Theranostics: Leveraging Molecular Imaging and Therapy to Impact Patient Management and Secure the Future of Nuclear Medicine

Abstract

Nuclear medicine is experiencing a renaissance, with U.S. Food and Drug Administration approval recently being obtained for theranostic agents and a wide variety of such agents soon to impact patient care significantly in the era of precision medicine. The NETTER-1 trial demonstrated the therapeutic effect of a theranostic agent in markedly improving progression-free survival in patients with metastatic gastroenteropancreatic neuroendocrine tumors. Predominantly retrospective studies have demonstrated a significant response to 177 Lu-labeled agents targeting prostate-specific membrane antigen (PSMA) in patients with prostate cancer. At least 2 prospective clinical trials involving 177 Lu-PSMA agents are under way that will likely pave the way for Food and Drug Administration approval in the United States. A significant upside to theranostics is that patients tend to tolerate these agents better than chemotherapy. Theranostic compounds are likely to impact many cancers in the near future, not only through improvements in quality of life but also in terms of survival. This article provides an overview of already approved agents as well as those on the horizon. It is important that as these agents are clinically onboarded, nuclear medicine physicians have the expertise to deploy theranostics safely and efficiently, ensuring that these agents attain and maintain their position as leading lines of therapy in managing patients with cancer as well as becoming an important aspect of nuclear medicine practice in the future.

Absolute Quantification in Diagnostic SPECT/CT: The Phantom Premise

“…Recent research on absolute quantification has primarily focused on applications related to theranostics or radionuclide therapy [ 6 , 7 , 8 , 9 , 10 ] and dosimetry [ 11 , 12 , 13 , 14 , 15 , 16 , 17 ]. Next to its use in the therapeutic setting, accurate quantification of tracer uptake could become highly relevant, providing diagnostic information beyond just the absence or presence of disease.…”

An international multi-center investigation on the accuracy of radionuclide calibrators in nuclear medicine theranostics

“…In the last decades, the application of personalized molecular radiotherapy using theranostics has gained a lot of interest in nuclear medicine [1,2]. Theranostic approaches aim to optimize endogenous radiotherapy for individual patients using pre-therapeutic diagnostic imaging.…”

Theranostics in Oncology—Thriving, Now More than Ever

“…Tracing its roots back to the 1940s [ 1 ], theranostics in nuclear oncology has seen an unprecedented success, mainly due the beneficial effects of such image-guided therapeutic concepts for patients afflicted with radioiodine avid thyroid cancer [ 2 ]. Recent years, however, have witnessed an expanded use of novel molecular imaging agents tied to an individually tailored treatment decision [ 3 , 4 ]. Such a theranostic approach enables systemic or locoregional radiation of various cancer entities with mainly β-emitting radionuclides, which are linked to the identical molecule used for positron emission tomography (PET) or single-photon emission computed tomography (SPECT) imaging [ 4 ].…”

“…Recent years, however, have witnessed an expanded use of novel molecular imaging agents tied to an individually tailored treatment decision [ 3 , 4 ]. Such a theranostic approach enables systemic or locoregional radiation of various cancer entities with mainly β-emitting radionuclides, which are linked to the identical molecule used for positron emission tomography (PET) or single-photon emission computed tomography (SPECT) imaging [ 4 ]. The more widespread adoption of theranostics is further fueled by the encouraging results of recently published major trials like NETTER-1 for imaging and therapy of neuroendocrine neoplasms (NEN) targeting the somatostatin receptor (SSTR) [ 5 ] or reports on the beneficial effects of this concept for the treatment of prostate cancer (PC), as evidenced by the prospective LuPSMA or TheraP trials [ 6 , 7 ].…”