by
Lauren Dubinsky, Senior Reporter | June 12, 2017
From the June 2017 issue of HealthCare Business News magazine
“It is common for physicians to use a trial-and-error strategy until they find the treatment therapy that is most effective for the individual patient,” says Baum.
Following chemotherapy, lab testing and CT or MR exams are performed after several weeks or months to determine if the cancer is shrinking. In many cases, the therapy doesn’t work and the patient has to endure another round of chemotherapy.
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“Of course, it is based off of large clinical trials with thousands of patients where you know the drug is working in 70 out of 100 patients,” says Baum. “But if you are the individual patient, no one knows if you belong to the 70 percent or to the 30 percent that are not responding.”
The difference between the standard approach and the theranostic approach is that a test is performed before the therapy is administered. That informs the physicians that the drug will bind to the cancer cell, which means the treatment should be effective.
Baum explains to his patients that the diagnostic radiotracer fits like a key in a lock into the tumor cell, which allows him to predict if the same peptide will carry the therapeutic radioisotope into the tumor cell and kill it.
Neuroendocrine tumors
Each year, about 8,000 people in the U.S. are diagnosed with a neuroendocrine tumor, according to the American Society of Clinical Oncology. These tumors originate in the gastrointestinal tract and frequently localize in the lung, pancreas and small intestine.
The research on treating neuroendocrine tumors with molecular theranostics was pioneered in Europe. The diagnostic compounds are labeled with gallium-68 (Ga-68) and the therapeutic compounds are labeled with lutetium-177 (Lu-177).
"That targets these neuroendocrine tumors and has been shown to be very successful even in delaying disease progression,” says Dr. Johannes Czernin, editor-in-chief of the Journal of Nuclear Medicine and professor in the department of molecular and medical pharmacology and chief of the Ahmanson Translational Imaging division at UCLA.
The physician has the patient undergo a Ga-68-DOTATATE PET/CT exam to see if the target is expressed in the body. If it’s expressed, the patient then qualifies for therapy and is treated with the Lu-177-DOTATATE compound, which is on the market as Lutathera.
To date, major studies investigating this therapy have been published and Czernin expects it to be approved by the FDA later this year.
Prostate cancer
Prostate cancer is far more prevalent than neuroendocrine tumors. The American Cancer Society estimates that there will be about 161,360 new cases of prostate cancer and about 26,730 deaths from the disease this year.
