Theragnostics
In recent years, there has been growing interest in developing therapeutic radiopharmaceuticals for treating various malignancies that express specific receptors on cancer cells. The concept of “Theragnostics” involves combining therapy and diagnostics by using radiopharmaceuticals that target the same receptors on cancer cells. The diagnostic agent, usually a gamma or positron emitter, is used for imaging, while the therapeutic agent emits beta or alpha radiation that binds to the tumor and destroys it. Because the binding is specific to the target receptors, tissue destruction occurs mainly in cancerous lesions, resulting in fewer side effects compared to external radiation or chemotherapy. The Theragnostics principle is illustrated in Figure 1.
Figure 1- Principle of Theragnostics in cancer therapy
Cancer | Target for therapy | Diagnostic scan to confirm target | Therapeutic radio pharmaceutical |
Thyroid cancer | Iodine symporters on thyroid carcinoma cells | Iodine – 131 in low doses |
Iodine – 131 in high doses |
Castration resistant prostate cancer | Prostate specific membrane antigen in prostate cancer cells | Ga-68 PSMA PET CT or F-18 PSMA PET-CT |
Lu-177 PSMA PRRT |
Metastatic or inoperable neuroendocrine tumors | Somatostatin / Octreotide receptors in NET cells | Ga-68 DOTANOC / DOTATATE PET CT | Lu-177 DOTATATE PRRT |