Radiotheranostics in Cancer Diagnosis and Management

Abstract

The fundamental foundation for precision medicine is accurate and specific targeting of cancer cells. Advances in the understanding of cancer biology, developments in diagnostic technologies, and expansion of therapeutic options have all contributed to the concept of personalized cancer care. Theranostics is the systematic integration of targeted diagnostics and therapeutics. The theranostic platform includes an imaging component that "sees" the lesions followed by administration of the companion therapy agent that "treats" the same lesions. This strategy leads to enhanced therapy efficacy, manageable adverse events, improved patient outcome, and lower overall costs. Radiotheranostics refers to the use of radionuclides for the paired imaging and therapy agents. Radioiodine is the classic radiotheranostic agent that has been used clinically in management of thyroid diseases for nearly 75 years. More recently there have been major exciting strides in radiotheranostics for neuroendocrine tumors and prostate cancer, among other conditions. Regulatory approval of a number of radiotheranostic pairs is anticipated in the near future. Continued support will be needed in research and development to keep pace with the current momentum in radiotheranostics innovations. Moreover, regulatory and reimbursement agencies need to streamline their requirements for seamless transfer of the radiotheranostic agents from the bench to the bedside. In this review, the concept, history, recent developments, current challenges, and outlook for radiotheranostics in the treatment of patients with cancer will be discussed. RSNA, 2018.

Radioactive Iodine Therapy for Differentiated Thyroid Cancer: Lessons from Confronting Controversial Literature on Risks for Secondary Malignancy

“…In many NMS practices, pre-RAIT thyroglobulin levels and scintigraphy are not considered in decisions on which of the 3 RAIT goals to pursue and on what amount of activity to prescribe. In selecting the prescribed activity, it is critical to standardize pre-RAIT assessment, including the whole-body radioiodine scan, routine neck SPECT/CT, and thyroglobulin measurement, in order to advance our practice of RAIT into the conceptual framework of radiotheranostics (12). It is time for NMSs to decide whether to stay on the traditional course of being a technical assistant in RAIT or to change our training and practice in the way that enables a greater clinical decision making.…”

How clinical imaging can assess cancer biology

“…Theranostics is the systematic integration of targeted diagnostics and therapeutics. Imaging may select the therapeutic choice and may monitor subsequent changes in the biological characteristics of the tumor [161,162].…”

Radioiodine therapy for thyroid cancer

“…Методы диагностики и лечения заболеваний щитовидной железы с помощью радиоактивного йода, разработанные S. Hertz, легли в основу нового направления клинической медицины -тераностики, которое в настоящее время получило широкое распространение [34][35][36][37]. Это понятие включает две основные категории, на которых фактически базируется современная медицина: терапия (англ.…”