How 'theranostics' can help treat cancer patients

Ian Bolland spoke to James McArthur, MD of GenesisCare about the cancer treatments it offers.

GenesisCare currently treats one in three cancer patients in Australia and expanded its presence to the UK in 2014 through an acquisition of a network called Cancer Partners.

Outlining the company’s vision, McArthur said: “We want a patient to enter the eco-system from primary diagnosis and only leave if they’re having an in-patient or acute surgical procedure or we’ve treated their cancer.”

The company offers a course of treatment called theranostics – a combination of therapy and diagnostics – which typically acts as a next-line treatment to the more conventional methods of tackling cancer.

Currently it’s in high-volume use for targeting prostate cancer, and McArthur explained there’s research showing it can be used for lung and breast cancers, as well as other tumour groups.

McArthur said: “This treatment was born out of nuclear medicine. You have imaging which basically illuminates on a scan and highlights the areas of micro-tumour cells. This enables you to see on a patient scan very difficult or hard-to-see tumours. Theranostics does the same as a PSMA scan.

“For those patients who been through multiple lines of therapy – so they’ve had surgery, radiotherapy, multiple rounds of chemotherapy in some cases and relapsed - theranostics provides a unique opportunity to give those patients a second chance.

“I’m pretty sure, in time, as the diagnostic provision advances, targeted therapies like this, the combination of radioactive isotope with that tracer, creating that honing missile, will target not only prostate cancer but also other forms which is really exciting.”

As part of its prostate cancer treatment, GenesisCare offers a water-based gel aimed to offer better quality of life called SpaceOAR.

The gel is inserted in between the rectum and the prostate of the patient and dissolves over a number of months.

McArthur explains its uses, saying: “It essentially creates this spacing between the rectum and prostate which means that when you deliver radiation there’s less toxicity – or a remarkable decrease in toxicity to the surrounding healthy tissue.

“Because you’ve created that spacing between the two walls you reduce the standard side effects of things like rectal bleeding, pain, incontinence and all of the difficult side effects that come with radiotherapy.

“Spacing gels are placed between the prostate and the rectum to provide a protective shield for the rectum against the radiotherapy beam. The gel is easily inserted during a short procedure and stays in place while the patient undergoes prostate radiotherapy treatments to protect the healthy organs at risk. Patients who have spacing gels inserted report fewer long-term side effects to their bowel, as well as minor improvements to their urinary and sexual functions and an overall improvement in quality of life.”

McArthur also commented on a new technology that GenesisCare is bringing to the UK as part of its 10-year partnership with the University of Oxford’s Department of Oncology. This partnership will enable NHS patients most in need of treatment to use the MR Linac– which has already been installed at the GenesisCare centre in Oxford - as part of the University’s trial programme.

The technology is an upgrade to current radiation therapy, allowing patients to be treated quicker than over 20 days, with McArthur suggesting they could be treated within a week - and in some cases in one day.

“Where the market is going is where we can use an MRI scanner that is built into the linear accelerator – a combo machine basically, which can take real-time images at MRI resolution, which is much clearer. You can see soft tissue definition and so on.

“At the same time, you’re delivering the radiation which means we can see the whole anatomy in real-time as we deliver radiation.

“That’s a game-changer for radiotherapy because it means that the patient, who is clearly stressed about their cancer, can come into a GenesisCare clinic on Monday, be consulted, be treated, and finish their treatment within five sessions.”