Theranostics: Rapidly Expanding Medical Frontier Combines Precise Molecular Imaging and Targeted Treatment of Cancer to Advance Patient Outcomes

Innovations in Research

Among the latest innovations revolutionizing cancer diagnosis and treatment at University Hospitals is the rapidly advancing field of theranostic radiation therapy. The field employs a multi-disciplinary approach for imaging and targeting specific cancers with radio-labeled treatments.

The use of theranostics is being guided by a team of clinicians and researchers across nuclear medicine, medical and radiation oncology. They are building upon a strong tradition of innovation and leadership in molecular imaging involving University Hospitals and Case Western Reserve University (CWRU) and thriving industry partnerships. Together they are developing and deploying new theranostic technologies and techniques, including novel molecular imaging agents and targeted molecular therapies.

The image-guided therapeutics approach is designed to diagnose and treat cancers at a molecular level, maximizing precision, and minimizing damage or toxicity to healthy tissue. Theranostics combines the use of diagnostic technology, such as Positron Emission Tomography and computed tomography, with the delivery of targeted therapy.

“This is a rapidly expanding area of critical importance in cancer treatment, fueled by new research and continued innovation,” says Donna Plecha, MD, Ida and Irwin Haber and Wei-Shen Chin Chair of the Department of Radiology at University Hospitals Cleveland Medical Center, and Chair and Theodore J. Castele Professor of Radiology at Case Western Reserve University School of Medicine.

There are 12 active theranostic clinical trials underway in the Division of Nuclear Medicine within the Department of Radiology. These are in collaboration with the Department of Radiation Oncology and the Division of Solid Tumor Oncology within the University Hospitals Seidman Cancer Center.

With theranostics, physicians use a radionuclide to image the locations where cancer is present and then target this area with a special form of radiation to eradicate the tumor while sparing healthy, normal tissue throughout the body. This often is combined with external beam radiotherapy to maximize the therapeutic benefit.

“Theranostics gives physicians another powerful tool to deliver targeted radiotherapy for cancer patients, says Daniel Spratt, MD, Chair of the Department of Radiation Oncology at UH Cleveland Medical Center, and Professor of Radiation Oncology at the Case Western Reserve University School of Medicine. He also holds the Vincent K. Smith Chair in Radiation Oncology at UH Seidman Cancer Center and was recently appointed the new University Hospitals Clinical Research Center Medical Director and Associate Chief Scientific Officer. “The theranostics field is growing in importance because physicians now have greater ability to identify the complex biological processes that cause cancer cells to proliferate and predict how they are likely to respond to specific therapies.” The incorporation of artificial intelligence (AI)-assisted technologies is also enhancing diagnostic and treatment precision, leveraging multi-dimensional data, and shedding greater light on treatment effectiveness, according to Dr. Spratt.

Use of theranostics can lead to earlier diagnosis, more personalized treatment, and better outcomes. Many of the theranostic research projects underway at University Hospitals focus on targeting the prostate-specific membrane antigen (or PSMA) to improve cancer diagnosis and treatment. For instance, researchers are laying the groundwork for the development of PSMA-targeted nanoscale ultrasound contrast agents (aka nanobubbles) for biopsy guidance with transrectal ultrasound, to enhance cancer detection.

“We’re certainly leading the way here with clinical trials utilizing these agents, and our scientists are actively creating new radionuclides for the detection and treatment of other cancers,” says Theodoros Teknos, MD, President and Scientific Director at UH Seidman Cancer Center.  “This is a field that is emerging and offers a lot of promise in the future for patients with metastatic cancers of all types.”

For instance, University Hospitals is among the health systems using Pluvicto, an FDA-approved treatment for men with metastatic castration-resistant prostate cancer that have progressed on prior androgen receptor pathway inhibitor. Drs. Angela Jia and `Spratt are leading a multi-center trial evaluating the use of this therapy in men with an earlier stage of the disease aimed to eliminate the need for castration with hormone therapy. This novel trial is the first in the world to combine image-guided stereotactic body radiotherapy with Pluvicto for men with newly diagnosed non-metastatic prostate cancer.

“The combination of targeted external beam radiotherapy with theranostics will be a disruptor in cancer care that we have never seen before. It is well positioned to make some of the greatest strides and progress in decades for patients with metastatic cancer,” says Dr. Spratt.