Worth pointing out that SSTR PET is replacing the ageing Octreotide scan and not conventional imaging (CI).
To confirm the advantages of SSTR PET over Octreotide scans, a study comprising 1,561 patients reported a change in tumour management occurred in over a third of patients after SSTR PET/CT even when performed after an Octreotide scan. Eventually, all Octreotide scans should be replaced with SSTR PET. The quantification of the uptake can help decide whether a patient is suitable for PRRT. These agents have several benefits over In111-pentetreotide (Octreotide scan), including improved detection sensitivity, improved patient convenience due to the 2 hour length of the study (compared to 2 or 3 days with Octreoscan), decreased radiation dose, decreased biliary excretion due to earlier imaging after radiotracer administration, and the ability to quantify uptake. All of them can bind to SSTR2 and SSTR5, while only DOTA-NOC shows good affinity for SSTR3. The main difference among these three tracers (DOTA-TOC, DOTA-NOC, and DOTA-TATE) is their variable affinity to SSTR subtypes. They are collectively referred to as SSTR PET.Ħ8 Ga-DOTA-Phe 1 -Tyr 3 -Octreotide (TOC), Newer imaging agents targeting somatostatin receptors (SSTR) labelled with 68 Ga have been developed, namely, DOTATATE, DOTATOC and DOTANOC. THERANOSTICS – FIND Octreoscan vs Ga68 PET Ga68 PET Theranostics – a step towards personalised medicine – graphic courtesy of Advanced Accelerator Applications. AAA’s pipeline now includes several theranostic drug pairings for oncology indications including prostate and breast cancer and gastrointestinal stromal tumors (GIST). Advanced Accelerator Applications’ theranostic platform is based on radiolabelling a single targeting molecule with either gallium Ga-68 for diagnostic use or lutetium Lu-177 for therapeutic use. Nuclear medicine makes it possible by using the same molecular targeting compound to create diagnostic and therapeutic drugs, which work as theranostic pairings. As mentioned above, the Ga68 PET scan can give a reasonably indication of therapeutic success using PRRT based on measurements taken during the scan (too complex for this article).
the use of the same agent in the diagnostics – the ability to find, estimate likely success criteria and then hopefully destroy – or at least reduce the capability of the tumours and extend life.Ī great example of an approved Theranostic Pair in Neuroendocrine Cancer, is the combination of the Somatostatin Receptor based Ga68 PET scan using NETSPOT or SomaKit TOC™ (US/Europe respectively) and Peptide Receptor Radiotherapy (PRRT) using Lutathera which both target NETs expressing the same somatostatin receptor, with PRRT intended to kill tumor cells by emitting a different kind of low-energy, short-range radiation than that of the diagnostic version. That is the beauty of theranostic pairing, i.e. The nuclear scan uses the same targetin agent as the therapy, therefore if you cancer lights up on the nuclear scan, then the therapy will find its way to the cancer and hopefully work well. When they are found and identified, it’s also really helpful to know from the intelligence gathered, how successful the destroy (therapeutic) part of the mission might be. Moreover, once found, they can then be difficult to treat (destroy), as they can often prove resistant to conventional cancer drugs and many are inoperable due to sheer quantity, spread and positioning. With Neuroendocrine Cancer, finding the tumours (the bad guys) can often be a challenge – they can be small and/or difficult to find – they are sometimes expert at camouflage. The basic aim of theranotistics is to find and then destroy the ‘ bad guys‘. You may also see it conveyed as ‘ Theragnostics’ and these terms are interchangeable. Theranostics is a joining of the words therapeutics and diag nostics. By Ronny Allan 5 Comments Courtesy of Pashtoon Kasi MD on Twitter
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