Theranostics, the combination of ther(apy) and (diag)nostics, aims to develop molecular diagnostic tests and targeted therapeutics with the goals of individualizing treatment by targeting therapy to an individual's specific disease subtype and genetic profile. It can be diagnosis followed by therapy to stratify patients who will likely respond to a given treatment. It can also be therapy followed by diagnosis to monitor early response to treatment and predict treatment efficacy. It is also possible that diagnostics and therapeutics are co-developed (sonotheranostics, immunotheranostics, magnetotheranostics, optotheranostics, radiotheranostics, etc.). This talk will highlight two representative types of theranostics, namely radiotheranostics and immunotheranostics, in cancer imaging and therapy. Some translational work will also be mentioned.
Radionuclide theranostics for precision oncology is being driven by rapid advances in novel diagnostics and therapeutic interventions, with dramatically expanded radiopharmaceuticals toolbox over the last few years. The rapid development and availability of new isotopes and agents has fundamentally changed the landscape for molecular targeted therapy. 177Lu-PRRT lends a significant benefit in progression free survival as well as in overall survival in metastasized and/or progressive NENs as compared to other treatment modalities and regardless of previous therapies. 177Lu-PSMA RLT is safe and effective with appropriate selection and follow-up of patients by 68Ga-PSMA PET/CT applying the concept of theranostics. The initial clinical results of PTRT provide preliminary evidence for the feasibility of radiomolecular precision theranostics using the novel FAP targeted radiolabeled ligands as well as TANDEM 177Lu-/225Ac- and 90Y-/225Ac-FAP of a number of advanced, therapy-refractory adenocarcinomas. Specific uptake and long tumor retention of the radioligands ensure usability of therapeutically effective longer-lived radionuclides for therapy. New strategies and platforms including new targets, novel radionuclides such as alpha emitter (225Ac, 212Pb), tumor microenvironment with optimized ligands and optimal isotopes (177Lu, 225Ac, 90Y, TANDEM) and administration schedules will be systematically explored in the near future.