Teragnosis' is a medical concept that combines the diagnosis and treatment of diseases. Recently, this technology has proven to be highly effective in increasing the survival of cancer patients. In addition, the development of new materials for theranostic treatments has great potential in the field of personalised medicine. Through personalised solutions, theragnostic therapies could be developed in the field of cancer treatment.
Theragnostic therapies combine diagnostic and screening activities with the treatment of serious diseases such as cancer. In the area of nanotechnology for health, many pharmaceutical companies face high financial pressures due to the expiry of their patents on blockbuster drugs and increased competition for their generics, which could lead to a substantial drop in revenues and increased investment in innovative products.
However, teragnostic therapies are sometimes slowed down because it is not easy to determine the applicable standard when their main mode of action is not obvious, or when two or more components regulated under various regulatory frameworks are involved. It is also due to the international shortage of interdisciplinary teams of medical professionals, especially radiotherapists with additional experience in the field of radiopharmacy, capable of working with standardised and efficient protocols such as those governing the use of radioactive substances. Hence the call for harmonised governance to ensure rapid access to therapeutic solutions.
In search of target receptors
The way teragnostic therapies work is similar to the different imaging techniques used in tumour detection. First, they look for 'target' receptors that can be used to identify the tumour. Scientists often use proteins that are naturally overexpressed in tumour cells in order to correctly differentiate them from healthy cells. Molecules are then designed to specifically fit into these receptors and bind with radioactive markers. Like all radioactive substances, these markers disintegrate by emitting radiation that we can detect from the outside, using devices such as tomographs and gammagraphs. The doses of radioisotopes administered are not dangerous; they are calculated to generate only the radiation necessary for the diagnostic test.
In the case of teragnosis, receptors are first used to identify and localise the tumour. Once the danger has been detected, the same molecules are used to target the therapy in a selective and specific manner. In this case, the radioactive isotopes are not markers, but substances with sufficient energy to attack the tumour and destroy the cancer cells. By using exactly the same targets and carrier molecules, doctors have great confidence in the specificity of the treatment. The radioisotopes will reach only the cancer cells previously identified by imaging, ensuring a high-precision treatment that is much less invasive than alternatives such as chemotherapy.
Experts believe that, very soon, this type of treatment could be adapted to many other tumours, thanks to receptors such as fibroblast activation protein inhibitors, which allow the affinity for different types of malignant cells to be modified. The great interest in this technology was demonstrated in October 2018 after the pharmaceutical giant Novartis invested €1.7 billion in teragnostic therapies with lutetium-177. In 2021, the Swiss company announced very positive results from its phase III clinical trials, where drugs are tested in humans against existing treatments and placebos to ensure the safety and effectiveness of new drugs. A few months later, the US Food and Drug Administration (FDA), which is in charge of regulating new drugs, decided to accelerate the review of these types of theragnostic treatments because of their enormous potential to diagnose, treat and prevent diseases.
Theragnostics is no longer a futuristic technology, it is the present. As medical specialists explain, it is a technology that offers precision and personalised molecular radiotherapy. It is not killing flies with cannons, but attacking the tumour cell directly, putting radiation into it and destroying it without affecting healthy tissues and with hardly any side effects. The results of the first clinical studies are very encouraging, and there is no doubt that this type of treatment could be adapted for different types of cancer and other diseases. Spain is in a privileged position, and could be key to establishing Europe as a pioneer and leader in these therapies.
