Brave New Visions  pg. 2

PET tracers exist for some of these and are well embedded in clinical care. An example is 18F-fluorodeoxyglucose (FDG), which provides a measure of glucose metabolism. Others, such as 18F-fluorodeoxy-L-thymidine (FLT), which may reflect cell proliferation, are still being validated.

The beauty of being able to track aspects of tumor growth and viability means that you can see very early on after administering an experimental therapy whether it is impacting tumor physiology in any way at all. If it is, then you have a very good reason to carry on and look for tumor regression.

In our oncology projects, we’re also looking for molecular imaging agents that can tell you whether people are likely to respond to targeted therapies and how well our drugs engage them.

I think that imaging truly has the opportunity to revolutionize and personalize care in oncology. We’re going to see the fruits of that ripen in the near future.

How has imaging improved our understanding of the brain?

Functional imaging has fundamentally changed the way we can question brain systems because we can see them in action. It has given whole new dimensions to many areas of neuroscience such as pain, basic sensory systems, psychiatric disorders and their co-morbidity with other disorders of the central nervous system, cognition, language and neural mechanisms that underlie developmental plasticity and recovery of function.

Imaging studies that help us understand neurodegenerative brain disease can also help pave the way to better health care in the future.

At Merck, we have participated in the Alzheimer’s Disease Neuroimaging Initiative (ADNI), a collaborative consortium between industry, academia and the National Institute on Aging. The goal is to validate imaging tools such as PET and magnetic resonance imaging (MRI) and fluid biomarkers—alongside neuropsychiatric scores—for tracking the progression of Alzheimer’s disease in people currently on the best therapies available for this condition.

This is an important study because it will tell us what an aging Alzheimer’s disease population looks like in North America today. Once we have an understanding of that, then we have a reference library or baseline that we can use to evaluate whether our new medicines produce true improvements in clinical care by modifying disease progression.

It would be brilliant if you could prevent Alzheimer’s disease totally, but just think of a therapy that delays its onset by 10 years. That too would be a phenomenal achievement.

Can these collaborations overcome concerns about disclosure and conflicts of interest?

It’s in the interest of the patient, the National Institutes of Health, the FDA, healthcare providers, and all of us in the pharmaceutical industry to move safe and effective new medicines forward efficiently.

We will attempt internally to make imaging agents that validate target engagement for our new therapies and have the desired mechanistic effects. That’s proprietary to drug discovery programs. Eventually, when appropriate, we will try to make these agents available to all for research.

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