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Oncologists at Nebraska Cancer Specialists
Oncology

Theranostics: The oncologist’s view

Cancer treatment has made tremendous progress in recent years. Learn how the latest advancement in precision therapy offers a path to truly personalized cancer care.
Sophie Gräf
Published on November 29, 2024
At Nebraska Cancer Specialists (NCS), theranostics plays a key role in the treatment of different types of cancer, offering their patients an oncologic home. “I strongly believe that theranostics care should be a service line within a medical oncology practice,” says Samuel Mehr, MD, director of Nuclear Oncology at NCS. “Just as a medical oncology practice would not refer their chemotherapy or immunotherapy patients to outside sources for therapy.”

Leveraging the synergy between diagnostics and therapeutics

Theranostics offers a powerful approach to treating patients with cancer like neuroendocrine tumors (NETs). This cancer care pathway begins by accurately diagnosing and selecting the right treatment for the right patient. Glenda, a 61-year-old NET patient, was referred for theranostics treatment with 177Lu-DOTATATE and benefited significantly from this option.

Glenda‘s theranostics experience

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Diagnostic phase

Glenda began her theranostics journey with a PET/CT scan using a radiolabeled somatostatin analog, which allowed Mehr to assess the tumor’s characteristics and determine how likely it was the therapy would be successful.

“We look at the amount of the DOTATATE, which is the non-radioactive portion of the molecule that accumulates in tumor sites,” says Mehr, explaining the importance of this diagnostic phase. “There’s a direct correlation between how much of the drug gets to tumor sites in the diagnostic scan and how much of the therapeutic drug will get there.”

Highly targeted therapy

After the PET/CT scan confirmed Glenda was eligible, she received infusions with her therapeutic dose of 177Lu-DOTATATE every eight weeks in four sessions. 

This highly targeted therapy delivers radiation directly to cancer cells, offering a precision that minimizes damage to healthy tissue. Each infusion session is delivered over approximately 45 minutes and is preceded by anti-nausea medication and an amino acid infusion to protect kidney function, lasting approximately six hours in total.

Personalized cancer care

To monitor the therapeutic progress and deliver personalized care that optimizes radiation dose to tumors while limiting potential toxicity, the team at NCS uses SPECT/CT imaging to map the distribution of the therapeutic compound at tumor sites. Mehr points out the importance of SPECT/CT for cases like Glenda’s: “It’s useful in patients who have a late, potentially life-threatening manifestation of their neuroendocrine tumor, and that’s liver failure due to hepatic metastases. In those cases, we feel comfortable in determining the quantity of drug that gets to the tumors.

For patients undergoing theranostic treatment for neuroendocrine tumors, SPECT/CT also plays a vital role in avoiding potential misinterpretations. Mehr notes the risk of a phenomenon known as “pseudo-progression,” where tumors may appear temporarily larger on CT scans due to inflammation caused by the radioactive drug. “If it’s misinterpreted as failure, physicians might stop a very effective treatment, depriving the patient of its benefits,” he explains.

Theranostics complements the oncologists' toolbox

By sharing their expertise with other practices, NCS seeks to make theranostics more broadly available—so more patients can benefit from personalized care while staying closer to their homes and loved ones. “We’re working hard with the medical oncology community to encourage medical oncologists to obtain the necessary training and credentials to practice theranostics on their own,” Mehr says. "Just as chemotherapy and immunotherapy belong within the purview of the medical oncologist, so does theranostics."

By Sophie Gräf
Sophie Gräf is an editor at Siemens Healthineers.

Oncology

Theranostics: A cancer patient's perspective
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