Therapeutic advances have improved the vital prognosis of patients with metastatic cancer. Nevertheless, in a majority of cases, the disease continues to progress. Others do not respond to treatment. Oligometastatic disease is characterized by an intermediate state between locoregional tumor and disseminated malignancy. To meet this new challenge and stop the pathology before it worsens, Gustave Roussy is launching the Loca-Mets programme, part of the Institute's 2020-2030 institutional strategic project. This world-first platform combines the best combinations of cutting-edge personalized treatments with collaboration between clinical and scientific disciplines.
Oligometastatic cancers are characterized by a limited number of secondary lesions and slow tumor growth. This represents a new challenge for oncologists, who aim to cure patients with a small number of metastases that can be treated locally. However, clinical selection of oligometastatic patients is not easy, and the pathology remains poorly understood and characterized, preventing clinical trials demonstrating an effect on overall survival.
Thanks to close collaboration between onco-radiotherapy and interventional oncology, a promising programme, Loca-Mets, has been launched at Gustave Roussy by Prof. Eric Deutsch and Dr. Frédéric Deschamps, medical researchers in radiotherapy and interventional radiology.
Optimizing care for patients with oligometastatic cancers
The aim is to create the world's first platform for collaboration between experts in minimally invasive radiotherapy and interventional radiology treatments.
It will be built on three pillars: optimizing oligometastatic patient care, clinical demonstration and research development.
The deployment of several tools will provide the best personalized treatment for patients with metastatic cancers.
To enhance the potential of current treatments (radiofrequency, cryotherapy or radiotherapy), Loca-Mets combines state-of-the-art high-tech equipment with human expertise, with the creation of a dedicated multidisciplinary consultation meeting (RCP). Its ambition is to guarantee the best local and precision treatments, thanks to the sharing of expertise and the establishment of personalized treatment plans tailored to the characteristics of metastases (number, size, location), possible side effects and expected efficacy.
Treatment with new technologies, supported by robotics and Artificial Intelligence
Loca-Mets aims to increase the precision of local treatments by relying on robotics- and artificial intelligence-assisted interventions. The programme is based above all on new-generation guided imaging machines and robotics, which will enable us to refine the degree of characterization of metastases and guarantee the safety of care.
Gustave Roussy plans to install Europe's first PET-lignac. This new equipment merges a PET-scan and a radiotherapy machine. The device also takes into account biological markers to learn more about tumor constitution through molecular imaging. It will offer patients with multiple metastases the possibility of having, in a single day, a diagnosis of the disease and its extension, as well as treatment as soon as the medical imaging examination has been carried out. An innovative and disruptive approach.
The acquisition of an MRI guidance system should ensure the safety of treatments in real time, thanks to more precise guidance of interventional radiology needles and stereotactic radiotherapy, and be very low-radiation, adaptable to new indications (including pediatrics and focused ultrasound).
A dedicated coordinated research programme
The creation of a dedicated RCP for oligometastatic diseases will enable data to be collected to build a database of all local metastasis treatments carried out at the Institute. Patient follow-up will help to assess prognostic criteria, toxicities and long-term tolerance, to understand the evolution of certain cancers and better characterize the heterogeneity of metastases.
The clinical research developed in Loca-Mets aims to improve the efficacy and tolerability of local treatments for oligometastatic diseases.
To be personalized, local treatments will be adapted to the patient's therapeutic, clinical and metastatic situation by integrating sequential biopsies of affected tissues, molecular imaging examinations and functional and radiomic analysis of the tumor (a useful method for obtaining predictive, diagnostic or therapeutic markers from a large number of biomarkers). Tumor organoids will enable in-depth analysis of the major responses of certain patients, and characterize them in order to better understand oligometastatic disease and combat it more effectively.
Major innovation in the near future
In the longer term, in 5 years' time, the programme aims to combine new drugs, particularly immunological ones, with local treatments. Its ambition is to offer each metastatic patient a functional imaging work-up, circulating DNA characterization (liquid biopsy), and then to isolate tumor antigens from a blood sample in order to produce a customized messenger RNA vaccine. Combining vaccination with local treatments (radiofrequency and/or radiotherapy) should boost inflammatory and immunological responses for greater treatment efficacy.
