Revolutionizing Radiotherapy: A Personalized Approach

A groundbreaking European research initiative, hi-Roc (Targeting Hypoxia wiht Heavy ions to Gain Control of Radioresistant Cancers), aims to transform cancer treatment by predicting individual patient responses to radiotherapy. The core objective is to decipher a tumor’s unique “signature” to determine whether conventional radiotherapy will be effective or if alternative treatments, such as adrotherapy with carbon ions, are more suitable. This personalized approach, spearheaded by the National Center of Oncological Adrotherapy (CNAO) in Pavia, Italy, seeks to overcome the limitations of current protocols that primarily rely on tumor stage and histological type, rather than individual biological characteristics.

Unlocking the Secrets of Hypoxia: The Key to Radioresistance

Hypoxia, or oxygen deficiency within neoplastic cells and the tumor microenvironment, plays a crucial role in cancer’s resistance to conventional radiotherapy.While hypoxia diminishes the effectiveness of customary photon-based radiotherapy, it has less impact on heavy particle therapies like carbon ion adrotherapy. The hi-Roc project focuses on identifying a comprehensive biomarker for hypoxia to guide treatment decisions.

Ester orlandi, CNAO clinical department manager, researcher at the University of Pavia, and project coordinator, explains the project’s focus:

Our investigation will focus on identifying a global hypoxia biomarker, or the lack of oxygen in neoplastic cells and in the tumor micro-environment.

Currently, treatment selection lacks the precision needed to address individual patient needs.The absence of a reliable, non-invasive hypoxia biomarker hinders the ability to tailor therapy effectively. Hi-Roc aims to define a multi-faceted “signature” that accurately reflects a tumor’s hypoxic state in each patient.

The Hi-Roc study: A Multi-Institutional Collaboration

The hi-Roc study is a collaborative effort involving several prestigious institutions, including the national Cancer Institute, Polytechnic of Milan, Heidelberg University Hospital Heidelberger Ionenstrahl-Therapiezentrum, neolys, Luxembourg Institute of Health, and Maastricht University. This project is supported by the European Partnership for Personalized Medicine (EP PerMed) and receives funding from the Regional Foundation for Biomedical Research (FRRB) in Italy, with a contribution of nearly 500,000 euros.

Hyperion Pilot Study: Testing the Hypoxia Signature

The research methodology involves analyzing clinical, biological, and radiological data from approximately 200 patients previously treated with conventional radiotherapy. By examining imaging data and biological samples, researchers aim to identify parameters that contribute to the hypoxia signature. Patients will be categorized based on their treatment outcomes and the quantified hypoxia signature.

Orlandi further elaborates on the hyperion pilot study:

A part of the project will analyze clinical, biological and radiological data of about 200 patients already treated with conventional radiotherapy… Than, in the Hyperion pilot studio, the Multimodale signature will be tested in association with a signature of radiological hypoxia recently identified and, on the basis of it, the patients will be treated with conventional radiotherapy or with a treatment that includes carbon ions. This study can represent a first step towards personalized and precision radiotherapy.

The multimodal signature will be tested alongside a recently identified radiological hypoxia signature. Based on these signatures, patients will receive either conventional radiotherapy or a treatment regimen incorporating carbon ions.This study represents a important stride towards personalized and precision radiotherapy, potentially improving treatment outcomes and reducing needless exposure to ineffective therapies.

The Promise of Adrotherapy with Carbon Ions

Adrotherapy, particularly with carbon ions, offers a promising alternative for patients with radioresistant tumors. Unlike conventional radiotherapy, carbon ion therapy is less affected by hypoxia, making it a potentially more effective treatment option for tumors with significant oxygen deficiencies. This research could lead to wider adoption of adrotherapy for suitable patients, improving overall survival rates and quality of life.

According to recent studies, carbon ion therapy has shown promising results in treating various types of cancer, including prostate cancer, bone and soft tissue sarcomas, and head and neck cancers. For example,a study published in The Lancet Oncology demonstrated that carbon ion therapy resulted in considerably higher local control rates compared to conventional radiotherapy in patients with chordoma and chondrosarcoma of the skull base.