What is theranostics?
Theranostics is an innovative approach to treating that combines two components – one designed to detect cancer cells, and the other to destroy them.
The field is relatively new, but already three IHI projects are tackling it from various angles to try to see how this innovative approach could become a gamechanger for people with aggressive cancers with poor prognoses.
How does it work?
There are many different theranostics techniques. One form involves radionuclides, also known as radioisotopes, which are particles that emit energy. They are used to target and kill cancer cells, but there are some advantages and disadvantages tied to each.
For instance, some particles excel at attacking cancer cells but can be easily blocked or deflected. By attaching these particles to other molecules that are skilled at finding cancer, scientists can ensure that the attacking particles are delivered to where they are most effective. This is also better for the patient because it means that fewer healthy cells run the risk of being caught in the crossfire.
What is IHI doing to accelerate it?
Two IHI projects are directly looking at how to improve specific types of theranostics treatment for cancers that are resistant to existing therapies, while a third is focused on how to improve the European infrastructure more broadly so that the EU can become a world leader in theranostics.
What is ACCELERATE.EU doing?
“Accelerate.EU focuses on cancers with poor prognosis and limited treatment options, offering the potential for higher therapeutic precision and efficacy with reduced side effects,” says Anne Royer Moës of IBA RadioPharma Solutions, who is leading the project from the industry side.
The idea is to develop radiotheranostic pairs in which the therapy part features the radioactive isotope astatine-211 (211At). This isotope releases alpha particles, which are more successful at slipping past the defences of resistant and highly aggressive cancers than other treatments, including those that rely on beta and gamma particles or chemotherapy.
“The project will provide new therapeutic options for patients with currently limited treatments,” says Royer Moës. “Astatine-211 allows for precise destruction of cancer cells with minimal damage to healthy tissues — improving both efficacy and quality of life for patients.”
The project’s next steps will be to set up a pilot study whereby 211At is applied to suppress secondary tumour formation in recurrent brain cancers, which will start midway through 2026. A phase I study focused on breast cancer is planned for 2027.
What is ILLUMINATE doing?
The ILLUMINATE project focuses on a specific radiopharmaceutical called Lutetium-177-PSMA (Lu-177-PSMA), which is used to treat prostate cancer that has spread to other organs and become resistant to treatments such as hormone therapy.
However, the treatment doesn’t work well for everyone. About 30% of patients don’t benefit from Lu-177-PSMA, but by the time that clinicians realise this, they have usually already undergone a course of therapy. ILLUMINATE aims to make it easier to pinpoint who will benefit and who won’t, using a new technology called metabolic Magnetic Resonance Imaging (metabolic-MRI).
Metabolic-MRI can be used to rapidly and repeatedly assess tumour persistence and treatment response, and to visually highlight the characteristics of a tumour and determine how it responds to Lu-177 treatment.
“New imaging will inform patients early on whether their treatment is or will be effective. Treatments will be more personalised; the imaging will allow patients to have information to make decisions regarding the continuation or discontinuation of their treatment,” says Astrid Janssens of UMCU, who leads ILLUMINATE’s work on patient and public engagement and education for healthcare professionals.
In addition, the project wants to deliver improved manufacture methods which will minimise the risk of shortages. The raw material used to make Lu-177-PSMA, Ytterbium-176, is scarce and only a handful of suppliers worldwide have the facilities to manufacture Lu-177. ILLUMINATE aims to improve the different steps in the Lu-177 production process, and develop a new process for the recycling of Ytterbium-176.
The consortium is currently preparing a clinical trial involving 150 patients to validate its integrated metabolic-MRI and theranostics approach. Going forwards, the project plans to upscale metabolic-MRI technology, optimise Lutetium-177 manufacturing, and launch the clinical study in 2026.
What is Thera4Care doing?
Thera4Care is focused on improving the European ecosystem as a whole for theranostics, to help position Europe as a global leader in the field. To do this, the project has identified several key challenges: how the manufacture and supply of radiotheranostics can be strengthened, how the delivery of treatments to healthcare facilities can be optimised, and how cancer models for studying theranostics in the lab can be developed. A survey has been launched to determine the state-of-play for theranostics in Europe in 2025, and the results are currently being analysed.
The project will also deliver a comprehensive framework for phase 1 clinical trials of radiopharmaceuticals, as well as delivering AI-based advances in imaging, personalised dosing protocols and establishing a multi-modal oncology platform to help physicians to visualise relevant patient data.
“Thera4Care will offer an European ecosystem for theranostics that could improve the experience and innovation for patients undergoing treatments, both in areas that are already targeted like prostate cancer, but also offering new radiopharmaceuticals that are not already available, like for instance for gynaecological or gastro-enteric cancers," says Salvatore Annunziata of the Fondazione Policlinico Universitario Agostino Gemelli IRCCS, who is the scientific coordinator of Thera4Care.
He also pointed out that strengthening Europe’s capacity to manufacture and use theranostics will add to the union’s health resilience, making us more resistant to future health threats and increasingly aggressive cancers.
“We hope to build up the European Union so that it has the largest theranostics infrastructure worldwide,” he said.
The future of theranostics
The researchers all agree that theranostics can – and will – revolutionise cancer treatment. Here are their views on what a future with theranostic treatments will look like:
“In ten years, theranostics will redefine cancer care,” says Royer Moës. “By uniting diagnosis and therapy, we’ll deliver truly personalised treatments that are precise, effective, and accessible to every patient.”
“The vision in the next years is personalisation,” agrees Annunziata. “We need to go towards personalised treatment, especially where there are poor prognoses for cancers like gynaecological cancer or gastrointestinal cancer.”
“ILLUMINATE envisions a future within the next decade where theranostics becomes a standard of care in oncology, with imaging and therapy fully integrated to deliver truly personalised, effective, and accessible cancer treatment across Europe,” says Sophie Huiskes-Berend, who leads ILLUMINATE's work package on programme management and communications.