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Theranostics in Neurooncology: Heading Toward New Horizons
Nelleke Tolboom1, Antoine Verger2, Nathalie L Albert3
1Department of Radiology and Nuclear Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.
Abstract:
Therapeutic approaches to brain tumors remain a challenge, with considerable limitations regarding delivery of drugs. There has been renewed and increasing interest in translating the popular theranostic approach well known from prostate and neuroendocrine cancer to neurooncology. Although far from perfect, some of these approaches show encouraging preliminary results, such as for meningioma and leptomeningeal spread of certain pediatric brain tumors. In brain metastases and gliomas, clinical results have failed to impress. Perspectives on these theranostic approaches regarding meningiomas, brain metastases, gliomas, and common pediatric brain tumors will be discussed. For each tumor entity, the general context, an overview of the literature, and future perspectives will be provided. Ongoing studies will be discussed in the supplemental materials. As most theranostic agents are unlikely to cross the blood-brain barrier, the delivery of these agents will be dependent on the successful development and clinical implementation of techniques enhancing permeability and retention. Moreover, the international community should strive toward sufficiently large and randomized studies to generate high-level evidence on theranostic approaches with radioligand therapies for central nervous system tumors.
Insights
Therapeutic approaches for brain tumors face drug delivery challenges. Theranostic strategies show promise for some brain tumors like meningiomas but require larger studies for central nervous system tumors.
Area of Science:
- Neuro-oncology
- Radiopharmaceutical therapy
- Molecular imaging
Background:
- Drug delivery to brain tumors is a significant challenge.
- Theranostic approaches, successful in other cancers, are being explored for neuro-oncology.
- Current theranostic applications in brain tumors show mixed results.
Purpose of the Study:
- To review the current state and future perspectives of theranostic approaches in neuro-oncology.
- To discuss the application of theranostics in specific brain tumor types: meningiomas, brain metastases, gliomas, and pediatric brain tumors.
- To highlight the need for advanced drug delivery techniques and robust clinical trials.
Main Methods:
- Literature review of theranostic applications in neuro-oncology.
- Analysis of preliminary clinical results for various brain tumor entities.
- Discussion of challenges and future directions, including drug delivery and clinical trial design.
Main Results:
- Theranostic approaches show encouraging preliminary results for meningiomas and pediatric leptomeningeal tumors.
- Clinical outcomes for brain metastases and gliomas have been less impressive.
- Significant limitations exist in drug delivery across the blood-brain barrier.
Conclusions:
- Theranostics hold potential for treating specific brain tumors but require further development.
- Enhanced drug delivery methods and large-scale randomized trials are crucial for advancing theranostic radioligand therapies in CNS tumors.
- Future research should focus on overcoming the blood-brain barrier and generating high-level evidence.
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