University of California San Francisco
Helen Diller Family Comprehensive Cancer Center
Robert Flavell, MD, PhD

Robert Flavell, MD, PhD

Assistant Professor in Residence, Department of Radiology and Biomedical Imaging, UCSF

Cancer Center Program Memberships

Prostate Cancer

Research Summary

Robert Flavell, MD, PhD, is an Assistant Professor in the Nuclear Medicine subspecialty in the Department of Radiology and Biomedical Imaging at the University of California, San Francisco. He received his medical degree from Weill Cornell Medical College, and his PhD from the Rockefeller University as part of the Tri-Institutional MD PhD program. He completed his one-year internship at the Memorial Sloan­Kettering Cancer Center in New York. Dr. Flavell completed a four-year diagnostic radiology residency at the University of California, San Francisco, where he also finished a Nuclear Medicine fellowship. In June 2016. he joined the faculty as an Assistant Professor in Residence.

Dr. Flavell’s laboratory focuses on the development of new molecular imaging tools for better understanding of disease progression in patients with prostate and other cancers. One area of interest is the relationship between acidic interstitial pH and disease progression. Solid tumors are poorly perfused and secrete acids into the adjacent interstitium, resulting in a pH which is mildly acidic, typically ranging from 6.5 – 7.0. This property has been associated with high-grade malignancy, local invasion, and metastasis in animal models. Therefore, it would be desirable to have a method which could be used in patients for monitoring tissue pH. Therefore, one focus of Dr. Flavell’s research is developing methods of imaging acidic interstitial pH with potential for clinical translation. Specifically, two methods are being developed, one of which permits whole body evaluation of areas of acidic pH using positron emission tomography (PET) imaging, and one method which permits quantitative, local determination of interstitial pH based on hyperpolarized 13C magnetic resonance spectroscopy (HP-MRS). The PET method is based on pro-drug glycosylamine derivatives of the commonly used oncologic tracer, [18F]FDG, termed [18F]FDG amines, which are blocked with an acid-labile protecting group. When exposed to the mildly acidic pH present in the interstitium of a solid tumor, the caging group decomposes, liberating native [18F]FDG, which is subsequently absorbed by the adjacent cancer cell (Flavell R.R. et al., Bioconjugate Chem., 2016). The HP-MRS method is based on the administration of a 13C labeled probe which has a predictable change in its chemical shift based on pH. By comparison to a standard curve, quantitative pH measurements can be obtained (Flavell R.R. et al. Chem. Comm. 2015). These techniques are being optimized and ongoing directions include application in animal models, with the long term goal of clinical translation. Other areas of developing interest in the laboratory include techniques for imaging of metals in the microenvironment, and imaging of a metabolic signature associated with immune activation.

Education

Wesleyan University, Middletown, CT, B.A., 1996-2000, Mathematics and chemistry
The Rockefeller University, New York, NY, laboratory of Dr. Tom W. Muir, PhD, 2002 - 2010, Peptide and protein chemistry, radiolabeling methods, and PET imaging
Weill Cornell Medical College, New York, NY, MD, 2002 - 2010, Medicine
Memorial Sloan-Kettering Cancer Center, 2010 - 2011, Transitional year intern
Dept of Radiology, UCSF Medical Center, San Francisco, CA, 2011 - 2015, Diagnostic radiology residency
Dept of Radiology, UCSF Medical Center, San Francisco, CA 2015 - 2016, Nuclear medicine fellowship


Professional Experience

  • 2000 - 2002
    Research Assistant, Laboratory of Synthetic Protein Chemistry, Rockefeller University
  • 2016 – present
    Assistant Professor in Residence, Department of Radiology and Biomedical Imaging, University of California, San Francisco

Honors & Awards

  • 2000
    Honors for undergraduate thesis in chemistry, Wesleyan University, Middletown, CT
  • 2013
    Introduction to Academic Radiology Program, American Roentgen Ray Society
  • 2014
    Certificate of Merit, 2014 Radiology Society of North America meeting
  • 2014
    University of California, San Francisco catalyst program consultation award
  • 2015
    Radiology Society of North America, Roentgen Resident Research award
  • 2015
    Association of University Radiologists Research Scholar Program
  • 2015
    Certificate of Merit, 2015 Radiology Society of North America Meeting
  • 2016
    Runner up, Surbeck Scholar’s Award, University of California, San Francisco

Selected Publications

  1. Behr SC, Aggarwal R, Van Brocklin HF, Flavell RR, Geo K, Small EJ, Blecha J, Jivan S, Hope TA, Simko JP, Kurhanewicz J, Noworolski SM, Korn NJ, De Los Santos R, Cooperberg MR, Carroll PR, Nguyen HG, Greene KL, Langton-Webster B, Berkman CE, Seo Y. First-in-Human Phase I study of CTT1057, a Novel 18F Labeled Imaging Agent with Phosphoramidate Core Targeting Prostate Specific Membrane Antigen in Prostate Cancer. J Nucl Med. 2018 Nov 21.
    View on PubMed
  2. Ding Y, Sohn JH, Kawczynski MG, Trivedi H, Harnish R, Jenkins NW, Lituiev D, Copeland TP, Aboian MS, Mari Aparici C, Behr SC, Flavell RR, Huang SY, Zalocusky KA, Nardo L, Seo Y, Hawkins RA, Hernandez Pampaloni M, Hadley D, Franc BL. A Deep Learning Model to Predict a Diagnosis of Alzheimer Disease by Using 18F-FDG PET of the Brain. Radiology. 2018 Nov 06; 180958.
    View on PubMed
  3. Perez PM, Hope TA, Behr SC, van Zante A, Small EJ, Flavell RR. Intertumoral Heterogeneity of 18F-FDG and 68Ga-PSMA Uptake in Prostate Cancer Pulmonary Metastases. Clin Nucl Med. 2018 Nov 03.
    View on PubMed
  4. Villanueva-Meyer JE, Magill ST, Lee JC, Umetsu SE, Flavell RR. Detection of Metastatic Meningioma to the Liver Using 68Ga-DOTA-Octreotate PET/CT. Clin Nucl Med. 2018 Jun 22.
    View on PubMed
  5. Qin H, Carroll VN, Sriram R, Villanueva-Meyer JE, von Morze C, Wang ZJ, Mutch CA, Keshari KR, Flavell RR, Kurhanewicz J, Wilson DM. Imaging glutathione depletion in the rat brain using ascorbate-derived hyperpolarized MR and PET probes. Sci Rep. 2018 May 21; 8(1):7928.
    View on PubMed
  6. Taglang C, Korenchan DE, von Morze C, Yu J, Najac C, Wang S, Blecha JE, Subramaniam S, Bok R, VanBrocklin HF, Vigneron DB, Ronen SM, Sriram R, Kurhanewicz J, Wilson DM, Flavell RR. Late-stage deuteration of 13C-enriched substrates for T1 prolongation in hyperpolarized 13C MRI. Chem Commun (Camb). 2018 May 17; 54(41):5233-5236.
    View on PubMed
  7. Mutch CA, Ordonez AA, Qin H, Parker M, Bambarger LE, Villanueva-Meyer JE, Blecha J, Carroll V, Taglang C, Flavell R, Sriram R, VanBrocklin H, Rosenberg O, Ohliger MA, Jain SK, Neumann KD, Wilson DM. [11C]Para-Aminobenzoic Acid: A Positron Emission Tomography Tracer Targeting Bacteria-Specific Metabolism. ACS Infect Dis. 2018 May 08.
    View on PubMed
  8. Pittman S, Sethi P, Flavell RR, Pampaloni MH. Cardiac Fibroma: An Uncommon Cause of a Fixed Defect on Myocardial Perfusion Imaging. Clin Nucl Med. 2018 Feb; 43(2):e56-e58.
    View on PubMed
  9. von Morze C, Ohliger MA, Marco-Rius I, Wilson DM, Flavell RR, Pearce D, Vigneron DB, Kurhanewicz J, Wang ZJ. Direct assessment of renal mitochondrial redox state using hyperpolarized 13 C-acetoacetate. Magn Reson Med. 2018 Apr; 79(4):1862-1869.
    View on PubMed
  10. Ng QKT, Sethi P, Saunders TA, Pampaloni MH, Flavell RR. Discordant Findings on 18F-NaF and 99mTc-HDP Bone Scans in a Patient With ATTR Cardiac Amyloidosis. Clin Nucl Med. 2017 Dec 19.
    View on PubMed
  11. Pittman S, Sethi P, Flavell RR, De Marco T, Hernandez Pampaloni M. Abnormal pulmonary 18F-florbetapir uptake in a patient evaluated for recurrent cardiac amyloidosis following orthotopic heart transplant. J Nucl Cardiol. 2017 Nov 03.
    View on PubMed
  12. Neumann KD, Villanueva-Meyer JE, Mutch CA, Flavell RR, Blecha JE, Kwak T, Sriram R, VanBrocklin HF, Rosenberg OS, Ohliger MA, Wilson DM. Imaging Active Infection in vivo Using D-Amino Acid Derived PET Radiotracers. Sci Rep. 2017 Aug 11; 7(1):7903.
    View on PubMed
  13. Neumann K, Flavell R, Wilson DM. Exploring Metabolism In Vivo Using Endogenous 11C Metabolic Tracers. Semin Nucl Med. 2017 Sep; 47(5):461-473.
    View on PubMed
  14. Salimy MS, Parwani PJ, Mukai K, Pampaloni MH, Flavell RR. Abnormal 18F-FDG and 82Rb PET Findings in Chagas Heart Disease. Clin Nucl Med. 2017 May; 42(5):e265-e268.
    View on PubMed
  15. Lawhn-Heath C, Flavell RR, Glastonbury C, Hope TA, Behr SC. Incidental Detection of Head and Neck Squamous Cell Carcinoma on 68Ga-PSMA-11 PET/CT. Clin Nucl Med. 2017 Apr; 42(4):e218-e220.
    View on PubMed
  16. Behr SC, Mollard BJ, Yang J, Flavell RR, Hawkins RA, Seo Y. Effect of Time-of-Flight and Regularized Reconstructions on Quantitative Measurements and Qualitative Assessments in Newly Diagnosed Prostate Cancer With 18F-Fluorocholine Dual Time Point PET/MRI. Mol Imaging. 2017 Jan-Dec; 16:1536012117736703.
    View on PubMed
  17. Flavell RR, Behr SC, Mabray MC, Hernandez-Pampaloni M, Naeger DM. Detecting Pulmonary Nodules in Lung Cancer Patients Using Whole Body FDG PET/CT, High-resolution Lung Reformat of FDG PET/CT, or Diagnostic Breath Hold Chest CT. Acad Radiol. 2016 Sep; 23(9):1123-9.
    View on PubMed
  18. Liu W, Truillet C, Flavell RR, Brewer TF, Evans MJ, Wilson DM, Chang CJ. A reactivity-based [18F]FDG probe for in vivo formaldehyde imaging using positron emission tomography. Chem Sci. 2016 Aug 01; 7(8):5503-5507.
    View on PubMed
  19. Flavell RR, Naeger DM, Aparici CM, Hawkins RA, Pampaloni MH, Behr SC. Malignancies with Low Fluorodeoxyglucose Uptake at PET/CT: Pitfalls and Prognostic Importance: Resident and Fellow Education Feature. Radiographics. 2016 Jan-Feb; 36(1):293-4.
    View on PubMed
  20. Flavell RR, Truillet C, Regan MK, Ganguly T, Blecha JE, Kurhanewicz J, VanBrocklin HF, Keshari KR, Chang CJ, Evans MJ, Wilson DM. Caged [(18)F]FDG Glycosylamines for Imaging Acidic Tumor Microenvironments Using Positron Emission Tomography. Bioconjug Chem. 2016 Jan 20; 27(1):170-8.
    View on PubMed

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