PET-Based Personalized Management in Clinical Oncology: An Unavoidable Path for the Foreseeable Future

Conventional chemotherapy treatment for cancer tends to show severe systemic toxicities like hair loss (alopecia), anemia, diarrhea, edema and loss of appetite. Radiopharmaceuticals emerge in the management and treatment of cancer since last two decades due to their ability of emitting radiations which aids in visualizing tissues or infected cells accurately in human body with minimal toxicity. Currently, many radionuclides are identified or developed with specific biological activity towards various types of cancer such as lung, brain, breast, bone, etc. Combination of radiopharmaceuticals with chemotherapeutics, targeting antibodies or peptides results in theranostic system suitable for targeting tumor cells. The present review article focuses on nanotechnology-based radiolabeled theranostic systems like metallic, polymeric, silica, liposomes and dendrimers in the management of cancer at pre-clinical and clinical stages. In brief, methods for radiolabeling to nanoparticles and imaging techniques such as positron emission tomography, single photon emission computerized tomography, computerized tomography, molecular magnetic resonance imaging and fluorescence are also described. The examples given in this review article strongly recommended that nuclear medicine in combination with nanomedicine can provide a new way for diagnosing and treating cancer patients with lesser side effects.

The extensive interest in magnetic nanoparticles (MNPs) has been increasing owing to their biocompatibility, superparamagnetism, tuneable sizes and shape, high chemical stability, lower toxicity, high specific surface area, enhanced programmed cell death, and options for functionalization. The functionalized or ligand conjugated MNPs act as a multifunctional and noninvasive vehicle in targeted drug delivery and diagnosis applications. The magnetic properties of these nanostructures allow the control of the location and orientation of MNPs by varying the direction of the applied external magnetic field. Here, we primarily discuss the significant magnetic properties of MNPs and then review their recent biomedical applications in the cancer therapy and theranostics with certain in vitro, preclinical, and clinical experiments. The diverse bio-applications of MNPs based nanocontainers include drug delivery, magnetic hyperthermia, magnetic bioseparation, and various interesting imaging modalities. In addition, the surface stabilization and the functionalization necessities of the MNPs are reviewed.

Radiomics – the high-throughput computation of quantitative image features extracted from medical imaging modalities- can be used to aid clinical decision support systems in order to build diagnostic, prognostic, and predictive models, which could ultimately improve personalized management based on individual characteristics. Various tools for radiomic features extraction are available, and the field gained a substantial scientific momentum for standardization and validation. Radiomics analysis of molecular imaging is expected to provide more comprehensive description of tissues than that of currently used parameters. We here review the workflow of radiomics, the challenges the field currently faces, and its potential for inclusion in clinical decision support systems to maximize disease characterization, and to improve clinical decision-making. We also present guidelines for standardization and implementation of radiomics in order to facilitate its transition to clinical use.

Emerging advances in nanoparticle-based molecular imaging and therapeutic systems have great benefits in the biomedical applications. Accordingly, the functionalized metal nanohybrids (NHs) may contain different types of homing agent (e.g., antibody, peptides, aptamers, etc.), imaging agent (e.g., radionuclides and fluorophores), and targeting agent. These advanced NHs can be used for targeted diagnosis and therapy of different diseases such as various malignancies. Besides, the recent progress in the field of imaging modalities such as single-photon emission computed tomography (SPECT) and positron-emission tomography (PET) has highlighted the importance of the multifunctional radiolabeled hybrid NPs (RHNPs). These advanced NHs, as theranostics, offer great capability for simultaneous prognosis, visualization/monitoring, and treatment of diseased cells/tissues in various malignancies. Of these NHs, radiolabeled nanosystems appear to provide significantly improved clinical outcomes. In this chapter, we will discuss the use of gold nanoparticles (AuNPs), magnetic nanoparticles (MNPs), and their hybrid nanoparticles (Au-MHNPs) as radiolabeled nanoparticles for targeted diagnosis and therapy.