The development and use of theranostics with nuclear medicine provides ample opportunity for nuclear medicine and molecular imaging to become more familiar to the public, and can help grow the local nuclear medicine industry, says South African Society of Nuclear Medicine president Moshe Modiselle.

Theranostics is a treatment strategy that combines therapeutic techniques with diagnostics. It involves a diagnostic test that identifies patients most likely to be helped or harmed by a new medication, and targets drug therapy based on the test results.

Modiselle adds that theranostics can provide the foundation for successful, targeted radionuclide therapy.

While the use of nuclear medicine is becoming more established and recognised in South Africa, there is still an imbalance between private- and public-sector hospitals in terms of the amount of nuclear facilities and the equipment these sectors can access.

Modiselle points out that private-sector hospitals have more access to nuclear facilities and equipment, compared to public-sector hospitals, with the latter mainly having access to it through academic institutions and teaching hospitals.

Owing to this, many hospitals will not have access to such services and medicine, consequently reducing access to nuclear medicine for people who need it for diagnosis of diseases and treatment, he adds.

He emphasises the contribution of the SAFARI-1 research reactor as a commercially used research facility, and its importance to increasing access to these treatments. He adds that if more facilities like this were in operation, more people would have access to nuclear medicine and the theranostics that come with it.

The facility is owned by nuclear company NTP Radioisotopes- a subsidiary of the Nuclear Energy Commission of South Africa - and is based outside of Pretoria.

He particularly highlights the facility’s contribution to conducting clinical trials with and producing radiopharmaceuticals or radioisotopes, which includes the key medical radioisotopes molybdenum-99, together with other radioisotopes such as iodine-131.

It is, however, the production and use of the advanced medical isotope lutetium-177, which can be used in the preparation of radiopharmaceuticals for therapy treatment for neuroendocrine tumours and prostate cancer, which Modiselle says presents the best growth opportunity for the local industry.

An additional facility was built for the production of this isotope, as Modiselle claims that it can contribute to theranostic procedures being used for these diseases.

“While it’s not quite novel, we’ve been doing theranostics for years for cases such as thyroid cancer and benign thyroid conditions, but now there are new and novel traces of these isotopes being used. Many patients undergo traditional therapies, with little to no effect. That’s where we come in with nuclear medicine. We prefer to become involved with and diagnose patients earlier, to have a significant impact on the patient’s management or treatment.”

He claims that recent advances and traces of these radioisotopes have led to their being used for treatments for prostate cancer. The group at University of Pretoria led by Professor Mike Sathekge has also been focusing on targeted alpha therapy and is already showing promising results

“Theranostics is growing. South Africa pioneered this therapy in Africa, and we’re hoping that neighbouring countries will benefit from this. The main benefit, though, is that we can individualise patient management.”

Modiselle explains that this will enable professionals to more accurately determine which patients would be suitable for this therapy and will allow for the specific therapy chosen to be more individually beneficial.

The advantages of this over conventional cancer diagnostics and therapeutic procedures includes improved diagnosis and treatment, reduced patient recovery time, increased survival rates and lower pharmacological toxicity and side effects.

Radioisotopes, such as lutetium-177, can now be produced locally, making access to supply easier, and reducing the cost. He reiterates that this can result in earlier detections of diseases and individualising patient management.

Despite the recent growth of the industry and changing public sentiment around the use of nuclear medicine, Modiselle emphasises the need to market the industry and its benefits.

This is particularly important to grow the industry, as well as attract more professionals to the field, as nuclear-related healthcare professionals are emigrating to other countries.