Present and future of target therapies and theranostics: refining traditions and exploring new frontiers—highlights from annals of Nuclear Medicine 2021

Excerpt

The first clinical application of nuclear medicine treatments can be dated back to 1936, when John H. Lawrence utilised an artificial radionuclide—phosphorus-32—to treat a case of leukaemia, although earlier reports on the therapeutic use of isotopes can be found in literature [ 1]. Ten years later, Samuel M. Seidlin, Leo D. Marinelli and Eleanor Oshry employed an “atomic cocktail” of iodine-131 to treat a thyroid cancer patient [ 1]. Later on, the use of iodine-131 was expanded to thyroid imaging and benign conditions [ 1], becoming the most widely referenced—and dated—example of theranostics. The basic principle of theranostics relies on the utilisation, for both diagnostic imaging and therapy, of the same radiolabelled agent with a specific metabolic pattern or molecular target. The in vivo visualisation of where the radionuclide will settle and act allows a proper selection of patients who would potentially benefit from treatment [ 2]. This approach offers the invaluable advantage of monitoring its effectiveness and the biological evolution of the disease over time, tailoring treatment to the individual clinical case. Moreover, the ever-expanding knowledge on cancer biology and the identification of new molecular targets increasingly grow the therapeutic applications available, thus making targeted radionuclide therapy the greatest opportunity and challenge in the field of nuclear medicine. …