New Initiative for Theranostics and Particle Therapy launched

The University of Wisconsin Carbone Cancer Center is now home to the Initiative for Theranostics and Particle Therapy.

This initiative will foster collaboration between experts across medical oncology, radiation oncology, radiology, nuclear medicine, medical physics and other specialties to accelerate precision radiation therapy and imaging for patients treated through the UW Health | Carbone Cancer Center.

The University of Wisconsin–Madison is the perfect setting for this initiative, according to Dr. Zachary Morris, co-director of the initiative, radiation oncologist at UW Carbone and associate professor of human oncology at the University of Wisconsin School of Medicine and Public Health.

“We have a unique combination of unparalleled strengths here at UW,” he said.

A key focus of the initiative will be translational research, or research that is designed to benefit human health. Investigators will assess how particle beam radiation may be effective to treat cancers that are difficult to treat using conventional radiation therapy, how diagnostic and treatment steps can be combined into a single step referred to as theranostics, and how radiation treatment plans can be personalized for each patient.

Particle therapy: Precision for patients

Depending on location of a tumor or other considerations, traditional radiation methods could expose neighboring healthy tissue to radiation doses that would exceed safe limits. Limiting radiation exposure for children with cancer can also be a goal. In such instances, particle beam radiation may be a preferred treatment.

Some researchers and clinicians with the Initiative for Theranostics and Particle Therapy will focus on particle beam radiation used in, for example, proton therapy, in which radiation travels to a specified depth in the tissue and stops, reducing the delivery of potentially harmful radiation to healthy tissues and sparing patients from some treatment-related toxicities.

Proton therapy will be offered to patients at the UW Health Eastpark Medical Center.

Theranostics: Combining diagnosis and therapy

Targeting tumors typically requires using medical imaging to locate the precise position of a tumor during treatment. If there are many tumors to target throughout the body — in particular, small and microscopic tumors — this can be impossible.

To address this challenge, researchers with the initiative will also focus on radiopharmaceutical therapy, also known as targeted radionuclide therapy, or TRT. This type of therapy involves injecting an agent that selectively delivers radiation to tumors no matter their size or location. These agents have been shown to prolong survival for many patients, including those with certain forms of thyroid, prostate and neuroendocrine cancers as well as pediatric neuroblastoma.

“Investigators at UW are pioneering the development of novel TRT agents and testing these in combination with other cancer treatments like immunotherapies with the goal of curing cancer in patients previously believed to have incurable disease,” Morris said.

Depending on the form of radioactivity attached to the radiopharmaceutical, the same TRT agent can be used not only for cancer therapy but also as a new way to detect and image cancers using advanced technologies such as positron emission tomography, or PET. The combination of PET molecular imaging and TRT provides a powerful tool for both diagnosis and treatment. These agents are called “theranostics” due to this dual therapy and diagnostic role, according to Dr. John Floberg, assistant professor of human oncology, UW School of Medicine and Public Health, and radiation oncologist, UW Health.

“Researchers with the initiative will be doing critically important work to advance the translation of theranostics and particle therapy into curative treatments for patients with metastatic cancers,” he said.

Dosimetry: Personalizing the right dose for individual treatment plans

Theranostic imaging allows doctors to measure precisely how impactful a TRT is for an individual patient’s cancer cells. By leveraging that capability, researchers at UW–Madison have also developed technologies that allow doctors to use theranostic images to personalize the prescription of a TRT to be maximally effective and safe for each patient. The process of identifying patient-specific amounts of a radiopharmaceutical therapy drug is called dosimetry, according to Bryan Bednarz, professor of medical physics at UW–Madison.

Dosimetry allows doctors to calibrate in a way that is more fine-tuned than if they rely solely on standard dosage guidelines, so they can create a personalized dosage plan for each individual that maximizes effectiveness while minimizing harm, he said.

“This combination of advancements is a critical component of the future for cancer diagnosis and therapy,” Bednarz said.

Creating synergy between areas of expertise

Morris describes the initiative as uniquely cooperative.

“The initiative provides a central mechanism for those involved in these fields to engage with one another and put ideas together for collective advancement,” he said. “This area is inherently multidisciplinary. If we stay in our silos, we only get so far, but when we work together, we can see the confluence of opportunities.”

Initiative researchers aim to develop novel cancer-targeted molecular imaging and radiotherapy TRT agents, produce more effective theranostic imaging and particle therapy, advance dosimetry methods and translate discoveries to clinical practice.

The initiative will also establish premier graduate and fellowship training programs for researchers and practitioners in theranostics, particle therapy, dosimetry and nuclear and radiochemistry, according to Jamey Weichert, professor of radiology, UW School of Medicine and Public Health, and co-director of the initiative.

“We’re creating a destination theranostics and particle therapy clinical center at UW Health | Carbone Cancer Center with this work,” he said.

For researchers and clinicians at UW who work in these areas and wish to become involved, the initiative will establish membership criteria, and the unit will be governed by an executive board of six UW–Madison faculty members who engage in research, clinical care and education related to theranostics and particle therapy.

This work is possible thanks to major federal funding provided to UW–Madison, including the first National Institutes of Health-supported program project grant for theranostics, according to Anjon Audhya, senior associate dean for basic research, biotechnology, and graduate studies at the UW School of Medicine and Public Health.

“Over the last several years, our outstanding investigators have competed successfully for nationally recognized awards related to theranostics,” he said.

The funding includes a recent $8 million grant to construct a new national theranostic cyclotron resource center that will drive fundamental and translational medical science. It also includes $20 million in grants from the National Cancer Institute and a $1.5 million seed investment from the Wisconsin Alumni Research Foundation, according to Audhya.

“This support is critical because ultimately, our goal is to be the preeminent site for preclinical and clinical theranostics research globally,” he said.