During a recent PW Podcast episode, we spoke with Gil Padula, MD—Chief Medical Officer at Univer- sity Hospitals St. John Medical Center and Clinical Collaborator with NuView Life Sciences—about re- search he’s conducting in the novel field of Theranos- tics, particularly in regard to the care of patients with cancer. Following is a summary of that interview:
Can you explain Theranostics, particu- larly as it pertains to oncology?
In oncology, theranostics looks at what molecules cancer cells express and if we can tag them with radiation. If we can, we can screen at an earlier stage and really target those same peptides or mole- cules in treating the cancer. It offers a two-pronged approach to elucidating what’s best for making treatment right for the patient.
Some cancers express certain molecules. For exam- ple, the VPAC receptor is expressed in a multitude of GU cancers and potentially in breast and endo- metrial cancers. We can potentially screen for those peptides or molecules being expressed to the point that somebody could get a simple urine test that could conceivably show they have prostate cancer, for example. Right now, if you have a diagnosis of prostate cancer, you have to undergo an invasive biopsy. We’d like something less invasive, hope- fully at a lower cost, that can catch patients at an earlier stage, and theoretically, we could use another radiolabeled peptide to treat the cancer. We don’t have clinical trials yet to validate it, but the ultimate goal is to improve life expectancy.
Cancer therapy in general has become more pre- cise, defined, effective, and less invasive, and thera- nostics is the next level on top of that. The VPAC receptor we’re working on is expressed likely in many types of cancers. So, we could hopefully have a very easy, cost-effective screening or testing tool that is available in a multitude of cancers and use that peptide that’s expressed to also treat the cancer, with tagging the peptides with radiation.
Although PET scans are a very advanced form of testing for cancer, they’re not 100% accurate. Inflammation and other processes can mimic can- cer on a PET scan and lead to false positives. While theranostics holds the promise of being significantly less invasive, in no way would I suggest that patients forego standard therapy and instead undergo ther- anostics, which must go through rigorous clinical trials and regulatory approval before it’s ready for “prime time.” Theoretically, theranostics would be used in combination with standard care, but that first needs to be tested in clinical trials. I would say it will be months to years before doctors see this approach enter into clinic. I think we’d begin clinical trial testing in patients with stage IV disease, as this population is often the earliest to enter trials, and if benefits are seen there, we might move into testing in patients with earlier-stage disease.
In the long term, I think we’ll see more therapies that are less toxic, not only in oncology, but in a multitude of rheumatologic, cardiac, and neuro- logic diseases. We’re starting to target disease at the cellular and molecular level, as opposed to the tissue level, getting much more specific with therapies. I think, at the end of the day, we’re going to see ther- apy that is much less toxic and much more specific than what’s available today.