On the 20th March 2019 the NET Patient Foundation attended the ‘Theranostics is here and now’ meeting, arranged by the Royal Free Hospital and University College London UCL).
The meeting was an update by recognised experts highlighting advances in nuclear medicine imaging and associated PRRT treatments. This whole area of medicine is now termed ‘Theranostics’.
So what is new:
Prof Rodney Hicks from Australia was the first speaker. He talked of the The power of Theranostics – See It Treat It.
He shared the history of radionuclide therapy right back to Marie Curie. He talked about the power of Theranostics and his experience of personalising treatments. You may be used to hearing about the four rounds of treatment, and these are likely to be the same dose. He shared his experience of giving higher dose treatments in the first round and then adjusting doses according to the lesions and their avidity (how bright they are when scanned).
Diagnosis:
Understanding and appreciating the heterogeneity of these tumours (how different each one can be in one person and they can evolve and change over time). By dual scanning with both FDG and Gallium PET scans we can see a clearer picture. This was bought up at ENETs too but there are concerns that this will cost too much to do this.
Treatment:
- Personalised
- Using different radionuclide peptide combinations to optimise therapeutic outcome
- Combination of Yttrium amd Lutathera for bulky disease
- New advances in chemoradionuclide therapy
- When we have whole genome sequencing for a patient we can choose the most appropriate treatment, and in PRRT it seems to be those patients who had damage to DNA repair that responded best
- There are new peptides, and we need to find ways to sensitise cells to make them more receptive to treatments.
The topic about the outcome measures we use currently came up, and the conclusion that we need to do better than progression free survival as a measure of how a patient is doing. We discussed this in our post about ENETs.
PRRT does give meaningful oncological control, and by meaningful we mean the whole person has benefit, not just the size of the tumour. Something we whole heartedly support.
There was also a talk from AAA sharing insights into where they are going in terms of research and development. There was talk of combination treatments with immunotherapy, the next generation of alpha emitters and the need to reimagine nuclear medicine.
One interesting comment was how in some countries they have dedicated clinical trials funded by government, for rare and uncommon cancers! Something to aim for here in the UK?!
The afternoon also covered the use of Theranostics in other cancer types; breast, thyroid and prostate.
