How Theranostics Could Impact the Future of Prostate Cancer Treatment

With current clinical trial results creating “a lot of excitement” in the field of theranostics, Dr. Phillip J. Koo believes Food and Drug Administration (FDA) approval of this treatment method could offer a potentially curative option for patients with prostate cancer.

Koo, the chief of diagnostic imaging at Banner MD Anderson Cancer Center in Phoenix, recently spoke with CURE® about how patients – some with metastatic disease – are experiencing “amazing” responses with this treatment modality that uses one radioactive drug to identify the cancer and a second to treat it. If cleared for use in this patient population, theranostics offers not just another solid option, but could also pave the way for further trials in other disease states, too.

Transcription:

CURE®: What potential does theranostics have as a treatment option in prostate cancer?

Koo: I think there's a lot of excitement because a lot of those single-site trials have shown in some patients this amazing response on imaging, and amazing response with regards to their PSA levels. So, their PSA values might go from hundreds or thousands to maybe even undetectable, or their imaging scans might go from seeing all these different metastases throughout the body, to then no longer seeing them. So, you can see how visually, you know, a picture speaks 1000 words. Visually, it creates this excitement that creates a lot of hope, that something like this can really make a huge difference. And again, that's kind of why we need to sort of see the data to really understand where it best fits. For the time being, the studies have really looked at it in later-stage patients, patients who have metastatic castration-resistant disease and have received two to three lines of therapy already. And there are patients who will definitely respond. And there might be some patients who don't.

And that's another question we need to figure out. How do we know who the patients who will respond are and who the patients who won't respond are, because that's another important piece as well, because we do not want to have patients undergo this therapy and potentially suffer from any side effects or adverse events if it's not going to benefit them. So, I think when you look at the PSA response and the imaging response, it creates a tremendous amount of hope for those patients who will respond to this therapy.

Where do you see this field in terms of future development?

No. 1, we're hoping that the data from the VISION trial gets presented in maybe mid-2021. And if (those) data (turn) out to be positive, you know, clearly proves that it's good for patients, we're hoping that maybe it receives FDA approval soon after that, and then it could be distributed to patients, perhaps late 2021 or 2022.

That's just the beginning. That is what allows for this drug to get FDA approval. But that's just only step one, you know, (steps) two, three and four (involve) even more trials, testing this in, you know, a variety of different disease states, testing it in combination with other drugs, testing it perhaps earlier in disease, maybe someone with metastatic hormone sensitive disease, someone who actually, at the first moment they get a diagnosed with metastatic prostate cancer, maybe they would benefit from this, and maybe it have an even longer lasting effect, where potentially, if you give it up front, you might be able to cure a patient.

So, you could imagine that there's going to be even more questions that need to be answered.The potential applications of this could increase exponentially in the future as well.

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