![]() Since the early days of theranostics with radioiodine in thyroid disease, the research and recently clinical use of other theranostic agents have increased dramatically. Theranostics has long been a major player in the history of nuclear medicine, and the list and interest in use of theranostic companions are increasing as we gain more basic knowledge on relevant biologic markers and synthesis of agents that target these biomarkers ( 5). This concept is especially important since there is remarkable molecular heterogeneity between cells in an individual tumor, between cancers of same type, and between primary tumor and its metastases ( 4). The imaging counterpart of a theranostic compound identifies whether and to what extent a particular biologic target is present in a particular disease process, including cancer, to identify those subset of patients who would be anticipated to benefit from the companion therapy agent. This systematic integration of targeted diagnostics and therapeutics is aligned with the concept of personalized precision medicine, which is hoped to lead to improved patient outcome ( 2, 3). The term theranostics is a portmanteau word of “therapeutics” and “diagnostics” that has been coined to refer to agents or techniques that couple diagnostic imaging with targeted therapy ( 1). In this review, the concept, history, recent developments, current challenges, and outlook for radiotheranostics in the treatment of patients with cancer will be discussed. Moreover, regulatory and reimbursement agencies need to streamline their requirements for seamless transfer of the radiotheranostic agents from the bench to the bedside. Continued support will be needed in research and development to keep pace with the current momentum in radiotheranostics innovations. Regulatory approval of a number of radiotheranostic pairs is anticipated in the near future. More recently there have been major exciting strides in radiotheranostics for neuroendocrine tumors and prostate cancer, among other conditions. Radioiodine is the classic radiotheranostic agent that has been used clinically in management of thyroid diseases for nearly 75 years. Radiotheranostics refers to the use of radionuclides for the paired imaging and therapy agents. This strategy leads to enhanced therapy efficacy, manageable adverse events, improved patient outcome, and lower overall costs. The theranostic platform includes an imaging component that “sees” the lesions followed by administration of the companion therapy agent that “treats” the same lesions. Theranostics is the systematic integration of targeted diagnostics and therapeutics. Advances in the understanding of cancer biology, developments in diagnostic technologies, and expansion of therapeutic options have all contributed to the concept of personalized cancer care. The fundamental foundation for precision medicine is accurate and specific targeting of cancer cells. ![]()
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