Theranostics and Clinical Trials for GI Cancers

Transcript

00:00 --> 00:03Funding for Yale Cancer Answers is
00:03 --> 00:06provided by Smilow Cancer Hospital.
00:06 --> 00:08Welcome to Yale Cancer Answers
00:08 --> 00:10with Doctor Anees Chagpar.
00:10 --> 00:11Yale Cancer Answers features the
00:11 --> 00:13latest information on cancer care
00:13 --> 00:14by welcoming oncologists and
00:14 --> 00:17specialists who are on the forefront
00:17 --> 00:18of the battle to fight cancer.
00:18 --> 00:21This week it's a conversation about
00:21 --> 00:23theranostics and clinical trials for GI
00:23 --> 00:25cancers with Doctor Gabriella Spilberg.
00:25 --> 00:27Dr. Spilberg is an assistant professor
00:27 --> 00:29of radiology and biomedical imaging
00:29 --> 00:31at the Yale School of Medicine,
00:31 --> 00:33where Doctor Chagpar is a professor
00:33 --> 00:34of surgical oncology.
00:35 --> 00:38Gabriella, maybe we can start off by
00:38 --> 00:40you telling us a little bit more about
00:40 --> 00:44yourself and what it is you do.
00:44 --> 00:47I started nuclear medicine basically
00:47 --> 00:50in about 2018 when I went to
00:50 --> 00:53train at Dana Farber in Boston,
00:53 --> 00:57and I didn't know much about it when I first
00:57 --> 01:01got in contact with this interesting field.
01:01 --> 01:05I'm originally from Brazil, and I trained
01:05 --> 01:08previously in Brazil and in Brazil
01:08 --> 01:12this was not something that was
01:12 --> 01:15widely available or
01:15 --> 01:17in practice back then,
01:17 --> 01:20so when I came here and I first
01:20 --> 01:23encountered this field where you were not
01:23 --> 01:26really looking at anatomic structures,
01:26 --> 01:29but you were looking at molecular processes
01:29 --> 01:33and what was happening at the cellular level,
01:33 --> 01:34that really intrigued me.
01:34 --> 01:38And it really changed how you see
01:38 --> 01:41imaging and everything around imaging.
01:41 --> 01:47And then back in 2018 was about when
01:47 --> 01:49one of the big drugs for a neuroendocrine
01:49 --> 01:51cancer was approved.
01:55 --> 01:58When you see that things are
01:58 --> 02:02not really just a visual structure
02:02 --> 02:05but you can see what's happening,
02:05 --> 02:09it just changed my whole conception about
02:09 --> 02:13what imaging could be and what was happening.
02:13 --> 02:17So that's what got me so interested.
02:17 --> 02:21When I decided that there
02:21 --> 02:24was not really a step back into this
02:24 --> 02:27field because this was just the next
02:27 --> 02:30level and what the future will be,
02:30 --> 02:32it was very clear to me that
02:32 --> 02:33this was my path.
02:33 --> 02:37So I stayed at Dana Farber for about
02:37 --> 02:41two years and that's when I really
02:41 --> 02:45had a very extensive experience and
02:45 --> 02:48deep dive into what was happening
02:48 --> 02:51and how these things were done.
02:54 --> 02:59Basically this is when I acquired
02:59 --> 03:02my foundational knowledge.
03:03 --> 03:06Maybe we can take a step back.
03:06 --> 03:08I mean it sounds like this
03:08 --> 03:11is very futuristic,
03:11 --> 03:13forward-looking career path,
03:13 --> 03:16but for our audience,
03:16 --> 03:18maybe you can tell us a
03:18 --> 03:20little bit more about what
03:20 --> 03:22exactly is theranostics?
03:22 --> 03:25Theranostics is when you take an
03:25 --> 03:30agent which has a specific target.
03:30 --> 03:33So let's say for neuroendocrine
03:33 --> 03:36cancers you're looking to somatostatin
03:36 --> 03:39receptors and when you see this target,
03:39 --> 03:42this agent binds into it and
03:42 --> 03:46sends a signal and the signal
03:46 --> 03:48we were able to see where
03:48 --> 03:50the signal is sent from.
03:50 --> 03:54So when you use the same agent
03:54 --> 03:59that you detect a specific cell
03:59 --> 04:01and then you bind into another agent,
04:01 --> 04:06which now has a different behavior and is
04:06 --> 04:09basically a radiation therapy agent and
04:09 --> 04:14we inject the same agent in your vein.
04:14 --> 04:16It again binds into the tumor
04:16 --> 04:18cell that you're targeting and
04:18 --> 04:20now it destroys the tumor cell.
04:20 --> 04:25So the concept of being able to use a
04:25 --> 04:29diagnostic biomarker and translate that
04:29 --> 04:30into a therapeutic agent,
04:30 --> 04:34that's when you get to the theranostics.
04:40 --> 04:43This theranostics concept when you use the
04:43 --> 04:47exact same molecule to look and to
04:47 --> 04:50treat a certain pathology or disease.
04:51 --> 04:53And so that seems to play
04:53 --> 04:56into this whole concept that we've
04:56 --> 04:58talked about on the show previously
04:58 --> 05:00about you know, targeted therapies.
05:00 --> 05:03Usually we talk about targeted
05:03 --> 05:05therapies for chemotherapy or
05:05 --> 05:07immunotherapy where we're looking
05:07 --> 05:09at a particular biomarker.
05:09 --> 05:12But here it sounds like you're delivering
05:12 --> 05:15radiation with the same kind of concept.
05:15 --> 05:16Is that right?
05:16 --> 05:18Yes, that is exactly right.
05:18 --> 05:21So this is a targeted therapy, so you
05:21 --> 05:24choose your target and there
05:24 --> 05:27are a lot of these targets
05:27 --> 05:30being developed in the pipeline,
05:30 --> 05:35and each specific cancer usually will have
05:35 --> 05:40a specific target that you want to reach,
05:40 --> 05:43and the idea is to always
05:43 --> 05:45hit targets which are
05:45 --> 05:47present in cancer cells,
05:47 --> 05:50but not in normal body cells.
05:50 --> 05:55So as we move forward into more
05:55 --> 05:57personalized and better precision therapies
05:57 --> 06:01where when we talk about these words,
06:01 --> 06:04we're talking about things that
06:04 --> 06:06will target the diseased cells
06:06 --> 06:08and not the normal cells.
06:08 --> 06:12And again then you use this target and you
06:12 --> 06:16bind into an agent that is capable of
06:16 --> 06:17delivering radiation,
06:17 --> 06:20and this radiation goes inside the vein.
06:20 --> 06:23It doesn't come from outside of your body,
06:23 --> 06:26as when patients go for radiation therapy.
06:26 --> 06:29It's really injected into the blood,
06:29 --> 06:30just like a blood draw.
06:30 --> 06:33You inject into an IV or when you
06:33 --> 06:35have an infusion and then this
06:35 --> 06:37travels throughout your bloodstream
06:37 --> 06:41and it reaches a target to bind and
06:41 --> 06:43deliver the radiation in a very
06:43 --> 06:46precise way and very controlled way.
06:46 --> 06:49In the exact location that you're
06:49 --> 06:53targeting and this is really where
06:53 --> 06:56a lot of things are trending
06:56 --> 06:59because we're we're looking into
06:59 --> 07:03disrupting the cancer processes without
07:03 --> 07:07influencing the normal cellular process.
07:08 --> 07:09And so when we think about that,
07:09 --> 07:12I mean on the one hand you think, gosh,
07:12 --> 07:14this may really reduce side effects
07:14 --> 07:17because you are minimizing the dose
07:17 --> 07:19that you're giving to normal tissues.
07:19 --> 07:23So presumably you will have less of
07:23 --> 07:26the side effects that are associated
07:26 --> 07:27with treating normal tissues.
07:27 --> 07:29On the other hand,
07:29 --> 07:31the concept of delivering
07:31 --> 07:33radiation through a vein,
07:33 --> 07:35albeit in a targeted way,
07:35 --> 07:38may induce some other side effects.
07:38 --> 07:39So can you
07:39 --> 07:41tell us a little bit more
07:41 --> 07:42about the side effect profile
07:42 --> 07:45of this kind of modality?
07:45 --> 07:49Sure, yes, that is exactly the point.
07:49 --> 07:52When you deliver something in the blood,
07:52 --> 07:54you have a target, but not always.
07:54 --> 07:57The target is only expressed
07:57 --> 07:59in tumoral cells
07:59 --> 08:01or only the target ends up
08:01 --> 08:03in only tumorous cells.
08:03 --> 08:07For example, the kidney filtrates the blood.
08:07 --> 08:09So when you deliver these
08:09 --> 08:11radiation therapies in the vein,
08:11 --> 08:14eventually you will have radiation
08:14 --> 08:17agents crossing through your kidneys.
08:17 --> 08:20So there are side effects related
08:20 --> 08:23to where the cells circulate and
08:23 --> 08:26to other locations that also
08:26 --> 08:29express this type of target.
08:29 --> 08:32That is present in whatever
08:32 --> 08:33therapy you're using.
08:33 --> 08:35So for example,
08:35 --> 08:38the bone marrow receives a certain
08:38 --> 08:41dose of radiation and we control that.
08:41 --> 08:44We know the exact dosage which
08:44 --> 08:47is toxic for the bone marrow.
08:47 --> 08:48And we always,
08:48 --> 08:51when we're looking into our patient
08:51 --> 08:54who is a candidate for these therapies,
08:54 --> 08:57we have to make sure that the
08:57 --> 08:59bone marrow is functional
08:59 --> 09:01enough to receive that.
09:01 --> 09:03And the other issue usually
09:03 --> 09:06is kidney function, which
09:06 --> 09:10we know that as the radiation
09:10 --> 09:12circulates into the blood,
09:12 --> 09:16there is a part of it that will
09:16 --> 09:17end up in the kidneys.
09:17 --> 09:18So we control for that.
09:18 --> 09:21We make sure that the function of
09:21 --> 09:24the kidney and the marrow are within
09:24 --> 09:26as normal as possible or within
09:26 --> 09:29acceptable range to have these therapies.
09:30 --> 09:34Usually the side effects are
09:34 --> 09:37really different from traditional
09:37 --> 09:41chemotherapy as I just mentioned.
09:41 --> 09:43Yeah, and different from
09:43 --> 09:45traditional radiation therapy as
09:45 --> 09:47well because radiation therapy as
09:47 --> 09:50you had mentioned previously is
09:50 --> 09:52generally given from the outside.
09:52 --> 09:55So oftentimes when we give radiation there
09:55 --> 09:58are skin changes and so on and so forth.
09:58 --> 10:00You would think that a lot of
10:00 --> 10:01that would not be present
10:01 --> 10:02when delivering radiation
10:02 --> 10:04from the inside.
10:04 --> 10:06Yes, that's accurate.
10:06 --> 10:10There is a very hypothetical
10:10 --> 10:14risk of you having an infiltration
10:14 --> 10:16as you deliver these therapies.
10:16 --> 10:18So there's a little leakage
10:18 --> 10:20around the vessel that happens
10:20 --> 10:22with this high dose radiation.
10:22 --> 10:23But usually we're very careful.
10:23 --> 10:26We always test the veins, we observe
10:26 --> 10:30as the therapy is ongoing to make
10:30 --> 10:32sure there's no fluid extravasation
10:32 --> 10:34from the veins.
10:34 --> 10:36So usually this is
10:36 --> 10:39a very, very rare complication
10:39 --> 10:42to have any cutaneous effect,
10:42 --> 10:44and that would really be
10:44 --> 10:46related to the infusion itself,
10:46 --> 10:48but usually that's not the problem.
10:48 --> 10:51And then for radiation,
10:51 --> 10:52sometimes,
10:52 --> 10:55for example if you're radiating the lungs,
10:55 --> 10:58you can have the heart very close
10:58 --> 11:00to the lungs and you can have
11:00 --> 11:02some kind of damage to the heart.
11:02 --> 11:06Which is for us when we're doing intravenous,
11:06 --> 11:08that's not really a problem of
11:08 --> 11:11the anatomy of where things are.
11:11 --> 11:13The radiation with the liver
11:13 --> 11:14doesn't travel very far.
11:14 --> 11:17These particles travel very,
11:17 --> 11:21very small range and they really
11:21 --> 11:24are from where they bind,
11:24 --> 11:29the effect is really very local.
11:29 --> 11:31So adjacent organs
11:31 --> 11:36are usually not the problem.
11:36 --> 11:38It sounds like, you know,
11:38 --> 11:42this is really potentially a wonderful
11:42 --> 11:44way of delivering radiation.
11:44 --> 11:47If you can spare adjacent organs,
11:47 --> 11:49you can spare a lot of the
11:49 --> 11:51cutaneous side effects that we
11:51 --> 11:52see with traditional radiation.
11:52 --> 11:55And as you mentioned,
11:55 --> 11:58many cancers these days have potential
11:58 --> 12:01targets and more and more are being
12:01 --> 12:03discovered and developed every day.
12:03 --> 12:07But is this really something that is
12:07 --> 12:10being offered for all kinds of cancers?
12:10 --> 12:13Does it have a role in particular
12:13 --> 12:16types of cancers or is this
12:16 --> 12:18something that is still kind of
12:18 --> 12:20working its way through clinical
12:20 --> 12:23trials or is this actually something
12:23 --> 12:24that's ready for prime time?
12:26 --> 12:30So the first therapy that was approved
12:30 --> 12:33for neuroendocrine cancers in the
12:33 --> 12:36United States happened in 2018.
12:36 --> 12:39So this is something that's been
12:39 --> 12:41widespread and commercially
12:41 --> 12:44available for four years now.
12:44 --> 12:47So it's a new technology even
12:47 --> 12:49though there has been other
12:49 --> 12:53uses in elsewhere in the world,
12:53 --> 12:56particularly Europe and Australia.
12:56 --> 12:59They have been leading places
12:59 --> 13:01for these therapies.
13:07 --> 13:11As we move into more knowledge
13:11 --> 13:16of this latest therapy we
13:16 --> 13:20are just expanding their use.
13:20 --> 13:23So usually how these work is
13:23 --> 13:25they get approved into the end
13:25 --> 13:28of cycle of therapy of a disease
13:28 --> 13:31when patients don't have a lot
13:31 --> 13:34of therapy options and
13:34 --> 13:37then start working the way back
13:37 --> 13:39into looking how these therapies
13:39 --> 13:43do earlier in the disease cycle and then
13:43 --> 13:45by understanding that a little better,
13:45 --> 13:49that's how these get more widely spread.
13:49 --> 13:51So we'll pick up this conversation,
13:51 --> 13:53but first we need to take a
13:53 --> 13:55short break for medical minute.
13:55 --> 13:57Please stay tuned to learn more about
13:57 --> 13:59the role of theranostics with my
13:59 --> 14:01guest doctor Gabriella Spilberg.
14:01 --> 14:03Funding for Yale Cancer Answers is
14:03 --> 14:05provided by Smilow Cancer Hospital,
14:05 --> 14:07where their survivorship clinic is available
14:07 --> 14:10to educate survivors on the prevention,
14:10 --> 14:12detection, and treatment of complications
14:12 --> 14:14resulting from cancer treatment.
14:14 --> 14:18Smilowcancerhospital.org.
14:18 --> 14:21The American Cancer Society estimates that
14:21 --> 14:23over 200,000 cases of Melanoma will be
14:23 --> 14:26diagnosed in the United States this year,
14:26 --> 14:29with over 1000 patients in Connecticut alone.
14:29 --> 14:31While Melanoma accounts for only
14:31 --> 14:34about 1% of skin cancer cases,
14:34 --> 14:37it causes the most skin cancer deaths,
14:37 --> 14:38but when detected early,
14:38 --> 14:41it is easily treated and highly curable.
14:41 --> 14:43Clinical trials are currently
14:43 --> 14:45underway at federally designated
14:45 --> 14:47Comprehensive cancer centers such as
14:47 --> 14:49Yale Cancer Center and Smilow Cancer
14:49 --> 14:51Hospital to test innovative new
14:51 --> 14:53treatments for Melanoma. The goal of
14:53 --> 14:55the specialized programs of research
14:55 --> 14:58excellence in skin Cancer Grant is to
14:58 --> 15:00better understand the biology of skin cancer,
15:00 --> 15:02where the focus on discovering
15:02 --> 15:04targets that will lead to improved
15:04 --> 15:06diagnosis and treatment.
15:06 --> 15:08More information is available
15:08 --> 15:09at yalecancercenter.org.
15:09 --> 15:12You're listening to Connecticut public radio.
15:14 --> 15:16Welcome back to Yale Cancer Answers.
15:16 --> 15:18This is doctor Anees Chagpar,
15:18 --> 15:20and I'm joined tonight by my guest,
15:20 --> 15:22Doctor Gabriela Spilberg.
15:22 --> 15:23We're talking about theranostics
15:23 --> 15:26and clinical trials for GI cancers.
15:26 --> 15:28And right before the break, Gabriela,
15:28 --> 15:32you were starting to tell us about how
15:32 --> 15:34theranostics and in fact many therapies
15:34 --> 15:37find their way into clinical practice.
15:37 --> 15:40So you started by saying that
15:40 --> 15:42usually these are, you know,
15:42 --> 15:45looked at in the setting
15:45 --> 15:48of situations where individuals may
15:48 --> 15:51not have other options and then gradually
15:51 --> 15:55they kind of work them their way into
15:55 --> 15:58not being something of last resort,
15:58 --> 16:00but being more mainstream
16:00 --> 16:03in terms of practice.
16:03 --> 16:05So can you kind of pick up the
16:05 --> 16:08conversation there and tell us a little
16:08 --> 16:10bit more about how theranostics is
16:10 --> 16:12finding its way into clinical practice
16:12 --> 16:15where it's still in clinical trials?
16:15 --> 16:17You mentioned prior to the break that
16:17 --> 16:19this really started with neuroendocrine
16:19 --> 16:22tumors and was approved back in 2018.
16:22 --> 16:25So is it now the case that everybody
16:25 --> 16:27with neuroendocrine tumors are
16:27 --> 16:29being offered theranostics or is
16:29 --> 16:31it still kind of a niche thing?
16:32 --> 16:36So one of the things to realize even
16:36 --> 16:39before that is the administration
16:39 --> 16:41of these therapies are complex,
16:41 --> 16:46they require a multi specialty clinical team.
16:46 --> 16:49And not everywhere that's available.
16:49 --> 16:53So whenever you have that available and you
16:53 --> 16:58have cancers that have indication to therapy,
16:58 --> 17:02that's when these usually are more used or
17:02 --> 17:06if patients are referred to cancer centers,
17:06 --> 17:09which have specifically lines of
17:09 --> 17:13therapies at the moment for GI cancers,
17:13 --> 17:16these are available for gastroenterology,
17:16 --> 17:18pancreatic cancers,
17:18 --> 17:22for example for bronchial carcinoid or
17:22 --> 17:27more rare types of neuroendocrine cancers.
17:27 --> 17:31These are not on label FDA
17:31 --> 17:33approved therapies.
17:33 --> 17:36However, there are initial experiences
17:36 --> 17:40of places who have used them on
17:40 --> 17:43clinical trial basis or off label use,
17:43 --> 17:47so every patient is different.
17:49 --> 17:54Different set of findings and exams and
17:54 --> 17:58genetic mutations and information really.
17:58 --> 18:01And each cancer develops in a
18:01 --> 18:02different way from another.
18:02 --> 18:06So you won't find one cancer that has
18:06 --> 18:09the exact genetic profile as another.
18:09 --> 18:12So these have to be looked at in a
18:12 --> 18:14very individualized way and I think
18:14 --> 18:16that's one of the big challenges
18:16 --> 18:19is always to pinpoint who is
18:19 --> 18:21going to really benefit
18:21 --> 18:22from these therapies?
18:22 --> 18:25So patient selection
18:25 --> 18:28plays a very important role and
18:28 --> 18:31who can really get these therapies.
18:31 --> 18:35These are patients that are usually discussed
18:35 --> 18:37in multidisciplinary tumor boards
18:37 --> 18:40which are meetings where multiple
18:40 --> 18:43specialties of doctors come together
18:43 --> 18:46to look at something and come up with
18:46 --> 18:49a team opinion of what is the best
18:49 --> 18:52approach. These are not usually
18:52 --> 18:55patients with very initial staging
18:55 --> 18:58of disease or very early.
18:58 --> 19:00These are patients who have a history,
19:00 --> 19:03who have had disease for a while or
19:03 --> 19:05when they discover they have disease,
19:05 --> 19:08it's not very localized.
19:08 --> 19:15So any type of systemic therapy
19:15 --> 19:17with theranostics at the moment,
19:17 --> 19:20that's how it's been used.
19:21 --> 19:25It's made its way prime time for
19:25 --> 19:28GI specifically,
19:28 --> 19:31but it's not yet widespread for
19:31 --> 19:34every single type of neuroendocrine
19:34 --> 19:38cancer and we're not there yet.
19:38 --> 19:43There's a lot of pipeline development
19:43 --> 19:47into which better receptors or targets
19:47 --> 19:51we should use and as of this year,
19:51 --> 19:532022, this was recently approved
19:53 --> 19:55for prostate cancer.
19:55 --> 19:58Another agent but the same concept.
20:00 --> 20:04So it sounds like first off,
20:04 --> 20:07there are certain cancers that
20:07 --> 20:10are approved for theranostics and
20:10 --> 20:13others that are not. Why is that?
20:13 --> 20:17I mean if so many cancers have targets
20:17 --> 20:20and as a breast cancer surgeon,
20:20 --> 20:23I'm thinking about certainly breast cancer
20:23 --> 20:26has a number of targets that we use all
20:26 --> 20:30the time in terms of ER and PR and HER II.
20:30 --> 20:32When we think about all
20:32 --> 20:33kinds of other cancers,
20:33 --> 20:36there are similar markers.
20:36 --> 20:39What is it about some markers
20:39 --> 20:42that make them good candidates
20:42 --> 20:46for theranostics and makes other
20:46 --> 20:49markers and other cancers not?
20:50 --> 20:53Well, so specifically for breast cancer,
20:53 --> 20:56I think we will get there,
20:56 --> 20:59we just need a little time.
20:59 --> 21:01So all these processes require
21:01 --> 21:04something called radiolabeling,
21:04 --> 21:07which means you have to attach a
21:07 --> 21:10radioactive particle into these targets
21:10 --> 21:13and radiolabeling is a difficult
21:13 --> 21:16process that not always works
21:16 --> 21:20with any target you need or want,
21:20 --> 21:25but there is a lot of work being done for
21:25 --> 21:29HER 2 targeting and for imaging.
21:29 --> 21:33So it's bringing all these pieces
21:33 --> 21:36of the technology together to make a
21:36 --> 21:39specific agent a good candidate for a
21:39 --> 21:43theranostics pair is what's hard.
21:43 --> 21:46Just this technology
21:46 --> 21:48is very new. If you think about it,
21:48 --> 21:51it was first approved in the US four
21:51 --> 21:53years ago and here we are four years
21:53 --> 21:57later we have a second one in the market
21:57 --> 22:00and there's multiple others in the pipeline.
22:00 --> 22:04And I think also molecular imaging
22:04 --> 22:07requires a lot of structure.
22:07 --> 22:09So you have to have a radio chemist,
22:09 --> 22:13you have to have sometimes a cyclotron.
22:13 --> 22:16Which is where you generate
22:16 --> 22:19these radioactive particles.
22:19 --> 22:20They have 1/2 time,
22:20 --> 22:23which means that they decay every
22:23 --> 22:26one hour 5 hours or 10 hours
22:26 --> 22:286 days depending on the agent.
22:28 --> 22:32Half of what you generated is just gone,
22:32 --> 22:33you don't have it anymore.
22:33 --> 22:37So these technologies are difficult
22:37 --> 22:41to develop and are hard to join
22:41 --> 22:44a big team to work on something.
22:44 --> 22:47So until we get there,
22:47 --> 22:49it's just going to take a while.
22:49 --> 22:51But it doesn't mean that the
22:51 --> 22:53cancers are not suitable.
22:53 --> 22:57It's just the time that the technology
22:57 --> 23:01needs to get to deployment into
23:01 --> 23:04clinical practice and widespread use.
23:04 --> 23:10At the moment we don't have any of
23:10 --> 23:15the newer alpha therapies.
23:15 --> 23:18But the difference between these other
23:18 --> 23:21therapies that we're looking at and
23:21 --> 23:23what's currently approved,
23:23 --> 23:26which is a better meter is basically
23:26 --> 23:28how much damage to the tissues
23:28 --> 23:31surrounding them they can make.
23:31 --> 23:34And alpha therapies are much higher energy,
23:34 --> 23:37which means they have a destruction
23:37 --> 23:39power which is higher than lutetium.
23:39 --> 23:43So these are expected also to
23:43 --> 23:45revolutionize the market and
23:45 --> 23:48how these therapies are used and
23:48 --> 23:50approached because what's currently
23:50 --> 23:51available,
23:51 --> 23:54which is a beta doesn't destroy
23:54 --> 23:57or shrink the tumor as much as we
23:57 --> 23:59were hoping or we would like.
23:59 --> 24:05So there is also this concept
24:05 --> 24:07that is an evolving field.
24:07 --> 24:10This is not a mature field at all.
24:10 --> 24:13There's a lot of knowledge
24:13 --> 24:15that we're still gaining from.
24:15 --> 24:17The deployment of these therapies,
24:17 --> 24:20the prostate cancer therapies
24:20 --> 24:23specifically was initially approved
24:23 --> 24:26for patients who failed a taxane
24:26 --> 24:29based therapy and yet there were
24:29 --> 24:32results published from a trial
24:32 --> 24:35just recently showing that even in
24:35 --> 24:37patients that don't fail therapy
24:37 --> 24:39but have metastatic disease,
24:39 --> 24:42they do have a benefit on them.
24:42 --> 24:46So oncology trials are trials that
24:46 --> 24:48they long for you to gather
24:48 --> 24:50information enough to understand
24:51 --> 24:53what really is happening.
24:53 --> 24:55And on that point,
24:55 --> 24:57you know in thinking about
24:57 --> 24:59the role of theranostics,
24:59 --> 25:02is it your perception that eventually
25:02 --> 25:05these will replace external beam radiation?
25:05 --> 25:09So standard radiation will now be given
25:09 --> 25:12with the more targeted intravenous
25:12 --> 25:16radiation of theranostics and
25:16 --> 25:17if you believe that that's
25:17 --> 25:18where the field is going,
25:18 --> 25:21do we have the clinical trial data
25:21 --> 25:24to suggest that theranostics is
25:24 --> 25:27equally if not more efficacious
25:27 --> 25:30than standard radiation therapy?
25:31 --> 25:33I don't think we're there yet.
25:33 --> 25:36I think they have complementary use.
25:36 --> 25:38When you're thinking about radiation,
25:38 --> 25:41you're thinking about
25:41 --> 25:43external traditional radiation,
25:43 --> 25:45you're thinking about local therapy.
25:45 --> 25:48When you're thinking about theranostics,
25:48 --> 25:51you're thinking about systemic therapy,
25:51 --> 25:53which are two different concepts.
25:53 --> 25:57So when someone has a small lung nodule and
25:57 --> 26:01you want to target that one small nodule
26:01 --> 26:04and there is no knowledge
26:04 --> 26:06of widespread disease,
26:06 --> 26:09but it's possible that external radiation
26:09 --> 26:13would still be better than intravenous
26:13 --> 26:17radiation because you have some
26:17 --> 26:20side effects, but they're different
26:20 --> 26:23from when we do intravenous radiation
26:23 --> 26:26and then when patients have disease
26:26 --> 26:29that we know that are not localized,
26:29 --> 26:33that they can't have surgery to remove,
26:33 --> 26:35just targeting one location
26:35 --> 26:38is not going to be enough.
26:38 --> 26:40That's when you do systemic
26:40 --> 26:43therapy and you use theranostics,
26:43 --> 26:46which is the same concept as chemotherapy,
26:46 --> 26:48except now
26:48 --> 26:52we're using radioactive chemotherapy.
26:52 --> 26:56It's another term that's been
26:56 --> 26:58used to treat these patients.
26:58 --> 26:59So you're not really looking
26:59 --> 27:01for a localized disease,
27:01 --> 27:03but you're looking for systemic,
27:03 --> 27:06widespread.
27:07 --> 27:08And finally, you know,
27:08 --> 27:11you had mentioned that one of the
27:11 --> 27:14things that's very important is
27:14 --> 27:15thinking about patient selection.
27:15 --> 27:18So are there particular patients
27:18 --> 27:22that are better suited or not
27:22 --> 27:24suited to radioactive chemotherapy
27:24 --> 27:26or this intravenous radiation.
27:27 --> 27:32Yes. So one of the key concepts is that
27:32 --> 27:36whatever target you are looking at,
27:36 --> 27:38the patient has to have high
27:38 --> 27:40expression of the target.
27:40 --> 27:43So for example, a neuroendocrine patient
27:43 --> 27:46when we do lutetium dotatate specifically,
27:46 --> 27:50which is the therapy that's approved,
27:50 --> 27:53we are targeting somatostatin
27:53 --> 27:56receptor Type 2.
27:56 --> 28:00So if the disease they have
28:00 --> 28:02doesn't really express significant
28:02 --> 28:05density of those receptors,
28:05 --> 28:10then those patients are not great
28:10 --> 28:12patients for that therapy,
28:12 --> 28:15great candidates because you're not going
28:15 --> 28:17to be targeting whatever they have.
28:17 --> 28:21So having the target overly expressed
28:21 --> 28:25in the disease is really key here
28:25 --> 28:28and that's looked at by using the
28:28 --> 28:31diagnostic agent with PET CT.
28:32 --> 28:34Doctor Gabriela Spilberg is an assistant
28:34 --> 28:36professor of radiology and biomedical
28:36 --> 28:39imaging at the Yale School of Medicine.
28:39 --> 28:41If you have questions,
28:41 --> 28:43the address is canceranswers@yale.edu,
28:43 --> 28:45and past editions of the program
28:45 --> 28:48are available in audio and written
28:48 --> 28:49form at yalecancercenter.org.
28:49 --> 28:51We hope you'll join us next week to
28:51 --> 28:53learn more about the fight against
28:53 --> 28:55cancer here on Connecticut Public Radio.
28:55 --> 28:57Funding for Yale Cancer Answers is
28:57 --> 29:00provided by Smilow Cancer Hospital.

Information

Theranostics and Clinical Trials for GI Cancers with guest Dr. Gabriela Spilberg December 25, 2022 Yale Cancer Center visit: http://www.yalecancercenter.org email: canceranswers@yale.edu call: 203-785-4095