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Recent advances in theranostics and challenges for the future.

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  • 11 Faculty of Health and Medical Sciences, The University of Western Australia , Perth, WA , Australia.

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Theranostic nuclear oncology, using targeted radionuclide therapies like 68-gallium/177-lutetium-DOTA-octreotate, shows promise for neuroendocrine tumors and prostate cancer. Further controlled trials are needed for regulatory approval and wider clinical adoption.

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Area of Science:

  • Nuclear oncology
  • Theranostics
  • Oncology

Background:

  • Theranostic nuclear oncology is advancing, with the NETTER-1 trial providing Level 1b evidence for 68-gallium/177-lutetium-DOTA-octreotate in mid-gut neuroendocrine tumors.
  • Phase 2 studies show promise for 68-gallium/177-lutetium-prostate specific membrane antigen theranostics in metastatic castrate-resistant prostate cancer.

Purpose of the Study:

  • To review recent theranostic advances and discuss strategies for establishing an evidence base for regulatory approval and reimbursement.
  • To highlight the potential for personalized, tumor-targeted molecular theranostic management of various cancers, including prostate cancer and non-Hodgkin lymphoma.
  • To emphasize the goal of improving cancer patient survival and quality of life through theranostic nuclear oncology.

Main Methods:

  • Review of recent theranostic advances and clinical trial data.
  • Discussion of strategies for clinical trial design and collaboration.
  • Exploration of the role of multidisciplinary collaboration in advancing theranostic nuclear oncology.

Main Results:

  • Established Level 1b evidence for the efficacy and safety of 68-gallium/177-lutetium-DOTA-octreotate in neuroendocrine tumors.
  • Encouraging results from Phase 2 studies of 68-gallium/177-lutetium-PSMA theranostics for advanced prostate cancer.
  • Identified the need for controlled clinical trials to support regulatory evaluation and reimbursement.

Conclusions:

  • Theranostic nuclear oncology is nearing clinical adoption, driven by positive trial data for specific cancer types.
  • Controlled clinical trials are crucial for regulatory approval and integration into routine cancer care.
  • Multidisciplinary collaboration is essential to realize the full potential of theranostic nuclear oncology for improved patient outcomes.