Theranostics

Theranostics is described by some as the therapeutic equivalent of a ‘smart homing missile’ to seek and destroy cancer cells. It is an innovative approach using peptide receptor radionuclide therapy (PRRT) to seek out and destroy cancer cells. PRRT uses molecules that preferentially attach to the receptors on cancer cells to locate and deliver a dose of radiotherapy directly into the tumour site – exploiting the vulnerability of the cancer to detection and attack from its own signalling mechanisms.

At GenesisCare, our Theranostics service uses the radioactive isotope ⁶⁸Gallium PSMA, or 2nd generation ¹⁸Flourine PSMA radionuclide, which provides a suitable alternative to ⁶⁸Gallium PSMA, to identify and diagnose cancerous targets via tumour receptors in PET-CT imaging. It then uses a second radioactive isotope, to treat them using PRRT. If the tumour receptors are visible on a PET-CT scan, the isotope can travel directly to the main tumour and any metastatic sites where it delivers a dose of radiation and destroys the cancerous cells, while avoiding healthy tissues.

A complete Theranostics diagnostic and treatment pathway is provided as an outpatient service in our purpose-built facilities including the latest generation PET-CT scanners. We produce our own radionuclides in our on-site radiopharmacy in Windsor.

Our Theranostics treatments are offered as outpatient appointments in our state-of-the-art therapy suites at our centres in Windsor and Surrey, and are typically delivered in up to four to six cycles, with each treatment lasting between three to four hours.

The service is provided by an experienced multidisciplinary team of nuclear medicine experts, including nuclear medicine physicians, physicists, imaging professionals and a dedicated radionuclide therapy nurse. Patient safety is a priority and we have a robust clinical governance framework, requiring a continuous process of peer review and credentialing, with protocols based on best practice from world centres of excellence.

A specialist radionuclide therapy nurse and a nuclear medicine physicist are available to support and answer any questions throughout the treatment. We also provide dedicated support via telephone for any post treatment questions. GenesisCare is proud to be in the top 1% of healthcare providers worldwide and we consistently achieve a net promoter (patient satisfaction) score over 95%.

This information is for healthcare professionals only.

Radium-223 therapy is proven to reduce pain and improve quality of life in metastatic castration-resistant prostate cancer (mCRPC) patients with painful bone metastases who have had or aren’t suitable for docetaxel and can also help some men live longer lives¹.

Radium-223 therapy is a targeted alpha therapy for mCRPC and is recommended by NICE². It is also called Radium-223 dichloride therapy or Xofigo (Bayer AG). We offer this targeted treatment at our specialist outpatient oncology centres in Oxford , Windsor and Surrey

Nuclear medicine plays an increasingly important role in the management of patients with mCRPC and we know how important quick access to treatments is. We aim to treat patients two weeks from referral to help reduce pain and improve their quality of life as soon as possible. This two-week time period is how long it takes to order and receive the specified dose required for each patient from the manufacturer.

Radium-223 therapy uses a radioactive isotope, Radium-223, to deliver radiation to cancer cells in the tumour microenvironment while minimising toxicity to surrounding tissues.

Radium-223 is a calcium mimetic and is therefore taken up by areas of increased bone turnover in skeletal metastases. The short range of the alpha radiation means damage to nearby healthy tissues is limited making it an effective and more targeted therapy than chemotherapy. This is a step-change in how these patients have been treated in the past.

Radium-223 therapy is normally given as a course of up to six treatment cycles that are each four weeks apart, and is administered in our specialist outpatient cancer centres in Oxford , Windsor and Surrey.

Around two weeks after each treatment cycle, we’ll conduct a blood test and a consultation (either in person or using our remote consultation using our Telehealth videoconferencing platform) with the patient to ensure it is safe to continue treatment without unnecessary risks of severe side effects.

Our consultants make treatment decisions based on multiple factors including the patient’s wellbeing and comorbidities. A patient may be eligible for Radium-223 therapy if they:

• Have had hormone treatment that is no longer working
• Have either had or aren’t suitable for docetaxel
• Have cancer that has spread to bones but not other organs
• Experience bone pain

Exclusion criteria:

• Patients who have cancer that has spread to other organs such as the liver or have large amounts of cancer in their lymph nodes. In these patients with visceral metastases, ¹⁷⁷Lutetium PSMA therapy, another innovative form of Theranostics available at our centre in Windsor and Surrey, may be offered to these patients.
• Patients with faecal incontinence, due to the risk of exposing other people to radiation when handling soiled clothing.

Side effects of Radium-223 therapy aren’t usually serious. Patients may experience a temporary reduction in blood cell production (anaemia, thrombocytopenia, neutropenia, pancytopenia, leukopenia or lymphopenia) as well as fatigue and some patients may also have:

• Diarrhoea
• Vomiting
• Nausea
• Injection-site reactions
• Generalised bony aches and pain or a pain flare

Our Theranostics team will continue to follow up with the patient’s health and wellbeing by phone or email during and after their treatment and will be available by phone if there any concerns or serious side effects.

To ensure radiation safety for our Radium-223 patients and others, we provide each patient with information regarding hygiene practices, fertility and sexual precautions, and a treatment record to carry with them at all times and when traveling abroad until advised not to.

We carry out treatments in dedicated take-up or chemotherapy rooms that have been set-up to provide a radioactive intravenous medicine within our specialist cancer centres. We also have additional infection-control measures in place to limit risk to patients and staff within our centres. Find out more about our COVID-19 safety measures.

Our dedicated team is highly skilled and specially trained to manage Radium-223 treatments safely and compassionately. We have clinical nurse specialists and expert nuclear medicine nursing support to deliver high-quality and patient-centred care throughout the treatment pathway.

As a global company, we have access to many of the latest evidence-based innovations and techniques from around the word that are proven to make a difference to patient’s lives. We have implemented international best-practice processes in our Theranostics service to optimise care provision, minimise referral to treatment time and improve patient experience.

A randomised double-blind placebo-controlled trial (ALSYMPCA) compared Radium‑223 with placebo in people with hormone-refractory prostate cancer with painful bone metastases¹. In the trial, Radium-223 was found to prolong overall survival with favourable safety in patients with metastatic castration-resistant prostate cancer and symptomatic bone metastases compared with placebo. Median survival across 921 patients was 14.0 months in the Radium-223 group vs 11.2 months in the control group (HR 0.70, CI 0.55-0.88, two-sided P 0.002). Radium-223 therapy was also associated with low myelosuppression rates and fewer adverse events.

A significantly higher proportion of patients in the Radium-223 group had a meaningful improvement in their quality of life during the treatment period when compared to the placebo group according to their FACT-P score (25% vs. 16%, P = 0.02).

94% of patients in the Radium-223 group vs 97% in the control group had treatment-emergent adverse events (TEAEs) during treatment and up to 12 weeks after the last injection. Three year safety data shows that Radium-223 remained well-tolerated, with low myelosuppression incidence and no new safety concerns^3.

We know that painful bone metastases can have a profound impact on patients’ and their families’ quality of life. Bone metastases can affect mobility, cause fatigue, and make it difficult for patients to carry out their usual daily activities.

While Radium-223 therapy aims to improve quality of life by slowing disease progression and reducing pain, we also offer personalised wellbeing therapies that have been shown to ease cancer-related concerns at no extra cost to patients or their insurers. This is made possible through our unique partnership with the Penny Brohn UK charity. Every GenesisCare patient is offered access to a range of therapies, such as acupuncture, massage and counselling, to support them throughout this challenging time.

We welcome enquiries and referrals for Radium-223 therapy.

enquiries@genesiscare.co.uk

References

1. Parker C, Nilsson S, Heinrich D, Helle S, O’Sullivan J, Fosså S et al. Alpha Emitter Radium-223 and Survival in Metastatic Prostate Cancer. New England Journal of Medicine. 2013;369(3):213-223.
2. Radium-223 dichloride for treating hormone-relapsed prostate cancer with bone metastases | Guidance | NICE [Internet]. Nice.org.uk. 2021 [cited 23 February 2021]. Available from: https://www.nice.org.uk/guidance/ta412
3. Parker C, Coleman R, Sartor O, Vogelzang N, Bottomley D, Heinrich D et al. Three-year Safety of Radium-223 Dichloride in Patients with Castration-resistant Prostate Cancer and Symptomatic Bone Metastases from Phase 3 Randomized Alpharadin in Symptomatic Prostate Cancer Trial. European Urology. 2018;73(3):427-435.