[Recent advances in theragnostics and new perspectives in molecular radiotherapy]

Theragnostics represents an attractive approach in nuclear medicine as it combines diagnostics and therapy using the same molecular target by switching gamma- or positron-emitting radionuclides with alpha, beta- or Auger electron emitting radionuclides. Radioligand therapy targeting PSMA and somatostatin receptors already demonstrated a significant clinical benefit with lots of innovative clinical trials looking for new perspectives of efficacy during different moments of the disease history or searching for new therapeutic indications. Looking for effective and simple biomarkers to assess therapy efficacy or detect risk of early relapse, identify the best dosimetric approach and understand complex radiobiological effects are some challenges to approach. New radionuclides have emerged including alpha emitters, such as Ac-225, Pb-212 or At-211; they are currently being evaluated either alone or in combination therapies in several types of cancers in early phase trials. More than 270 clinical trials are at present ongoing in theragnostics, raising new questions and new expectations in the field of nuclear medicine as a precision medicine branch of oncology.