Theranostics Cancer Therapy and Treatment

Theranostics combines "therapy" and "diagnostics" into a single approach, often using the same or similar molecules for both purposes.

What Is Theranostics

Theranostics refers to using a diagnostic test to choose the right treatment for a patient based on their specific disease characteristics. This method is particularly common in personalized or precision medicine, where treatments are tailored to an individual's unique biological profile.

In nuclear medicine, theranostics uses radioactive medications given through a vein, also called radiopharmaceuticals, which are drugs that contain a radioactive substance. For example:

• Diagnostic imaging: A radiotracer is used in imaging scans to take images of organs and body functions involved with a specific disease, such as cancer. This allows the health care team to see tumors or metastases (cancer that has spread) using positron emission tomography (PET) or SPECT imaging.
• Therapeutic treatment: The same or a similar radiotracer delivers a therapeutic dose of radiation directly to a tumor, effectively treating the disease.

This combination of diagnostics and therapy allows more precise treatments, because the same molecule identifies the disease and delivers the therapy. Theranostics often reduces side effects and improves outcomes.

Cancers Treated by Theranostics 

Theranostics is currently used to treat several types of cancers, primarily those that can be targeted with specific radiopharmaceuticals. Within our health network, we use theranostics to treat neuroendocrine tumors (NETs) and prostate cancer.

Neuroendocrine Tumors (NETs) Treatment

NETs start in the neuroendocrine cells found throughout the body. Like nerve cells, they gather messages, and like endocrine cells, they release hormones.

• Theranostic Approach: A radiolabeled somatostatin analog is used with diagnostic imaging (with PET) and for therapy.
• Imaging: Gallium-68 DOTATATE or Copper-64 dotatate is used with PET/CT to see tumors.
• Therapy: Lutetium-177 Dotatate (Lutathera) delivers a therapeutic dose of radiation to a tumor.

Prostate Cancer Treatment 

• Theranostic Approach: Prostate-specific membrane antigen (PSMA)-targeting agents are used for imaging and treatment.
• Imaging: Gallium-68 PSMA or Fluorine-18 PSMA PET/CT is used to find metastatic prostate cancer.
• Therapy: Lutetium-177 PSMA is used to treat advanced or metastatic prostate cancer, delivering targeted radiation to PSMA-expressing cancer cells.

Will Theranostics Cure Cancer?

Theranostics does not cure cancer, but it can have a significant role in controlling and managing certain types of cancer, especially when the disease is advanced or hard to treat with traditional methods. Its main contributions are in targeting cancer cells more precisely, reducing tumor size, slowing disease progression and improving quality of life.

How Theranostics Works 

Theranostics treats cancer by combining diagnostic imaging and targeted therapy into a single, integrated approach, using specialized molecules within medicines called radiopharmaceuticals.

Targeting Cancer Cells 

Theranostics begins by identifying specific molecular targets that are unique or overexpressed on the surface of cancer cells. These targets could be receptors, antigens or other proteins that distinguish cancer cells from normal cells.

Radiopharmaceuticals (molecules tagged with radioactive isotopes) are designed to bind to these specific targets. The same or a very similar molecule can be used for imaging and therapy, but the radioactive isotope differs based on the purpose.

Diagnostic Imaging

In the diagnostic phase, a radiopharmaceutical with a radioactive isotope designed for imaging is injected into a patient’s bloodstream through a vein. Imaging medications (agents) linked with Gallium-68, Fluorine-18 or Copper-64 (for PET scans) are used. Once injected, these agents travel through the body and bind to cancer cells that express the target. The agents give off signals that imaging technologies like PET or SPECT scans can detect. This allows doctors to see the cancer's location, size and spread (metastasis) precisely.

Personalized Treatment Planning

Information from the diagnostic scan helps personalize the treatment plan, determining the exact extent of the disease and identifying patients who are likely to benefit from targeted therapy. The same target the imaging agent binds to will be used for therapy, but with a therapeutic isotope.

Targeted Radiotherapy 

Once we have a diagnosis and identify the extent of the cancer, we give a radiopharmaceutical tagged with a therapeutic isotope through an IV into the patient’s bloodstream. These therapeutic isotopes deliver localized radiation therapy. Examples include Lutetium-177, which emits beta particles, and Actinium- 225, which emits alpha particles. These particles travel a short distance in the body, ensuring the cancer cells are affected, while minimizing damage to surrounding healthy tissue.

Localized Radiation Delivery

The therapeutic radiopharmaceutical binds to the same molecular targets on the cancer cells and delivers a precise dose of radiation directly to the tumor. This kills or damages cancer cells, while minimizing radiation exposure to normal, healthy cells. Compared to traditional forms of radiation therapy, this localized radiation therapy reduces side effects.

Monitoring and Adjustments

After treatment, there may be more diagnostic imaging to evaluate how well the cancer has responded to the therapy. 

What to Expect With Theranostics

Theranostics treatment is typically well-tolerated, but it involves careful preparation, monitoring and follow-up. Follow your care team’s instructions. They will help you manage side effects, maximize the effectiveness of the treatment and minimize potential risks.

Consultation with Your Health Care Team

Your doctor or nuclear medicine specialist will explain the purpose of the treatment, how it works and what to expect. Ask your care team if you have the option of a virtual consultation. Our care team will also review your medical history, current medications and overall health. Make sure to ask about the specific radiopharmaceutical that will be used, potential side effects, how the treatment will be given and how it may affect your daily life.

Your doctor may evaluate whether or not you are a good candidate for theranostics based on factors such as tumor type, previous treatments and overall health.

Pre-Treatment Testing 

You will have diagnostic imaging scans (such as PET/CT or SPECT) to find out if your cancer cells express the target molecule needed for theranostics. These scans help confirm that the treatment will be effective. You will probably need routine blood tests to check your overall health, including kidney, liver and blood functions. Some radiopharmaceuticals are eliminated through the kidneys, so your health care team will want to make sure your body can handle this process. Women of childbearing age will need to take a pregnancy test, as the radiation involved in theranostics could harm a fetus.

Adjust Medications

Inform your health care team about all medications and supplements you are taking. They may ask you to stop taking certain medications that could interfere with the treatment or imaging process. 

Hydration and Diet

Drink plenty of fluids before and after treatment to help flush the radiopharmaceutical out of your system after therapy. Depending on the type of theranostic treatment, you may be asked to fast for several hours before the procedure. Your care team will give you specific instructions.

Preparing Emotionally and Physically

It’s normal to feel some anxiety before and during the procedure, but your medical team will be there to support you and answer any questions. Being well-informed about the treatment can help reduce anxiety. Discuss any concerns or fears with your care team and ask for resources to help you cope with the emotional aspects of cancer treatment.

Make sure you have a support system in place — friends, family or a health care team — to help you through preparation, treatment and recovery stages. By following these steps, you can ensure that you’re prepared emotionally and physically for your theranostics treatment, leading to the best possible outcomes.

The Day of the Procedure

When you arrive at the hospital or treatment facility, you’ll go through a standard check-in process. You may be asked to confirm your personal information and go over any last-minute questions about the procedure. Your medical team may also give you a quick review of the procedure, ensuring you understand everything. You may be encouraged to drink fluids before the procedure, as staying hydrated helps your body process and eliminate the radiopharmaceutical more effectively.

Administration of the Radiopharmaceutical

The radiopharmaceutical will be administered through an intravenous (IV) injection or infusion, depending on the treatment. The procedure is typically painless, similar to getting a standard injection. For example, in PSMA therapy for prostate cancer or Lutetium-177 DOTATATE for neuroendocrine tumors, the radiopharmaceutical is injected into a vein in your arm.

The care team will monitor you closely while the radiopharmaceutical is given to ensure there are no immediate side effects. 

After the radiopharmaceutical is given, you will be monitored for any immediate complications. During this time, you can relax in a treatment room. 

After the Procedure

You might feel tired or have mild side effects afterward. Plan to rest for the day. 

Your body will naturally eliminate the radioactive material through urine, stool or sweat. Drinking plenty of fluids helps speed up this process.

Radiation Safety Instructions

Some treatments may require you to avoid close contact with others, particularly young children and pregnant women, for a few days due to radiation exposure. Your care team will give you detailed instructions on how to minimize radiation exposure to others after treatment. This may include:

• Avoiding prolonged close contact with others
• Sleeping in a separate bed
• Using separate bathroom facilities, if possible
• Washing clothes and utensils separately

The length of time you need to follow these precautions depends on the type and dose of the radiopharmaceutical. Your doctor will give you specific instructions based on the treatment.

Prepare for Side Effects

Depending on the type of theranostics treatment, you may experience side effects such as: 

• Fatigue: Feeling tired is common and may last for a day or two.
• Nausea and vomiting: You may feel mildly nauseated, but your care team will give you medications to help you.
• Dry mouth or eyes
• Bone marrow suppression
• Kidney function changes
• Radiation-induced damage to other organs (rare)
• Allergic reactions (rare)

Your care team can provide medications or strategies to manage these symptoms. Staying hydrated and resting after the procedure can help manage fatigue or mild discomfort. Be sure to report any side effects.

Post-Treatment Follow-Up

Your doctor will schedule follow-up appointments to monitor your response to the treatment. This may include more imaging studies or blood tests to evaluate how the cancer is responding. Talk to your care team about virtual follow-up appointments.

Theranostics treatments often require long-term monitoring. In some cases, patients need multiple cycles of theranostic therapy, depending on how the cancer responds. Your health care team will discuss future treatment options with you based on your progress.

Long-Term Risks of Theranostics

Long-term risks from theranostics are rare but can happen, especially if you need multiple treatment cycles. The most serious long-term risks are usually related to complications from the radiation.

Monitoring and long-term follow-up with your health care team is critical. Follow-up blood tests will monitor blood counts, organ function (especially kidneys and liver) and overall health.

• Bone marrow damage (chronic suppression)
• Secondary cancers (very rare) — This risk is generally low, and the benefits of treating the primary cancer usually far outweigh the potential for secondary cancers.
• Organ damage
  • Kidneys: Long-term kidney damage may happen, especially if the kidneys are heavily affected in expelling the radiopharmaceuticals.
  • Liver: Some radiopharmaceuticals may affect liver function over time.
• Fertility issues — Talk to your care team about steps to take to preserve your fertility
• Chronic fatigue

Balancing Risks and Benefits

While there are short- and long-term risks with theranostics, these treatments are generally safe and effective — particularly for managing cancers that are hard to treat with conventional methods. The benefits, such as targeted tumor destruction and improved survival, often outweigh the risks, especially for patients with advanced or metastatic cancers.

Your health care team will carefully weigh these risks against the potential benefits of the treatment and will monitor you closely to minimize complications. Regular follow-up is crucial to managing any long-term risks effectively.

Theranostics: Froedtert & MCW Advantages

Our multidisciplinary team includes nuclear medicine physicians, radiation oncologists, medical oncologists, physicists, dosimetrists and advanced practice providers. Having close, seamless collaboration among these experts ensures you get personalized and well-rounded care. 

You will have access to the latest radiopharmaceuticals, including new drugs for emerging cancers — all delivered with cutting-edge imaging technology in state-of-the-art facilities.

A dedicated theranostics care coordinator will help you with scheduling, insurance, radiation safety protocols and managing side effects after treatment — so you can focus on recovery. We provide thorough pre-treatment consultations during which you and your family are educated on how theranostics works, what to expect during treatment and how to manage any side effects. We offer resources like printed guides and one-on-one counseling.

Radiation Safety Excellence

We offer the highest standards of radiation safety protocols for you and your care team. This includes advanced shielding and isolation rooms when necessary and providing clear guidance on radiation precautions after treatment.

Because we offer the largest cancer clinical trials treatment program in Wisconsin, you have access to clinical trials that may expand your treatment options. We stay on the cutting edge by quickly adopting new radioligand therapies as they become available.

Exceptional Patient Experience

We offer a streamlined patient experience through our new patient coordinators, who gather your medical records for you and arrange appointments, tests and other support. Our fast-track pathways minimize the time between diagnosis and treatment. Reducing delays in imaging, diagnosis and starting treatment improves patient satisfaction and outcomes.

Theranostics is available at our Froedtert Hospital campus in Wauwatosa, Wis. You have the option of a virtual consultations for initial discussions and follow-ups to make your treatment more convenient, especially if you are traveling a longer distance from home. We offer a warm, supportive and patient-centered environment, and we continuously gather patient feedback and use it to improve our quality of care.