Theranostics, also known as theragnostics 6, uses a diagnostic examination to determine if a patient may benefit from a specific therapeutic drug and thus couples the therapy with diagnostic information specific for the intended target 2.
Theranostics promises improved patient selection for therapy on the basis of specific molecular features of disease, using information from pharmacogenetics, proteomics, and biomarker profiling to provide a cost-effective targeted management protocol thereby generating a custom-made treatment plan based on the uniqueness of every individual 3.
Selection of patients for any radionuclide (or radioligand) therapy is achieved by the demonstration of adequate uptake in all involved tumor sites in order to deliver a radiation absorbed dose sufficient to accomplish therapeutic goals of symptom or disease control 4.
FDA-approved agents:
iodine-131 for benign and malignant thyroid disease
iodine-131 iobenguane for neuroendocrine tumors expressing the norepinephrine transporter
lutetium-177-dotatate 8 for neuroendocrine tumors expressing somatostatin receptor
lutetium-177-PSMA-617 7 for metastatic prostate cancer (see PSMA theranostics for further discussion)
yttrium-90 ibritumomab tiuxetan for follicular non-Hodgkin lymphoma (NHL)
While not technically a theranostic agent as alpha particles are not imaged, radium-223 dichloride, a radiopharmaceutical for for bone metastases from prostate cancer, is often grouped with these therapies.
History and etymology
It is a portmanteau of the terms "therapeutics" and "diagnostics". Many articles state that the term “theranostic” was coined in 2002 by John Funkhouser 1 ; however it is clear from a simple Pubmed search that an article from 2000 employs this term with a similar meaning 9.
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