Recent advances in theranostics and challenges for the future.

Recent advances in theranostics and challenges for the future.

Br J Radiol. 2018 Mar 22;:20170893

Authors: Turner JH

Abstract
Theranostic nuclear oncology is on the cusp of adoption into routine clinical management of neuroendocrine tumours (NETs) following publication of the Phase 3 randomized controlled trial, NETTER-1. For the first time, level 1b evidence of efficacy and safety of 68-gallium/177 lutetium-DOTA-octreotatepeptide receptor radionuclide therapy (PRRT), of midgut NETs was established. Multicentre Phase 2 studies of 68-gallium/177 lutetium-PSMA theranostic approaches to management of end-stage metastatic castrate-resistant prostate cancer (mCRPC), are also very encouraging. However, the retrospective uncontrolled data currently available are inadmissible for formal regulatory agency evaluation. The challenge is to engage with oncologists and urologists, and to collaborate with the pharmaceutical industry, to design and perform the controlled clinical trials required for regulatory approval, and eventual reimbursement for theranostic nuclear oncology procedures. Strategies to facilitate timely establishment of an evidence base are considered in this review of theranostic advances over the past year. The prime objective is the provision of novel, effective, safe, personalised, tumour-targeted molecular theranostic management of mCRPC, and other cancers, such as non-Hodgkin lymphoma, which express the appropriate molecular receptor tumour targets. It would also be desirable to offer theranostic treatments at an earlier stage of malignant disease when the benefit is likely to be greater. The ultimate goal of theranostic nuclear oncology is to prolong survival and to improve quality of life for cancer patients worldwide. This may only be achieved through close collaboration between oncologists, nuclear physicians, radiologists, dosimetric physicists, Pharma, and, above all, with the patients themselves, in ways which are explored in this review.

PMID: 29565650 [PubMed - as supplied by publisher]

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