Siteman Cancer Center at Barnes-Jewish Hospital and WashU Medicine bring specialists from different fields together to provide a multidisciplinary approach with every treatment for cancer available – including theranostics, a new targeted treatment option that combines diagnostic imaging testing with precise therapy. Sub-specialized WashU Medicine nuclear medicine physicians and radiation oncologists at the Center for Clinical Theranostics Research (CCTR), Division of Nuclear Medicine work together with WashU Medicine researchers at the Mallinckrodt Institute of Radiology (MIR) to provide this advanced treatment option as part of patient care.
Theranostics uses specially engineered radioactive tracers, called radiopharmaceuticals, in combination with advanced imaging techniques, such as PET/CT, SPECT/CT, and PET/MRI. Working together, the two elements not only find and map cancer cells throughout the body, they also serve as a beacon, lighting a path that cancer-destroying drugs can follow with precision.
WashU Medicine nuclear oncologists and radiation oncologists at Siteman are deeply engaged in patient care and work as a collaborative team to manage therapy. This improves treatment results for patients whose cancer didn’t respond to other therapies.
WashU Theranostics is a nationally recognized program by SNMMI and ASTRO. These are two trusted nuclear medicine groups that ensure quality, safety, and consistency for patients receiving radiation treatment. Experts from the MIR’s Division of Nuclear Medicine and WashU Medicine’s Department of Radiation Oncology see and treat Siteman patients.
WashU Medicine researchers at Siteman Cancer Center are leaders in the clinical trial development that led to the progress and approval of therapeutic radiopharmaceuticals for targeted cancer care – Siteman remains one of the few cancer centers that offers this therapy. And researchers have tackled the complex logistics of radiopharmaceutical therapy. This includes safe transport of radiopharmaceuticals, preparation, and administration. That means we can deliver theranostics efficiently to all eligible patients when they need if they are seeking a new path forward with their cancer.
Our Siteman care coordinators – oncology-trained nurses who help with scheduling, finding the right specialist, and guidance – can help you through the process.
Call us directly or submit a form, and we will call you back.
What Is Theranostics?
The term “theranostics” blends diagnostics and therapeutics. This cancer treatment uses radiopharmaceuticals to first confirm the presence of targets on cancer cells. Then, it delivers targeted radiation to cancer cells tailored to a person’s specific cancer type.
In theranostics, radiologists use a matched pair of molecules called a theranostics pair to confirm the molecular target and then deliver the therapy. Theranostics stands out from other radiotherapy methods. While those methods focus only on treatment delivery, theranostics uses precise imaging, too. Techniques like positron emission tomography (PET) and single-photon emission computed tomography (SPECT) help in providing personalized, targeted treatment. These scans also help physicians observe how the therapy distributes within the body and how the cancer cells respond after delivery.
At Siteman, we also use a combination of imaging including PET/CT, SPECT/CT, or a PET/MRI. We regularly use post-therapy SPECT/CT for our radiopharmaceutical therapy patients since 2023. Radiologists use robust dosimetry software and AI tools to monitor radiation levels and understand the effects on patients.
Because theranostics directly targets cancer cells, the side effects of theranostics are generally mild and often have less negative impact on patients’ quality of life compared to other types of systemic therapy. Treatment can ease pain, boost energy, and lessen hormonal symptoms with some cancer types. As a result of these benefits, in many instances, theranostics can also be used as a part of palliative care.
Cancer Types That Benefit from Theranostics
Theranostics treatment looks slightly different from one cancer type to another. In general, though, the concept is always the same: first you will receive imaging; then you will receive the therapy.
WashU Medicine physicians at Siteman hold a bi-weekly multidisciplinary tumor board to bring together experts from diagnostics and therapy to review cases in real time. During tumor boards, imaging specialists interpret disease patterns. All members of the team focus on making these therapies comfortable and safe for patients.
At Siteman Cancer Center, we also use theranostics to treat people who have:
- Neuroendocrine Tumors (NETs)
- Bone metastases
- Pheochromocytoma and paraganglioma
- Specific subtypes of lymphoma, including follicular and B-cell non-Hodgkin lymphoma
- Pediatric neuroblastoma
Further, we offer clinical trials to treat patients who have the following cancers:
- Breast cancer
- Colorectal cancer
- Meningioma
- Uterine/Endometrial cancer
- Ovarian cancer
- Pediatric osteosarcoma
We personalize your treatment to your specific type and stage of cancer. There are a few different types of theranostics that WashU Medicine physicians at Siteman administer:
- Prostate-Specific Membrane Antigen, or PSMA-targeted therapy for patients with prostate cancer
- Peptide receptor radionuclide therapy (PRRT), which is used for patients with NETs
- Radioiodine therapy, which is used for patients with thyroid cancer
- MIBG, or metaiodobenzylguanidine therapy, which is used for patients with pheochromocytoma and paraganglioma
Further, the collaboration Siteman shares with the CCTR and Theranostics Tumor Board has produced multiple clinical trials that evaluate this treatment with other types of cancers. These radiopharmaceuticals are being explored to treat patients with leukemia, brain tumors, liver cancer, melanoma, and breast cancer.
Clinical trials are research studies that help us find new ways to prevent, diagnose, and treat cancer. If you have a rare or complex diagnosis or your treatment path seems uncertain, you might qualify for a clinical trial.
Our team will help you find a study that is right for you. Call us to speak with a Siteman care coordinator.
Siteman’s National Authority in Theranostics
Researchers at Siteman Cancer Center have a strong history of improving nuclear medicine for cancer patients. For theranostics, our breakthroughs trace back to the 1990s. Siteman is one of the few cancer centers that has been involved in all three key clinical trials that approved Lu-177 PSMA 617 (Pluvicto) — today’s main therapeutic radiopharmaceuticals for advanced prostate and neuroendocrine cancers. It is also the leading cancer center in the region with extensive experience in radiation oncology.
The program recently received designation as a Comprehensive Radiopharmaceutical Therapy Center of Excellence (RTCOE) by the Society of Nuclear Medicine & Molecular Imaging (SNMMI). It is also one of the first programs to achieve the American Society of Radiation Oncology’s APeX accreditation for radiopharmaceutical theapy. Having both distinctions is unique to Siteman and signifies leadership in the field, with experience administering multiple radiopharmaceutical therapies, established care teams in specific disease areas, and a focus on research.
Since our physicians have extensive experience administering this treatment, full integration into patient care is simple. That experience directly translates into better patient care and a higher quality of life.
Our core physician leaders in theranostic treatment have more than 50 years of combined nuclear medicine and radiation oncology experience. Additionally, Siteman has over 25 nuclear medicine physicians and radiation oncologists who are authorized to administer this treatment. For patients, that means you have more specialists on hand who will review your case through every step of treatment.
WashU Medicine has established nationally recognized residency training programs in nuclear medicine and radiation oncology, offering advanced training in radiopharmaceutical therapies, signaling more advancements on the horizon. The one-year Nuclear Oncology Fellowship offered by the Division of Nuclear Medicine at Mallinckrodt Institute of Radiology is one of the most advanced training programs in the country.
Your Second Opinion at Siteman
Siteman wants to be your first choice for cancer care, but that might not always be possible. If you have received a cancer diagnosis, started care somewhere else, or are a physician seeking specialized care for your patient, ask us about a second opinion. You can start the process. To make it easy, our care coordinators guide scheduling for yourself or your patient.
Meet Our Theranostics Specialists
WashU Medicine physicians at Siteman Cancer Center not only treat patients with cancer but also design and lead clinical trials that shape the practice of theranostics across the country. Two of our leaders stand out in this field to advance this newer treatment.
Vikas Prasad, MD, PhD
Vikas Prasad leads the theranostics program at WashU Medicine and is a professor of radiology at the MIR. He joined Siteman in 2022 and is an internationally recognized leader in theranostics and molecular imaging, advancing next-generation targeted radiopharmaceutical therapies designed to deliver highly personalized cancer treatment. Before that, he spent over 20 years working on radiopharmaceutical therapy internationally.
Prasad helped launch the SNMMI Radiopharmaceutical Therapy Comprehensive Center of Excellence at Siteman. He is also the program director of the Nuclear Oncology Fellowship and is highly engaged with ECOG-ACRIN, ACR, and SNMMI where he holds leadership positions.
Jeff Michalski, MD, MBA
Jeff Michalski is the Carlos A. Perez Distinguished Professor of Radiation Oncology at WashU Medicine. He serves on the RTOG Foundation Board of Directors and has served as the president and chair of the board of directors to the American Society for Radiation Oncology (ASTRO). These are some of the largest cancer research networks in the United States.
His highly regarded work in radiation oncology focuses on integrating advanced imaging, precision treatment planning, and multidisciplinary cancer care to deliver the most personalized treatment for patients.
Frequently Asked Questions About Theranostics
The role theranostics plays in patient care is rapidly evolving through clinical trials. Several first-line treatment options are close to approval through the FDA, and it is an option for many patients who have limited success with other cancer treatments. Your care team at Siteman—radiation oncologists, nuclear oncologists, and other specialists—will talk with you about treatment options. They’ll help decide if theranostics is the right choice for you. You do not have to face this decision alone.
If your care team chooses this treatment, first, you’ll have a scan. This scan will check if your tumors show the target protein on cancer cells.
One clear advantage of theranostics is its focus on personalized medicine. It tailors treatment to the unique way your cancer cells express themselves. It is highly precise, with radiation targeted primarily where the cancer is. For the vast majority of patients, this means it does not damage healthy cells, which helps reduce negative side effects found in other types of interventions.
Theranostics extends the survival of patients with many different types of cancers – it can significantly shrink tumors and enhance quality of life.
While the risks of theranostics are more mild than chemotherapy, there are still risks and side effects you may experience.
You can expect nausea, fatigue, and a change in blood count. Your doctor will provide anti-nausea medicine during treatment. This helps manage your symptoms. They also take blood tests often throughout the course of treatment to flag them if complications arise.
You may also experience dry mouth, kidney or liver problems, and carcinoid syndrome. If you have trouble breathing, red skin, low blood pressure, a fast heartbeat, or severe diarrhea, call 911 right away for help.
WashU Medicine physicians will monitor you during treatment with great attention. They are here to help if any complications arise.
When you get to the Center for Clinical Theranostics Research, or Radiation Oncology on the lower level of the Center for Advanced Medicine, a therapist or technologist will check you in. Then, they will take you to one of our advanced radiopharmaceutical therapy rooms. After a short visit with one of our radiologists, you will begin treatment.
All of your sessions are performed on an outpatient basis, so you can return home after the appointment is complete.
Your first appointment will be focused on getting a high-quality scan of your cancer physiology. This image will guide the rest of your treatment and is a shorter appointment than the rest of your course. You will take a low-dose radioactive tracer via an IV, then lie on a table as you pass through a PET scanner. This process maps the cells to ensure that the therapy can actually target them.
If your cells exhibit the right traits, you will begin treatment. Each treatment session will involve an infusion followed by a period of observation for a couple of hours, and then you can go home.
Your schedule varies by cancer type. Appointments can last anywhere from a few minutes to a few hours depending on the tumor. The frequency and number of cycles of radiopharmaceutical therapy varies between 4-12 weeks; in some instances, a more personalized approach is needed. Most patients receive four to six therapy cycles, though this can be highly variable. This means your entire theranostics treatment can take anywhere from six to 12 months.
After you return home, you will need to isolate for a few days while your body passes the radiation. Your care team will give you further instructions on how to monitor your care after you leave our treatment center.
Most patients feel tired after treatment but can resume normal activities within a few days after their appointments.
Depending on your treatment, you will receive specific instructions for radiation safety, such as socially distancing yourself for two to seven days so other people are not exposed to radiation. Flush twice and wash your hands well after using the restroom. Also, use disposable utensils and dishes for eating and drinking.
The more liquids you drink, the faster your body will eliminate the radioactive material from treatment. Your care team will give you more details on safely tracking your radiation and side effects. This way, you can return to your normal daily routine as soon as possible.
You will receive treatment at the Center for Advanced Medicine (also known as the CAM), at the CCTR, or on Washington University Medical Campus. The CAM is located on the southwest corner of Forest Park Avenue and Euclid Avenue at 4921 Parkview Place, St. Louis, MO . The CCTR is located at 510 South Kingshighway Blvd, St. Louis, MO 63110.
Cost can be the first worry for newer treatments. Theranostics can be costly. However, most insured patients, including those with Medicare or Medicaid, will have coverage for these treatments. There are also programs that can reduce or cut out-of-pocket costs for others.
You don’t have to face the cost of treatment alone. If you need to explore financial assistance options, reach out to the billing department at WashU Medicine or BJC HealthCare, depending on who sent you the bill. They will let you know all of your options for coverage or payment plans.
Not everyone responds to theranostics in the same way, and our care team is prepared to handle that from the beginning. Many patients report improvements in pain, energy, and quality of life. But if you don’t see the results you wanted, we’ll want to understand why. Then, we can decide if a different approach might work better for you.
At Siteman, you are not facing your treatment alone or with just one doctor. Our specialists meet during tumor board meetings where they review your case to create a plan together as an integrated care team. They examine your medical records, imaging studies, biopsies, and genetic tests to ensure you receive an accurate diagnosis and staging before making any recommendations about treatment.
Yes – at Siteman, we are leading more than 30 active or about to be active theranostic clinical trials across prostate, leukemia, brain tumors, and pediatric cancers. These trials include brand-new investigational drugs and approved agents for new disease states. For patients, that means access to cutting-edge options that might be better than standard therapy.
Your care team will let you know if there is a clinical trial available for your specific cancer and review all your options for treatment.
There are many considerations for pediatric patients that differ from adult treatment. Siteman has a specific pediatric oncology program that collaborates with the theranostics team. This helps keep kids safe and parents informed during treatment.
Pediatric experts from Siteman Kids at St. Louis Children’s Hospital focus on children’s needs. They ensure accurate dosing, safe organ development, and positive future outcomes. Your care team participates in weekly tumor boards to review your child’s full picture and determine the best approach for their cancer.
Some pediatric patients can access FDA-approved theranostic treatments today. For others, Siteman offers clinical trials. These trials provide advanced treatments that you can’t find elsewhere as some of these trials and therapies may require hospitalization. Do not hesitate to ask your care team about clinical trials, and they will review all options for your child’s treatment.
