World Theranostics Day celebrates ongoing innovation and advancement in the field of theranostics. It takes place every year on 31 March, in recognition of the day the first radioiodine treatment was administered at Massachusetts General Hospital in 1941. On World Theranostics Day 2022, we explore how theranostics continues to evolve, showing great promise for supporting people living with cancer and other complex conditions, as well as the health systems that care for them.
Theranostics (also known as theragnostics) refers to care approaches which integrate diagnosis and therapy using one molecular target (i.e. the smallest fundamental unit of cellular or tissue structures) for both purposes. For example, theranostics can be used to identify people with certain types of cancer, who would benefit from radioligand therapy, and subsequently to treat them.
In an era where health systems are already overburdened, there is a pressing need to avoid expensive and inappropriate treatments and diagnostic methods. Personalised medicine, aided by theranostics, can play a crucial role in ensuring people only receive the care that they need. This will result in fewer unnecessary invasive procedures, improved monitoring of disease progression and significantly reduced costs to health systems.
Nanotechnology is emerging as an effective tool to improve theranostics. It often uses very small particles, known as nanoparticles, which have a wide variety of formats and structures. These particles can enhance imaging for diagnosis, as well as overcome the limitations of conventional drug delivery approaches by reducing invasiveness and toxicity. Developing less invasive and more palatable treatments is a major focus for cancer care, in particular.
As several of the imaging techniques used for theranostics, such as ultrasound and magnetic resonance imaging (MRI), are already in place many health systems, the cost of integrating these applications into health systems is dramatically reduced.
While personalised medicine is a benefit of theranostics, it is also a limitation. Variation in people’s drug metabolisms (chemical breakdown of drugs in the body), the influence of environmental factors and differences among populations each impact responses to treatment, making it challenging for current clinical frameworks to adopt such a tailored approach. Accordingly, knowledge of the biological challenges of theranostics is continuously evolving and more research is needed to fully understand the potential risks and limitations of this field.
Integrating theranostics into health systems will require systematic change, including specialist training, equipment and regulation. It is also difficult to know how this would impact health spending. Furthermore, the prompt and appropriate integration of theranostics will require clear regulatory and safety guidelines.
Complex manufacturing processes may prevent the smooth transition of theranostics entering clinics. For example, low-yield production systems and variations in the chemical and physical properties of theranostics are key challenges for large-scale production, especially of nanoparticles.
Theranostics has the potential to significantly impact the future of preventive, predictive and personalised medicine. Highly targeted diagnosis and treatment can lead to improved patient outcomes and care, but there are many clinical challenges that must be overcome, such as the industrial scale-up of theranostics production.
The importance of theranostic approaches has been known for decades, yet progress has been slow. As nanotechnology is rapidly growing, it is crucial that we consider how to effectively integrate theranostics into health systems.
Jessica Hooper, Researcher at The Health Policy Partnership