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The rise of theranostics in nuclear medicine

by John R. Fischer, Senior Reporter | June 24, 2019
Molecular Imaging
From the June 2019 issue of HealthCare Business News magazine

In more ways than one, 2018 was a year of expansion for Novartis International. In January the company completed its $3.9 billion acquisition of nuclear medicine company Advanced Accelerator Applications (AAA), and in October it completed the $2.1 billion purchase of biopharmaceutical enterprise, Endocyte.

But in addition to scaling its company footprint, the Swiss-based pharmaceutical provider expanded its stake in another area — the emerging and promising field of theranostics. With AAA providing it access to its neuroendocrine tumor treatment, 177-Lu-Lutathera, and Endocyte giving it the same for its prostate cancer drug, 177-Lu-PSMA-617.

Interest in theranostics has driven a lot of business activity in recent years and energized not just companies but providers in nuclear medicine in working to develop radiotherapeutic molecules that can diagnose, determine a personalized course of action for, and treat various forms of cancer. The word itself is a portmanteau of diagnostics and therapeutics.
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“The strong growth of radiotherapeutics represented around 14 percent of the total nuclear medicine market in 2018 - up from 3 percent in 2012 – and is expected to represent 60 percent, or even more, of the $26 billion U.S. nuclear medicine market by 2030,” Paul-Emmanuel Goethals, co-founder of MEDraysintell, a business intelligence firm specializing in nuclear medicine, told HCB News. “They are driving the growth of radiotheranostics, and their overall development along with that of conventional therapeutics will boost development of associated PET and SPECT tracers.”

Origins, and where it is today
Although the term was first coined in the 1990s, the concept of theranostics dates back to the 1940s when iodine was applied in both diagnostic imaging and therapy for benign and malignant thyroid tumors.

“You can give someone I-123, and using molecular imaging, you can see where the iodine goes and visualize metastatic thyroid cancer,” said Dr. Thomas Hope, a nuclear medicine physician and associate professor of radiology at the University of California, San Francisco. “Then, you can give them I-131, which has a different type of radiation emitted that can treat the thyroid cancer.”

This practice refers to a specific example of theranostics known as radiotheranostics. While in this scenario the same radionuclide is used for diagnosis and therapy, other forms of radiotheranostics involve different radionuclides paired together with a targeting ligand. One radionuclide is used to image the tumor, while the other is used to treat it.

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