For end-of-care cancer patients who have undergone conventional therapies without success, an emerging treatment option is showing evidence that it may hopefully extend – and improve the quality of – their lives.

For prostate cancer patients in particular, many oncologists are now turning to theranostics, which blends clinical medicine with data science, advanced analytics and artificial intelligence to diagnose, pinpoint the location of, precisely treat and monitor the effectiveness of treatment at every step in the patient journey.

Theranostics is on the cusp of transforming treatment for prostate cancer, with other theranostics-based cancer treatment trials underway for other forms of cancer. By combining molecular imaging with targeted radionuclide therapy, the hoped-for goal of eliminating tumor cells with fewer adverse effects is becoming a reality.

As advancements continue to occur, we are seeing results that reveal theranostics is highly effective in many cases and – importantly – more easily accessible for patients who have exercised all traditional treatment options.

Progress in prostate cancer care
Theranostics hinges on the existence of precision radiopharmaceuticals that can detect and then treat the disease. For the prostate cancer care pathway, a key step is the ability to produce radioisotopes for use in diagnostic tracers – particularly, Gallium-68 PSMA-11 – and then administer them to the patient.

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Thankfully, technology platform improvements have enabled GE HealthCare PETrace cyclotrons to now produce up to 100x the amount of Gallium compared to generators, opening the door to theranostics for many more patients.[1]

When the tracer binds to specific cancer cells, precise molecular information unique to each patient can be obtained from a PET/CT scanner.  Improvements in the sensitivity of PET/CT scanners have enabled clinicians to detect disease earlier, reduce the radioactive dose to the patient, increase diagnostic confidence and inform personalized therapy recommendations, all of which can help improve patient outcomes.

While the discovery and diagnostic capabilities of theranostics are critical, a vital step in the process, of course, is the treatment. With the FDA’s approval in March 2022 of Lutetium-177 PSMA-617, patients can now be treated with a highly-effective therapy for advanced prostate cancer. [2]

The key to this drug’s efficacy is its ability to bind to and deliver a small amount of radiation to prostate cancer cells anywhere in the body, thus helping patients live longer and enjoy a higher quality of life due to significant reductions in such side effects as bone marrow suppression, fatigue, kidney effects and nausea/vomiting.[2]

With GE HealthCare’s StarGuide SPECT/CT imaging platform, a new era of treatment imaging and patient experience has been born.  In what typically takes 60 minutes with conventional SPECT/CT technology, StarGuide can create precision treatment images in as little as 12 minutes. And when coupled with personalized dosimetry software, oncologists are able to quantify how much of each dose reaches the target tumor cells vs. healthy tissues and further personalize the next cycle of treatment for each patient to maximize efficacy and safety.

Theranostics: More to come
More progress is on the horizon. As Novartis announced in December 2022, Pluvicto becomes the first prostate-specific membrane antigen (PSMA)-targeted radioligand therapy to demonstrate clinical benefit in metastatic castration-resistance prostate cancer (mCRPC) patients before receiving taxane-based chemotherapy, addressing a significant unmet need. And there are even more active clinical trials looking to move treatment even earlier in the patient care pathway.[3]

These improvements in care for prostate cancer patients, via theranostics, are just the beginning. Similar radiotherapeutic pathways for discovery, diagnosis and treatment of patients with other cancers are being developed at a rapid pace, and more than 60 are active in a Phase I or later clinical trial.

As theranostics furthers the care team’s ability to precisely diagnose cancer patients and identify advanced therapies for their specific needs, we hope to see improved outcomes and lower costs. At last, challenges from late or imprecise diagnosis and treatment are evolving thanks to new abilities/opportunities to focus specifically on the nuances and needs of each patient, all the way down to the molecular level.

Precision care is no longer a future state. It has arrived. And it is positively transforming prostate cancer care.

[1] Svedjehed J, Pärnaste M, Gagnon K. Demystifying solid targets: Simple and rapid distribution-scale production of [68Ga]GaCl3and [68Ga]Ga-PSMA-11. Nucl Med Biol. 2022 Jan-Feb;104-105:1-10. doi: 10.1016/j.nucmedbio.2021.10.002. Epub 2021 Oct 28. PMID: 34763197.
[2] Breaking News: First-in-Class Radioligand Therapy Approved for Advanced Prostate Cancer. Prostate Cancer Foundation. March 23, 2022. Online. Last accessed on February 21, 2023
[3] Novartis Pluvicto™ shows statistically significant and clinically meaningful radiographic progression-free survival benefit in patients with PSMA–positive metastatic castration-resistant prostate cancer. Novartis Press Release. December 5, 2022. Online. Last accesses on February 21, 2023

Featured Image © 2022 – 2023 GE Healthcare. Used with permission.

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