Theranostics treatments for cancer underway at UCLA Health

Targeted radioactive drugs are used to treat patients with advanced prostate, thyroid and neuroendocrine cancer.
Prostate cancer cells

UCLA Health’s new leading-edge theranostics center that uses targeted radioactive drugs to treat advanced cancer is now open.

The 3,000-square-foot UCLA Health Outpatient Theranostics Center in Westwood is one of the largest clinics in the United States. Part of the UCLA Health Jonsson Comprehensive Cancer Center, it is specifically designed to treat patients with radiopharmaceutical therapy, said Jeremie Calais, MD, PhD.

“We have a state-of-the-art facility,” said Dr. Calais, who is director of the Ahmanson Translational Theranostics Division’s clinical research program. “We are leveraging the expertise of the theranostics team. We participated in the main clinical trials using these agents.”

The center’s first patient received an infusion for metastatic prostate cancer, said Johannes Czernin, MD, professor and vice chair of the Department of Molecular and Medical Pharmacology at the David Geffen School of Medicine at UCLA.

“It’s a signature event for the entire UCLA Health enterprise,” said Dr. Czernin, who is also a JCCC member “It really changes the way prostate cancer and other patients are managed.”

The center, which opened Feb. 13, will mostly treat advanced prostate cancer but will also see people with thyroid cancer and neuroendocrine tumors.

In the coming years, Dr. Calais expects that theranostics could expand to potentially include kidney, breast, lung, pancreatic and liver cancers.

“It’s a booming and expanding field,” he said. “There are multiple new agents and new targets in various cancers being investigated in clinical trials. There will be others.”

What is theranostics?

The term theranostics comes from the words therapeutics and diagnostics. Proteins present on the tumor cells can serve as an anchor for radioactive drugs. Radioactivity can be used to create images with a PET scan that allow doctors to visualize the cancer and then deliver radioactive medicine to kill them.

“It’s the combined use of a therapeutic agent and diagnostic agent that both have the same molecular target,” Dr. Calais said. “You see what you treat and you treat what you see – that’s the concept of theranostics.”

Dr. Czernin said the most novel theranostics treatment available is for metastatic prostate cancer, with a response rate of 40% to 50%.

“It prolongs life and really improves the quality of life,” he said.

For diagnostics, a patient receives an injection of a tiny amount of a radiotracer that can be detected with a PET scanner to show prostate-specific membrane antigen (PSMA) positive lesions. PSMA is overexpressed in prostate cancer. The injected agent binds to cancer cells so they show up as bright spots on a scan.

“The PET scan tells us exactly whether the therapeutic target is there, and how much of it is expressed in the patient,” Dr. Czernin said. “It’s really a new kind of precision medicine.”

For the therapeutics component, eligible patients receive up to six rounds of a radioactive drug, called Pluvicto, that binds to the same protein to kill cancer cells.

“You can monitor how the treatment works by doing imaging,” Dr. Czernin said. “You have immediate results of the therapeutic effects.”

The first patient at the new center underwent his fourth treatment cycle there. For his previous three, which were spaced six weeks apart, he received the Pluvicto infusions in the nuclear medicine clinic.

“His prostate cancer is responding nicely,” Dr. Czernin said. “His PSA is below detection rates now.”

The center, which is in the 100 Medical Plaza building, has eight infusion chairs in separate rooms with radiation shielding. Each treatment room has a private bathroom to prevent radiation exposure to others through urine and stool.

In addition to doctors and nurses, the center includes nuclear medicine technologists and radiation safety specialists.

Eligible patients

Prostate cancer patients need to have completed or attempted chemotherapy to qualify for Pluvicto, Dr. Czernin said. He said men who aren’t responding to chemotherapy after two or three cycles should be promptly referred to the theranostics center. He said no stage is too late for treatment, but it’s ideal to start as soon as possible.

“Once the disease gets too far advanced, treatment gets much more difficult,” Dr. Czernin said. “The referring physicians and patients should know that this treatment is safe. The agent we’re giving is safe. It doesn’t expose their environment to unmanageable amounts of radiation.”

Prior to opening the dedicated center, Dr. Czernin said patients came for theranostics treatment from around the country and internationally. He expects that to continue.

Dr. Calais said wait times are short because the center is so large. The UCLA Health team stays in close communication with the outside referring oncologist, he said.

“The patient will be managed during treatment by both teams,” Dr. Calais said. “After the treatment is done, patients fully return to the referring medical oncologist’s team.”

Treatment is covered by insurance and costs roughly $40,000 per cycle, Dr. Calais said.

Side effects are minimal because the therapy is targeted to the cancer cells and less to healthy organs. Some side effects can still occur. They may last a few days and include: fatigue, nausea, vomiting, bone pain and dry mouth.

“They appear in much less frequency and intensity in comparison to chemotherapy or immunotherapy,” Dr. Calais said.

After treatment, people are advised to take minor precautions for three days until the drug is naturally cleared from the body. For instance, patients should sleep in a separate bedroom from a partner or stay away from pregnant women, babies and young children to avoid unnecessary exposure to low amounts of radiation, similar to an X-ray.

“There’s really no reason to be worried about damaging anyone in the neighborhood or the household or the family,” Dr. Czernin said.

Other theranostics treatment

In addition to Pluvicto, the center offers the prostate cancer treatment, Xofigo, for disease that has spread to the bones. For people with neuroendocrine cancer, Lutathera can often achieve stable disease for many years, Dr. Czernin said.

He said thyroid cancer patients with intermediate or high risk of recurrence after surgery can be treated with radioiodine.

The first patient treated in the center, the man with prostate cancer, was impressed, Dr. Czernin said.

“He couldn’t stop thanking everybody.”

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UCLA Health's theranostics center is among the largest in the country

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