Theranostics is a combination of the words, therapy and diagnostics, that refers to a type of cancer treatment. Theranostic pairs are 2 closely related radiopharmaceuticals with similar biodistribution when administered in the human body, one emits a diagnostic radiation that permits imaging and comprehensive cancer staging, the other delivers a therapeutic radiation particle to treat cancer metastases.
The U-M Health Theranostics Program is part of Nuclear Medicine which offers peptide receptor radionuclide therapy (PRRT) Lu-177-DOTATATE (Lutathera™) for treatment of metastatic neuroendocrine tumors and radioligand therapy (RLT) Lu-177-PSMA (Pluvicto™) for treatment of metastatic prostate cancer. The clinic also performs Ra-223 alpha-therapy of bone metastases from prostate cancer, radioiodine therapy for treatment and staging of thyroid cancer, and imaging and treatment of benign thyroid disorders.
The diagnostic radiopharmaceutical is used in conjunction with radiology’s state-of-the-art Positron Emission Tomography (PET) Imaging Center to identify and stage the cancer and confirm suitability of the patient for subsequent treatment.
If the PET scan confirms a targeting of cancer, patients receive intravenous infusions of the therapeutic radiopharmaceutical, and additional imaging is used to confirm response to therapy.
Since its FDA approval in January 2018 the therapy clinic has performed Lu-177-DOTATATE (Lutathera™) treatment of metastatic neuroendocrine tumors. These rare hormonally active neoplasms that I would arise from bowel, colon, pancreas, lung and other organs. Patients with stage IV metastatic neuroendocrine tumor that are progressive and surgically inoperable will have a gallium 68 or copper 64 DOTATATE PET scan to assess for characteristic expression of somatostatin Type 2 receptors. If eligible based on the PET scan Lutathera treatment which is given as up to 4 cycles of treatment with protection of the kidneys with amino acid infusion.
Patients undergo a gallium-68 PSMA PET scan to confirm expression of prostate specific membrane antigen (PSMA), if present this means the patient is eligible for Pluvicto™ treatment with Lu177-PSMA. For patients with stage 4 metastatic prostate cancer who have experienced disease progression after chemotherapy and other treatments, Pluvicto™ which is given up to 6 cycles, could be an option.
Why choose Michigan?
The Division of Nuclear Medicine within radiology has been at the forefront of using radioactive drugs (known as radiopharmaceuticals) for the diagnosis and treatment of several types of cancer for more than 70 years. The program consists of a team of nuclear medicine physicians, nuclear radiologists, radiochemists, nurses, clerical support team, therapy-team technologists, pre-approval group, and radiation safety services (physicist-based), annually performing 150-200 Lu177-DOTATATE therapies, up 130-150 radioiodine therapies, 40+ Ra-223 therapies, 350+ Lu177-PSMA therapies, bone palliative radionuclides, with a nationally recognized dosimetry program. There have been 375 Pluvicto cycles administered from July 2022 to October, 2023.
Not only has Lutathera™ and Pluvicto™ have been available at University of Michigan Health since their FDA approval in 2018 and 2022, respectively, the Nuclear Medicine Division has been also involved in multiple clinical trials with new theranostic agents for treating other types of cancer. The trial Phase 1 Safety and Dosimetry Study of 68Ga-R8760 in Patients with Adrenocortical Carcinoma and Healthy Volunteers is currently screening for participants.
Talk with your care provider to see if Lutathera™ or Pluvicto™ is an appropriated treatment option for your disease progression.