How is Theranostics Impacting Cancer Care?
Summary
- Theranostics is a type of radiation treatment powered by radioisotopes.
- Doctors at Sylvester Comprehensive Cancer Center use theranostic treatments for hundreds of patients with prostate cancer and neuroendocrine tumors each year.
- As an NCI-designated cancer center, Sylvester has the infrastructure for theranostic research and clinical trials.
Imagine a world where cancer treatment, which is as precise as a laser, becomes even more targeted, minimizing harm to nearby tissues. It may sound futuristic, but a new type of cancer treatment called theranostics has made this a reality. With theranostics, doctors can target cancer with radiation at the cellular level, damaging tumors without harming nearby tissue as it binds radioisotopes to tumor cells.
Doctors at Sylvester Comprehensive Cancer Center, part of the University of Miami Miller School of Medicine, use theranostic treatments for hundreds of patients with prostate cancer and neuroendocrine tumors each year. Expanded facilities and investments will enable many more patients to access these innovative treatments as part of clinical trials soon.
“We are among a handful of sites in the country with access to the latest, first-in-human radio-pharmaceutical drugs,” said Aman Chauhan, M.D., leader of the Neuroendocrine Tumor Program and co-director of the Theranostic Program at Sylvester. “The next generation of early clinical trials is exploring these theranostic drugs in several common cancers that truly need better alternatives.”
What is Theranostics?
Theranostics is a type of radiation treatment powered by radioisotopes—unstable versions of elements that emit energy as they break down. At the heart of this approach is a powerful idea: combining cancer-targeting imaging probes with therapeutic doses of radiation to kill cancer cells.
Long before modern cancer medicine, radiation was the first “targeted” treatment. Although it has evolved over the years, the core concept remains—to deliver the radiation as close to the cancer as possible to minimize harm to healthy cells. Theranostics represents the next step, getting the radioactive molecules to attach to cancer cells.
“Theranostic treatments are more specific and very targeted to certain parts of a patient’s cancer, so we can target the tumor without damaging surrounding tissue,” said Russ Kuker, M.D., associate professor of radiology in the Division of Nuclear Medicine at Sylvester. “That means these treatments tend to have fewer side effects.”
Diagnostics Plus Therapy
A theranostic treatment begins with a positron emission tomography (PET) scan. This scan generates 3D images using radioisotopes that bind to cancer cells using targeting molecules. These molecules typically attach to proteins located on the surface of the cancer cells, known as receptors.
If the cancer has enough relevant receptors, it “lights up on the PET scan,” indicating that the patient may be a good candidate for theranostic treatment, Dr. Kuker said. “Then we use the same targeting molecule for the treatment itself. That’s what theranostics is.”
Radioactive elements vary in strength depending on the amount and type of energy they release. Radioactive elements that give off positively charged particles are used for imaging to assess the targeting molecule’s ability to find and attach to cancer cells. Radioactive elements that emit higher levels of cell-damaging energy are used for treatment, allowing potent radioactive therapies to come directly into contact with the cancer cells.
“You’re visualizing that the target is there,” said Matt Abramowitz, M.D., associate professor of clinical radiation oncology at the Miller School and co-leader of the Prostate, Bladder and Kidney Site Disease Group and vice chair of the Human Radiation Safety Committee at Sylvester. “You can see where it is in the patient. You’ve got it in your crosshairs.”
The treatment lutetium Lu 177 vipivotide tetraxetan is the first and only FDA-approved theranostics drug for prostate cancer. It targets a molecule called PSMA on prostate cancer cells, delivering radiation directly to the tumor. In clinical trials, lutetium Lu 177 vipivotide tetraxetan significantly improved survival rates for men with advanced prostate cancer. Sylvester has been providing this treatment to patients in South Florida since its approval in 2023.
Another approved theranostic drug, lutetium Lu 177 dotatate, treats neuroendocrine tumors, which can develop in many organ systems. This drug specifically targets tumor cells with somatostatin receptors, decreasing the risk of disease progression or death.
Sylvester’s Theranostics Research Group
“The next generation of studies is even more exciting,” Dr. Chauhan said. “We’re working to enhance and build on the successes so far, aiming to make these treatments even better, safer and last longer.”
Sylvester has formed a dedicated theranostics research group to advance the theranostics program, including an expanded radiation safety office (RSO) and clinical trial experts. Additionally, a new radioactive “hot lab” is equipped with the latest clinical trial tools. As an NCI-designated cancer center, Sylvester has the infrastructure for theranostic research and clinical trials.
The RSO team is critical in keeping everybody safe — patients, their families, caregivers and the clinical staff. Walter Lamar, Ph.D., and Maxwell Amurao, Ph.D., have helped take the theranostics program to the next level. The RSO helps educate patients and address their anxieties about the safety of radioactive treatments.
“Investing in these high-end technologies and expertise has enabled us to progress from phase 2, phase 3 and industry trials to conducting first-in-human investigator-initiated research,” said Dr. Chauhan. “Companies now contact us to conduct these early, intricate and sophisticated trials.”
New phase 1 and 2 clinical trials include theranostics for colorectal, breast, melanoma, pancreatic and other types of cancer. The team is collaborating with Sylvester experts in leukemia and breast cancer to expand clinical trials for these kinds of cancer. The hope is to partner with pharmaceutical companies to co-develop these treatments. These patients’ advanced cancers may have already spread, leaving them with limited treatment options.
“Our center now has a very robust phase 1 program for patients who have exhausted all other possibilities,” Dr. Abramowitz said. “This offers them new options for hope.”
Tags: cancer research, Department of Radiology, Dr. Aman Chauhan, Dr. Matt Abramowitz, Dr. Russ Kuker, neuroendocrine cancer, nuclear medicine, prostate cancer, Sylvester Comprehensive Cancer Center, theranostics