Although treatment algorithms vary, surgery is the primary treatment modality for most solid cancers. In oncologic tumor resection, the preferred outcome is complete cancer removal as residual tumor left behind is considered treatment failure. However complete tumor removal needs to be balanced with functional preservation and minimizing patient morbidity including prevention of inadvertent nerve injury. The inability of surgeons to visually distinguish between tumor and normal tissue including nerves leads to residual cancer cells being left behind at the edges of resection, i.e. positive surgical margins (PSM). PSM can be as high as 20-40% in breast cancer lumpectomy, 21% for radical prostatectomy, and 13% for HNSCC. Similarly, using white light reflectance alone which is the current standard of care in operating rooms, nerve dysfunction following surgery has been reported to be as high as ~2-40% ranging from immediate post op to long-term dysfunction.
Molecular imaging with fluorescence provides enhanced visual definition between diseased and normal tissue and have been shown to decrease PSM in both animal models and patients. Molecular imaging with fluorescence can also provide enhanced visualization of important structures such as nerves to improve preservation and minimize inadvertent injury. Our laboratory has extensive experience in development of both nerve and tumor injectable markers for surgical visualization. In presentation we will discuss the development of nerve and tumor markers combinations to improve intraoperative visualization – aka Precision Surgery TM.
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Dr. Nguyen is a Professor in the Department of Surgery at the University of California San Diego (UCSD). She received her combined MD/PhD degree from Washington University, School of Medicine in St. Louis, MO. She completed her General Surgery Internship at Barnes Jewish Hospital in St. Louis and residency in Head and Neck Surgery and subspecialty fellowship training in Neurotology/Skull Base Surgery at UCSD. She is board certified in both Head and Neck Surgery and Neurotology/Skull Base Surgery and is the fellowship director for the ACGME accredited fellowship in Neurotology/Skull Base Surgery at UCSD.
Her clinical practice is at UCSD Health Systems where she cares for patients with diseases of the facial nerve, ear, and skull base. She has subspecialty interest in facial nerve reanimation and surgical procedures for patients with facial paralysis. She also specializes in hearing restoration surgeries including stapedectomy and cochlear implantation.
Dr. Nguyen's interest in molecular imaging for fluorescence guided Precision SurgeryTM began during her fellowship at UCSD where she collaborated with Dr. Roger Tsien (1952-2016), Nobel Laureate, Chemistry 2008. She has been awarded the Presidential Early Career Award for Scientists and Engineers (PECASE, April 2014). The Presidential Award is the highest honor bestowed by the U.S. government on outstanding scientists and engineers beginning their independent careers.
Together with Dr. Tsien, Dr. Nguyen co-invented a tumor marker for fluorescence-enabled real-time detection of tumor margins and a nerve marker for fluorescence-enabled real-time illumination of nerves. The tumor marker was licensed by Avelas Biosciences, INC and is in currently in late stage clinical testing for patients with breast cancer undergoing surgery (NCT03113825). Dr. Nguyen founded Alume Biosciences, INC (Alume) in 2017 to enable the clinical translation of the nerve marker. Alume has received an allowance from the United States Food and Drug Administration (US FDA) to proceed with clinical trial testing in patients undergoing head and neck surgery (NCT04420689) at University of California, San Diego, Stanford and Harvard. Studies are expected to initiate in late Q2 2020.