Theranostics, a novel treatment paradigm integrating diagnostics and therapeutics, is quickly revolutionizing the field of prostate cancer management. Theranostics, says Jeremie Calais, one of the world’s leading experts in the rapidly emerging field, is “totally exploding and booming.” Researchers and clinicians alike are diving in to explore its tremendous potential to meaningfully improve patient outcomes. Last year, Pluvicto became the first theranostic agent ever to gain FDA approval. This innovative new approval dramatically changed the treatment paradigm in advanced metastatic prostate cancer.
This groundbreaking treatment modality is especially valuable to patients who have been diagnosed with stage four metastatic prostate cancer. Calais noted that for patients with grave prognoses, theranostics can dramatically increase patient survival. It’s important to keep in mind that theranostics is not a panacea.
Annually, more than 300,000 U.S. men are diagnosed with prostate cancer. From 2014 to 2019, the number of cases was growing by 3% a year. With the ongoing increase in cases, the need for better treatment options is greater than ever.
James Kelly directs one of the few academic centers in the country with a dedicated radiopharmaceutical development lab. In addition, he has been instrumental in discovering molecular targets for cancer and neurodegenerative diseases, highlighting the importance of personalized medicine. Dosimetry, he stressed, is key to tailoring treatment doses to individual patients. It guarantees sufficient radiation to destroy malignant cells and protect surrounding non-cancerous tissue.
Theranostics combines diagnostic imaging with targeted radioisotope therapy. Specifically, the diagnostic agent gallium-68 gozetotide seeks out and attaches to cancer cells while the therapeutic lutetium-177 emits beta radiation that selectively kills the cancer cells. Remarkably, patients are able to repeat this entire treatment cycle up to six times, with each treatment cycle taking about six weeks to complete.
So, picture this. Beyond Pluvicto, researchers are further exploring actinium-225 in the clinical trial known as ACCEL. This trial uniquely pairs actinium-225 with PSMA-targeting proteins that home in on and strongly attach to cancer cells. This research aims to maximize the effectiveness of every treatment we pursue. It hopes to provide alternative therapies for patients with inadequate responses to existing treatment.
Even with these advancements, the financial side of theranostics is frustrating because it presents a barrier for numerous patients. The typical six-cycle course equals about $40,000. That price point places it entirely out of reach for those people that are uninsured or whose insurance plans do not include coverage for this groundbreaking treatment. Daryl Eber, owner and operator of 3T Radiology & Research, is looking forward to running theranostics through his private practice. He highlighted the pressing need for accessibility in this space.
“They have to be very careful being around other people, including loved ones,” Eber explained, referring to precautions necessary during treatment due to radiation exposure. He stressed that the treatment process is pretty simple. The resultant impacts on patient safety and quality of life from those decisions are important factors to weigh.
With increasing research, the therapeutic landscape will undoubtedly change dramatically with time. Calais further emphasized the power of theranostics to produce “dramatic, deep responses that were unseen before” in some patients. He warned that although effective, too many patients ultimately relapse and progress their disease despite initial promise.
It’s the intersection of nuclear physics, biochemistry, chemistry, and medicine that catapults theranostics into something fascinating. “One of the great things about the theranostics field that keeps it so exciting is the fact that every day there’s new advancements being made,” Kelly said. This energizing ecosystem encourages novel thinking and collaboration, which can hopefully be translated into a cutting-edge approach for addressing challenging diseases such as prostate cancer.
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