Using advanced imaging to improve brain cancer treatment

Glioblastoma is one of the most treatment-resistant brain tumors, making it especially difficult to treat. Part of that resistance stems from its unique tumor microenvironment—the complex mix of cells and biological activity surrounding the tumor.

At the UCLA Health Jonsson Comprehensive Cancer Center, Benjamin Ellingson, Ph.D., and his team are developing advanced MRI and PET imaging techniques that allow clinicians and researchers to look beyond standard brain scans and study tumor biology and the tumor microenvironment in real time. Their work helps scientists track how tumors grow, respond to therapy and evolve over time, providing critical information to develop more personalized treatment strategies for patients with glioblastoma.

In addition to developing advanced imaging techniques, Dr. Ellingson, director of the UCLA Brain Tumor Imaging Laboratory and professor of radiological sciences at the David Geffen School of Medicine at UCLA, leads imaging efforts for major multicenter brain tumor clinical trials and works closely with researchers developing new therapies for glioblastoma.

In this interview, Dr. Ellingson discusses how advanced imaging is shaping the future of brain cancer care and why he remains optimistic about progress in the field.

What drew you to brain tumor imaging research?

I’m actually a biomedical engineer by training. I grew up in Wisconsin, and I was recruited to UCLA to help build the brain tumor imaging program here.

Originally, my background was more focused on neurotrauma—brain injury, spinal cord injury and neuroprosthetics. During my postdoctoral training, I started applying some of those imaging tools to brain cancer research, and that eventually became my focus. I really fell in love with the patients and the collaborative environment in cancer research. People are all working together toward solutions.

What kind of research is your lab working on right now?

Our lab works on everything from developing entirely new imaging techniques and biomarkers to helping run imaging for multicenter clinical trials.

We work very closely with drug development efforts. In the early stages, when researchers are testing whether a drug is hitting its target or changing tumor biology, we develop imaging tools to look at things like tumor vascularity, cellularity, metabolism and physiologic changes. We’re also involved in PET imaging to study how drugs distribute within tumors.

As treatments move into clinical trials, we use those imaging approaches to monitor how tumors respond over time. From a big-picture standpoint, we’re obviously looking to see tumors shrink. But beyond that, we’re also trying to better understand how these drugs work. Some therapies may not immediately shrink a tumor, but they may slow or stabilize its growth, and that can still be meaningful for patients.

Brain tumors are very different from many other cancers because you can’t repeatedly biopsy the brain the way you might with breast or lung cancer. Imaging becomes the primary way we understand what’s happening inside the tumor. Glioblastoma is especially complicated because different parts of the tumor can behave very differently. Imaging helps us capture that complexity.

Many people think of an MRI as simply a picture of the brain. How are the imaging techniques you’re developing different from standard scans?

We’ve developed a number of advanced imaging methods at UCLA that go far beyond standard MRI scans.

For example, we’ve created advanced perfusion imaging techniques that allow us to measure the size, shape and architecture of blood vessels within tumors, as well as how leaky those vessels are, all with a single contrast injection.

We’ve also developed metabolic imaging approaches that let us study the tumor microenvironment and biochemistry. We can evaluate whether a tumor is hypoxic, or low in oxygen, or acidic, which can influence how aggressive it is and how it responds to treatment.

One of the important things is that we’ve designed these techniques to fit into a clinical timeframe so they can realistically be integrated into patient care.

How can imaging help personalize treatment for patients with glioblastoma?

One of the biggest ways imaging helps is by giving us early insight into what’s happening inside the tumor before we see major physical changes or changes in a patient’s symptoms.

Instead of simply waiting to see whether a tumor shrinks, we can evaluate whether a treatment is slowing tumor growth, altering metabolism or changing blood flow within the tumor. Even slowing tumor growth can be meaningful for patients and can help researchers design more effective treatment combinations.

Those tools are also valuable for surgical planning. We use imaging to map white matter pathways and important functional regions of the brain so surgeons can avoid damaging critical areas. We’re also studying how imaging may help predict neurocognitive side effects from surgery or treatment.

What gives you hope about the future of glioblastoma research?

What gives me hope is that we’re finally starting to see progress. Over the last few years, a few drugs have begun to break through what felt like a glass ceiling in glioblastoma research.

There’s also been a major shift in how pharmaceutical companies think about brain tumors. Historically, many drugs were intentionally designed not to penetrate the brain because researchers wanted to avoid neurologic side effects. Now there’s growing recognition that we need therapies specifically engineered to reach brain tumors.

At the same time, researchers, patient advocacy groups and the U.S. Food and Drug Administration (FDA) are working together to rethink how we evaluate treatments for glioblastoma. Because this disease is so difficult to treat, there’s increasing interest in alternative ways to measure treatment benefit and accelerate the development of new therapies.

Who’s behind this story?

Robert Egan

Bachelor’s in mathematical biology, Master’s in creative writing. Well-traveled with unique perspectives on science and language.

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