Cleveland Clinic in Florida Launches New Theranostics Program

Theranostics is a rapidly emerging discipline in nuclear medicine that uses radiopharmaceuticals to identify and treat cancer. By pairing advanced molecular imaging with targeted radiation therapy, theranostics allows clinicians to localize disease and deliver treatment directly to cancer cells while limiting off-target toxicity.

Building on these advances, Cleveland Clinic Weston Hospital has launched a new Theranostics Program to offer patients access to innovative treatments for metastatic prostate cancer and neuroendocrine tumors. The program is led by board-certified nuclear radiologist David Wymer, MD, who joined Cleveland Clinic in Florida last September as Section Head of Nuclear Medicine.

“Theranostics is bringing precision medicine to a growing range of malignancies and expanding the traditional role of nuclear medicine in oncologic care,” states Dr. Wymer.

Foundations of theranostics

The application of a targeting molecule for both disease identification and targeted radionuclide therapy – often using matched diagnostic and therapeutic isotopes – is the foundation of theranostics.

A classic example is iodine-131, which has long been used for both the imaging and treatment of hyperthyroidism and differentiated thyroid cancer. Likewise, Yttrium-90 represents an early targeted therapeutic radionuclide, commonly paired with diagnostic surrogates, and has been used in radioimmunotherapy for non-Hodgkin’s lymphoma and in liver-directed therapies.

Modern theranostics represents an evolution of this concept, employing more sophisticated targeting molecules and optimized radioisotope pairs. The approach has demonstrated greater precision, reduced off-target toxicity, and personalized dosimetry across a broad range of cancers beyond thyroid disease.

“It’s a very exciting time for the field of nuclear medicine,” confirms Dr. Wymer, who currently serves on the boards of the American College of Nuclear Medicine and on the Southeastern Chapter of the Society of Nuclear Medicine and Molecular Imaging.

PSMA-targeted therapy

The Theranostics Program at Weston Hospital launched in January with PSMA-targeted therapy for prostate cancer as its first clinical offering. Prostate-specific membrane antigen (PSMA) is highly overexpressed on prostate cancer cells, making it an ideal target for both molecular imaging and targeted radiotherapy. PSMA PET imaging, using radionuclides such as gallium-68 or fluorine-18, is performed to localize and assess the extent of disease and confirm patient eligibility for treatment.

Lutetium Lu 177 vipivotide tetraxetan (Pluvicto®) is an FDA-approved radiopharmaceutical for the treatment of adults with PSMA-positive metastatic prostate cancer that has progressed despite therapies aimed at lowering testosterone levels. Initially indicated for patients with advanced, treatment-resistant disease, the therapy’s approval was expanded in March 2025 to include adults with PSMA-positive metastatic prostate cancer who have received androgen deprivation therapy and are considered appropriate candidates for delaying chemotherapy.

“Being able to offer this treatment before systemic chemotherapy is a meaningful advantage for patients who want or need to avoid the toxicities associated with chemo,” says Dr. Wymer. “Patients appreciate having an effective, targeted option that may help preserve quality of life.”

Patients receive Pluvicto as an outpatient intravenous infusion, typically administered over approximately 30 minutes, and are able to return home the same day. The standard dosage is 200 millicuries administered every six weeks for six doses, with the option to reduce the dose to 160 millicuries in the event of adverse reactions. Hematologic toxicities are the most commonly observed side effects.

General radiation safety precautions are recommended following treatment, including limiting close contact with household members for two days and with pregnant individuals and young children for seven days.

“Pluvicto is generally well tolerated and easy to administer,” adds Dr. Wymer. He notes, however, that dosimetry remains an area where further research is needed.

During his fellowship training, Dr. Wymer worked closely with nuclear medicine teams at a time when lutetium-177–based therapies were beginning to enter clinical use. He also has been involved in developing educational materials on Pluvicto for the Radiological Society of North America.

Neuroendocrine tumors

In addition to prostate cancer, the Theranostics Program at Weston Hospital is preparing to offer lutetium Lu 177 dotatate (Lutathera®) for patients with neuroendocrine tumors of the pancreas or gastrointestinal tract. These tumors frequently express somatostatin receptor type 2 (SSTR2), which serves as both a diagnostic marker and a therapeutic target.

Radiolabeled somatostatin analogs enable both imaging and targeted radiation delivery to these tumors. Lutathera is administered intravenously, typically in four doses given every eight weeks, along with amino acid infusions to protect healthy organs. Reported side effects include decreased blood counts, nausea, and liver-related issues.

“Lutathera will be offered at Weston Hospital later this year,” reports Dr. Wymer.

Future expansion

Looking ahead, Dr. Wymer hopes to expand the Theranostics Program to Cleveland Clinic Indian River Hospital in Vero Beach. For now, Cleveland Clinic patients in Florida who are potential candidates for theranostic therapies will be referred to the Weston-based team.

As theranostics continues to evolve, the new program at Weston Hospital reflects both the rapid growth of the field and its increasing integration into multidisciplinary cancer care. Under Dr. Wymer’s leadership, the program aims to deliver advanced molecular imaging and targeted therapies that align diagnosis and treatment within a single, patient-centered framework.