What Is Theranostics in Cancer Care? (video/podcast)

For decades, chemotherapy and radiation have been standard treatments for cancer. While they can be highly effective at destroying cancer cells, they can also harm healthy cells in the organs and tissues around the tumor. Additionally, patients often experience significant unwanted side effects that can make it difficult to tolerate treatment.

A newer type of radiation therapy called theranostics offers more personalized and precise treatment of cancer cells with fewer side effects. In this video, San Diego Health host Susan Taylor talks with Nikunj Patel, MD, a radiologist at Scripps Clinic, about this promising approach to treating some types of advanced cancer.

Theranostics is a combination of two terms: therapeutics and diagnostics. It uses unstable variants of elements called radioisotopes that release radiation.

During the diagnostic phase, radioisotope molecules are used to create images of a patient’s tumor. The radioisotope molecule is injected into the patient’s arm and circulates through the body, finding and attaching to the cancer cells. Using technology, such as a PET scan, the physician can view precise images of these cells to determine if they can be effectively targeted.

If the patient is a good candidate for theranostics treatment, a therapeutic version of the molecule will be injected to target and kill the cancer cells.

“Theranostics targets cancer cells in multiple areas simultaneously,” says Dr. Patel. “We call it the medical ‘smart bomb’ because we’re not affecting all the cells in body — just the ones that are the cancer cells. It’s not affecting the healthy cells.”

Moreover, after the therapeutic molecule is administered, physicians can visualize the radiation’s effect on the cancer cells. This allows them to determine how much therapeutic radiation actually reaches the cancer cell and how well it works. This type of precise tracking is not possible with other forms of radiation therapy.

“We are able to then image the patient and identify how many more cells are left that we need to treat,” Dr. Patel says. “We can individualize it for each patient and adjust the dosing for each patient accordingly.”

Theranostics is currently used to treat several types of cancer, including pancreatic cancer and prostate cancer, that have advanced to a later stage.

“Theranostics is an option when cancer has spread outside of the prostate gland or the pancreatic gland and is in other organs or elsewhere in the body,” explains Dr. Patel. “If the cancer is localized to just the prostate or the pancreas, then there are other therapies that may be used prior to this one.”

When theranostics was first introduced, it was approved for use only after patients had tried chemotherapy without success. Now, because it has been proven to target cancer cells so precisely and is well-tolerated by patients, theranostics is approved for use before chemotherapy.

Patients receive six theranostics sessions in six-week intervals. Because the total amount of radiation is lower than with other radiation treatments, there are usually fewer side effects. Some patients experience fatigue, which may last up to a week after treatment. Depending on the organ treated, there may be GI symptoms or dry mouth.

“We do have to monitor patients’ blood work, but overall it’s a treatment that is very well tolerated,” explains Dr. Patel. “It is very easy to administer and, more importantly, we can use this technology to actually see where the cancer cells are in the body and what’s left to be treated. It's a very specific therapy that really is going to change how we treat cancer in the future.”

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