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Theranostics in surgical oncology
S Stättner1, Kjetil Soreide2, Julie Hallet3
1Hepatobiliary Center, Department of General and Visceral Surgery, Kepler University Hospital GmbH, Linz, Austria; Johannes Kepler University, Medical Faculty, Linz, Austria.
Abstract:
Theranostics is a method where molecules that target surface structures in tumors are coupled with different radioisotopes, allowing them to bind to tumor cells for detection (diagnostic) and elimination (therapeutic). In the case of neuroendocrine tumors (NET), peptides targeting somatostatin receptors (SSTR) are most commonly used for this purpose. These peptides are, for example, coupled with 68Ga for diagnostic and 177Lu for therapeutic purposes. This allows SSTR-positive tumors to be detected with high sensitivity and treated effectively, which is particularly beneficial in cases where surgery (alone) is not feasible. However, theranostic procedures can also be used to guide surgical procedures or - in the context of a neoadjuvant approach - increase resectability. Other therapies currently in development aim to increase antitumor effectiveness or aim to combat tumors which are resistant to other radiopharmaceutical therapies (RPT) using new isotopes and SSTR-targeting peptides or combining RPT with other drugs. Modern radiological diagnostics, as well as the production and use of radiopharmaceuticals, require costly equipment and specialized procedures and are therefore not accessible to most patients around the world. However, the expansion of the repertoire of studied and approved theranostics promises to make these highly effective treatments available to more patients. The following review intends to provide an overview of current questions about theranostics with relevance to surgical oncology.
Insights
Theranostics combines tumor-targeting molecules with radioisotopes for cancer detection and treatment. This approach, particularly using somatostatin receptor (SSTR) targeting peptides, offers effective diagnostics and therapy for neuroendocrine tumors (NET).
Area of Science:
- Nuclear Medicine
- Oncology
- Radiopharmaceutical Therapy
Background:
- Theranostics couples targeting molecules with radioisotopes for dual diagnostic and therapeutic applications.
- Somatostatin receptor (SSTR) targeting peptides are crucial for neuroendocrine tumor (NET) theranostics, utilizing isotopes like 68Ga (diagnostic) and 177Lu (therapeutic).
Purpose of the Study:
- To review current theranostic applications and emerging developments in surgical oncology.
- To highlight the potential of theranostics in improving tumor detection, guiding surgery, and enhancing treatment efficacy, especially for difficult-to-treat or resistant tumors.
Main Methods:
- Review of current theranostic strategies utilizing SSTR-targeting peptides.
- Exploration of novel radiopharmaceuticals, isotopes, and combination therapies in development.
- Discussion of the role of theranostics in surgical oncology, including neoadjuvant approaches.
Main Results:
- SSTR-targeted theranostics enable high-sensitivity detection and effective treatment of SSTR-positive NETs.
- Theranostics can guide surgical interventions and improve tumor resectability.
- Ongoing research focuses on overcoming resistance and enhancing antitumor effectiveness through new isotopes and combination therapies.
Conclusions:
- Theranostics, particularly with SSTR-targeting agents, significantly benefits NET management.
- Expanding theranostic options promises wider accessibility and improved outcomes for more patients globally.
- Theranostics holds considerable promise for advancing surgical oncology and personalized cancer care.
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