Expanding Cancer Treatment with Theranostics (Podcast)

Theranostics is changing how we approach treatment of some cancers. A combination of therapy and diagnostics, theranostics is a part of precision oncology...

"The first step is imaging a patient with our dedicated PET-CT tools. The second step is treating those patients with particle radiation."

In a recent episode of Cleveland Clinic’s Cancer Advances podcast, Chair of the Department of Nuclear Medicine, Elcin Zan, MD discussed:

• How theranostics works
• New techniques such as PSMA PET for treating prostate cancer and somatostatin-based theranostics for treating neuroendocrine tumors
• Clinical trials using beta and alpha particles in different disease groups, such as melanoma, Merkel cell carcinoma, meningioma, neuroendocrine cancer, small cell lung cancer and colorectal cancer
• Addressing radiation safety with patients

Click the podcast player above to listen to the episode now, or read on for a short edited excerpt. Check out more Cancer Advances episodes at clevelandclinic.org/podcasts/cancer-advances or wherever you get your podcasts.

Excerpt from the podcast:

Dale Shepard, MD, PhD: Turning the new PET techniques, like PSMA PET, into a way to actually treat prostate cancer.

Elcin Zan, MD: That's correct. In PSMA PET, when we image those patients, we use radionuclides such as gallium-68 or fluoride-18. These are non-ionizing type of radiations. They only help us to image the patients on their PET-CT camera. And once we see the receptor distribution, then we know the patient is a good candidate for the PSMA targeting therapy.

For therapy purposes, we use two different types at the moment. One is lutetium-177, which is a beta particle emitting radionuclides, and this is FDA approved. But in the research space, right now we are exploring multiple different types of radionuclides, namely alpha particles, Auger electrons, and when I say alpha particles, it's not only one particle, but it is a group of alpha particles such as actinium-225, astatine-211, lead-212, and so on. At the Cleveland Clinic right now, we are delivering theranostics therapies which are FDA approved for prostate and prostate cancer and neuroendocrine tumor patients.

But at the same time, we are opening multiple clinical trials using beta and alpha particles in different disease groups such as melanoma, Merkel cell carcinoma, meningioma, neuroendocrine cancer, small cell lung cancer, colorectal cancer. Theranostics is a discipline that can be applied to multiple cancer groups because, once you identify target receptor expression, you can tailor your radioligands to find that receptor with different types of radiation that is loaded on them, which the technical term we use for this is radiolabeling. You can radiolabel almost any compound that can be a peptide antibody small molecule. And once you radiolabel with imaging agents, if you see receptor distribution, you simply change this type of radiation on this ligand and make it a therapy agent.

Since we give therapy to the patients who express the intent to treat target receptors, our therapies are validated, and the side-effect profile is really patient-friendly.