Theragnostics: A growing trend in molecular imaging
A new rising trend observed at the Radiological Society of North America (RSNA) 2023 meeting was the use of theragnostics as a treatment strategy in oncology. The burgeoning trend in molecular imaging intertwines targeted nuclear medicine therapeutics with a diagnostic imaging agents to both image and treat the patient at the same time.
A handful of vendors on RSNA expo floor showed products to help with tracking theragnostic treatment/imaging exams. This included larger nuclear imaging system vendors such as Siemens Healthineers, which had a dedicated area of their booth for this still largely experimental, but growing area of oncology. These vendors said theragnostics will become a major trend in patient care in the coming years.
Health Imaging spoke with Signify Research medical imaging principal analyst Bhvita Jani, who agrees the emergence of theragnostics is a pivotal take away at RSNA and something on the horizon to watch. She emphasized the transformative potential of theragnostics to propel oncology patient care towards personalization and precision, yielding superior outcomes rather than use of systemic chemotherapy or radiation therapy, which can cause a lot of collateral damage to the body.
"We're seeing the vendors with molecular imaging systems explaining how personalized cancer care is the future, and how these radiotraces can be used for both diagnosis and therapy. And it's really taken cancer care and oncology patient care pathways to the next level with them being much more personalized, more targeted, especially in the more complex cases," Jani explained.
She said the biggest application for theragnostics so far is for prostate cancer, adding how ligands, developed by research centers, can be locally produced within hospitals and tagged with radioisotopes, delivering targeted therapy exclusively to cancerous cells while sparing healthy tissue.
However, despite its promise, the field faces challenges. The complexity arises from utilizing diverse ligands and agents for therapy, including intricate approaches like alpha emitters, which demand a a complex understanding of physics. The necessity for meticulous patient-specific approaches and constant monitoring adds further layers of intricacy.
Commercialization of theragnostics remains primarily within academic settings and high-end hospitals due to cost considerations. Jani notes there is a need for a shift towards mainstream markets, anticipating a potential evolution spurred by more vendors entering this space. United Imaging, in particular, stands out for its strides in pushing molecular imaging solutions, possibly influencing the affordability and accessibility of these systems.
"Within molecular imaging, where we are seeing most of the systems being purchased for theragnostics is still very much in academic settings and very high-end hospitals. So this is at a price point where we have yet to see things shift more towards mainstream markets and commercialization," Jani said.
While the current usage of theragnostics is not significant, Jani added it is a trend that is worth paying attention to because is has the potential to change how many cancer patients are treated in the next decade, and that is why vendors are now trying to get involved with this technology very early on.
Jani said wide use of theragnostics may require the installation of more nuclear imaging systems to keep up with demand, and the expense is more than most centers want to invest in for a technology that is still largely experimental. But, but as the technology matures, she said the price point may of systems may favor new, lower cost vendors in the market, or vendors like China-based United Imaging, which are really pushing their molecular imaging solutions in attempts to break into the U.S. market.
Hospitals are beginning to create theragnostic oncology programs
A handful of academic center hospitals have opened theragnostics clinics in the past few years. Stanford's Department of Radiology opened its Division of Nuclear Medicine and Molecular Imaging’s Theragnostics Clinic in 2021. The clinic allows patients to navigate quickly between clinic consults, SPECT-CT or PET-CT scans, and treatment infusions, in a state-of-the-art facility. The Division of Nuclear Medicine working closely with other disciplines to develop a patient-tailored theragnostics approach to cancer and other pathologies.
UT Southwestern is home to the first Society of Nuclear Medicine Molecular Imaging (SNMMI) designated comprehensive radiopharmaceutical therapy center in North Texas. It is one of only a few medical centers in the area offering theragnostics for specific types of metastatic cancer that fail to respond to conventional treatment, such as chemotherapy.
The center currently treats six conditions and hopes to expand as more targeted agents become available. These include thyroid cancer, prostate cancer, neuroendocrine tumors, metastatic meningioma, pheochromocytomas and paragangliomas, and cancer-related bone pain.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: dfornell@innovatehealthcare.com