In precision oncology, theranostics stands out as a transformative approach that tailors cancer treatment to the unique molecular profile of each patient. By integrating advanced diagnostic imaging with targeted therapy, theranostics ensures that treatments are customized to the unique characteristics of each patient's cancer, thereby optimizing efficacy and minimizing adverse effects.
The Importance for Personalized Treatment
Cancer is a heterogeneous disease, with variations not only between different types but also among patients with the same cancer subtype. This diversity necessitates personalized treatment strategies, not a one-size-fits-all approach. Theranostics addresses this need by enabling clinicians to visualize specific molecular targets within tumors and deliver therapy directly to these targets. As James Cassuto, MD, PhD, System Associate Medical Director of Nuclear Medicine at Atlantic Medical Group noted, "Every patient is different. Every cancer the patient has is different. And because of that, I think we need to treat them differently."
The Science of Molecular Targeting
The theranostic process begins with the administration of a radiotracer that binds to specific molecular markers expressed on cancer cells. Positron Emission Tomography-Computed Tomography (PET-CT) imaging is then used to visualize the distribution of these markers, accurately identifying tumor locations and assessing the extent of disease.
Subsequently, a therapeutic agent labeled with a radioactive isotope is introduced, targeting the cancer cells identified during imaging and delivering localized radiation that attacks malignant cells while sparing healthy tissue. This dual-phase approach not only improves treatment precision but also allows for real-time monitoring of the effectiveness of the therapy.
“I can tell after every single therapy how well we were able to target disease, and thus what the outcomes are likely going to be,” Dr. Cassuto said.
Clinical Applications and Patient Selection
Theranostics has shown significant promise in treating various cancers:
- Prostate Cancer: Utilizing Prostate-Specific Membrane Antigen (PSMA) targeting agents, theranostics enables precise imaging and targeted radioligand therapy.
- Neuroendocrine Tumors (NETs): Peptide Receptor Radionuclide Therapy (PRRT) targets somatostatin receptors, prevalent in these tumors, allowing for effective treatment.
- Thyroid Cancer: Radioactive iodine has long been a standard theranostic agent for both imaging and treating thyroid malignancies.
Patient selection for theranostic applications involves evaluating the presence of specific molecular targets within tumors. Using a PET-CT is instrumental in this assessment, ensuring that only patients likely to benefit from targeted radionuclide therapy are selected.
“Once that referral comes in, I look at their case, review the lab work, and review the imaging,” said Dr. Cassuto, referring to the hands-on approach he takes when patients are referred to Overlook Medical Center. “There's a lot of discussions we're having with oncologists and radiation oncologists, a lot of discussions in tumor boards about what were we looking for and how this is going to benefit the patient, which helps make sure the right person is identified for the right therapy.”
The Benefits are Clear
Clinical studies have demonstrated the effectiveness of theranostics in improving patient outcomes. For instance, patients undergoing PRRT (ie: Lutathera) for neuroendocrine tumors have shown significant tumor reduction and prolonged survival rates. Similarly, PSMA-targeted therapies in prostate cancer (ie: Pluvicto) have resulted in notable decreases in tumor size, with manageable side effects. These advancements underscore the success of theranostics and precision cancer care today, but also the potential to transform how cancer is treated tomorrow.
Theranostics exemplifies the principles of precision oncology, offering a highly successful approach to cancer treatment. By aligning therapeutic interventions with the unique qualities of an individual's cancer, theranostics enhances treatment effectiveness and paves the way for more personalized and effective cancer care.
Refer a patient today to ensure the most advanced, personalized cancer treatment available.