father had a conventional angiogram, a diagnostic procedure that was so invasive he never completely recovered from it. Not long after, his mother refused a biopsy because it could have left her permanently intubated. She died two years later. For Chaudhry, sci-fi was an escape — and an inspiration.
 
“It was the ’90s, and there was "Terminator 2" and "The Matrix," and when I saw all the amazing stuff they could do, I thought, ‘They can teleport people, and we can’t even find a way to accurately see inside the body,’” he said. “That’s kind of where my medical career started.”
 
Medical imaging has come a long way since then, but Chaudhry is still asking why we can’t do better — and doing something about it.
 
Now 34 and a radiologist with degrees in biology and physics, he is the founder and director of City of Hope’s new Precision Imaging Lab, has published hundreds of articles, abstracts and presentations, and recently won one of the first $1 million ORIEN NOVA awards.
 
He is currently working with some paradigm-shifting concepts that promise to transform the diagnosis and treatment of cancer patients.

THERANOSTICS

“I’m a physician first and then a radiologist,” he said, “so I don’t want to just diagnose, I want to be able to treat people, too.”
 
That’s what drew him to a new field called theranostics, which involves imaging and treating the patient at the same time.
 
Here’s an example of how it can work: 18Fluorine, 64Copper and other tracers with low radioactivity are currently used for imaging, but if you substitute a stronger isotope, such as 131Iodine, you can image and treat the tumors with targeted radiation at the same time.
 
In a variation of this concept, Chaudhry’s ORIEN NOVA study administers both targeted radiation and targeted immunotherapy — along with a new alternative to traditional biopsy.

VIRTUAL BIOPSY

Ever since his mother’s death, Chaudhry has understood the need to find noninvasive alternatives to biopsy. In addition to the risk she faced, there are many other instances where a biopsy is too dangerous to perform — in certain areas of the brain, for example, or tumors that are too close to a blood vessel.
 
Virtual biopsy also has another important benefit for the patient — it eliminates the long, stressful wait for results.
 
What’s more, the new targeted immunotherapies require a more precise tumor analysis than traditional treatments did — but different tumors in the same patient may have different markers, and it’s often impossible to biopsy them all. This is one of the major reasons immunotherapy fails, even when a biopsy indicates the patient is a good candidate for treatment.
 
Chaudhry’s ORIEN NOVA study addresses this unmet need for a more accurate, noninvasive technique — one that can provide real-time information of whole-body disease burden and its response to immunotherapy.
 
The patient is first given an infusion of 64Copper to detect the disease locations. A few hours later, a whole-body PET-CT scan is performed. Once positive disease is confirmed, the radioactive isotope lutetium combined with the targeted immunotherapy drug pembrolizumab (Keytruda) is administered.
 
When a tumor lights up, it means it is not only getting targeted radiation, it’s also responding to pembrolizumab. Tumors that don’t light up will need a different type of treatment.

ELIMINATING RADIOACTIVE TRACERS

While PET-CT scans are highly accurate and give immediate results, they do require the infusion of a radioactive tracer. Chaudhry is using his background in biophysics to develop an alternative — tracers made of magnetic nanoparticles, which become visible when their molecules are made to spin at a different speed from those in the rest of the body. These new tracers will be nontoxic and biodegradable, which will also overcome the limitations of some existing MRI contrast agents.

A WEARABLE WITH ARTIFICIAL INTELLIGENCE

Also in development is an app that can potentially save your life, using your medical history and artificial intelligence. 
 
“Let’s say you’re wearing the watch and an arrhythmia is detected,” Chaudhry explained. “The app will alert your physician or cardiologist, or if there’s none listed, prompt you to get immediate medical attention.”
 
Or if someone has just had surgery and gets a headache, the app will walk them through specific questions — "Are you bleeding? Do you have a spiking fever?" and so forth. Based on the answers, the app can give instructions that might range from “take two Tylenol” to “call an ambulance immediately and get to a hospital.”
 
“The aim of this is to help our patients at City of Hope feel connected to the system regardless of whether they reside a few blocks from Duarte or hundreds of miles away,” he said.
 
Chaudhry also drew on his early experiences to create a child-friendly function.
 
“Imagine a kid, and someone in his family has a heart attack or respiratory arrest or some other medical crisis,” he said. “It should be easy for an 8-year-old to push one button and make an automatic call to 911 — or even be guided through some immediate patient-care steps he can take.”
 
When will this new app be ready? He expects the first stage of development to be completed in a few months and ready for patient use before the end of 2019.
 
Chaudhry’s imaginative creativity combined with rock-solid science has led to some exciting breakthroughs, but he’s quick to remind us what has made it all possible.
 
“I feel I’ve been blessed with great mentors and leadership at City of Hope that has allowed me to have made so much progress,” he said. “I am emboldened to say we at City of Hope are driven to turn the medical evolution into a revolution. Our aim is to accelerate the pace of discovery and biomedical technology development to improve patient care and redefine standard of care. We are City of Hope after all. Patients come here not just for any answer or some hope; they come here for the right answer and the best kind of hope — hope to be healed and made whole again.”
 
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