Theranostics as potential novel therapeutic pillar in oncology

Recent years have witnessed an expanded use of a novel therapeutic concept in oncology using radioactive probes for diagnosis and treatment. Professor Rudolf Werner, Head of the Department of Nuclear Medicine at LMU University Hospital Munich, explains the underlying rationale and provides an overview of established and future indications in clinical practice.

Professor Werner, what is Theranostics?

Theranostics combines the words “therapy” and “diagnostics”. In brief, theranostics relies on a tight interplay between varying disciplines, including trained medical staff, nurses, technicians, medical physicists, radiochemists and other referring physicians. Specifically designed radioactive probes can visualize target structures on the tumor cell surface using dedicated imaging devices, called positron emission tomography (PET). PET allows to capture the respective emission of the injected radioactivity, which then appears as a “tumor hot spot” on the screen. We can then slightly modify the radioactive PET probe to use it for therapeutic purpose to treat those previously identified “hot spots”.

For which indications is this type of treatment available today?

We are using this concept routinely for patients affected with advanced prostate carcinoma. Here, the so-called prostate-specific membrane antigen (PSMA) is targeted by using a PSMA PET scan, followed by a PSMA-directed radioligand therapy for treating the tumor. This can lead to substantial decrease of the tumor lesions, along with decline of the tumor marker (PSA levels). In addition, hormone-active, neuroendocrine tumors for example of the gastrointestinal region are also routinely treated with this concept.

What other tumor entities could be good candidates for Theranostics?

The landscape for Theranostics is continuously evolving, with multiple ongoing clinical trials. Depending on trial results, advanced breast cancer may be also well suited for this type of treatment. Moreover, radiosensitive cancer types such as blood cancer may also be eligible for a theranostic approach.

How is the access to Theranostics for patients in Germany and internationally?

The infrastructure for Theranostics in Germany is established, and procedures are routinely offered by Theranostics centers within Nuclear Medicine Departments. Globally, multiple national and international organizations such as the European Association of Nuclear Medicine (EANM) or the International Centers for Precision Oncology (ICPO) Foundation support the field through center certification programs, scientific exchange, and educational initiatives. Among others, ICPO regularly hosts the ICPO Theranostics Virtual Summit which gathers world-wide experts to present and discuss recent innovations in the field by using live streamed sessions. The next event will take place on November 12 & 13 this year.