From the June 2019 issue of HealthCare Business News magazine


Today, work in the field has extended to other types of cancer, most notably neuroendocrine tumors, with the FDA approving the use of the theranostic Lutathera for this condition in January 2018. The drug utilizes the amino acid peptide, DOTATATE, to image and target the somatostatin receptor, a common receptor of many cancer cells, before the radionuclide, lutetium-177 emits radiation to treat the tumor.

A promising frontier in theranostics is prostate cancer, with PSMA-617 showing promise and undergoing Phase III trials in the U.S. The therapy targets and binds a ligand to the prostate-specific membrane antigen (PSMA), and applies Lutetium-177 to destroy the tumor. It is designed for late-stage patients who have exhausted all treatment options available to them, though some argue its use should extend to those in earlier stages.


"Using something like peptide radiotherapy becomes more beneficial because, unlike many chemotherapies, it doesn't depend on rapid cell replication to be able to kill the cells. It targets the cell with enough radiation right where it is, just through the binding of the cell surface membrane,” said Dr. Geoffrey B. Johnson, chair of nuclear medicine at the Mayo Clinic in Rochester, Minnesota. “Many people believe the benefits, and the low amount of toxicity related to this therapy could be used at any stage for prostate cancer patients, even after the initial diagnosis.”

Reimbursement, and other challenges
While a source of excitement, the application of theranostics is still not well understood or even heard of in some medical circles. If it is to be integrated as a standard form of cancer care, changes and greater awareness must take place on a multitude of levels.

For U.S. providers, a key hurdle preventing adoption of theranostics is uncertainty over who is responsible for it. In many parts of Europe the responsibility falls to nuclear medicine — which is considered separate from radiology — but according to Dr. Wolfgang Weber, professor of nuclear medicine at the Technical University of Munich, no standards in the U.S. exist to dictate which area of study it falls under. This, in turn, leads to more problems, with providers unable to acquire the correct infrastructure or set up appropriate training programs for their staff.

“This problem lies partially in the fact that the application of radioisotopes for therapy is not really something that has been in the focus of radiology in recent years in the U.S.,” said Weber. “In Germany, it’s very clear that it’s a study of nuclear medicine, and there are a reasonable number of people who are trained in doing this."

June 2019 Magazine

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