New Scripps Health tech can make prostate cancer care more personalized

Scripps Health in recent years has been using what are described as “medical smart bombs” to help treat patients who have advanced prostate cancer. And with the introduction of new technology in coming months, the imaging process at Scripps Memorial Hospital La Jolla will soon deliver more precise, personalized care.

It comes at an opportune time, too, as a study released by the American Cancer Society on Sept. 2 shows an overall rise in prostate cancer between 2014 and 2021, especially in advanced stages.

The medical smart bombs, or targeted theranostics, latch onto tumor cell receptors and encompass both therapeutics and diagnostics. First, the location and quantity of tumor cells are identified throughout the body with a low level of radiation. If treatment is deemed appropriate, a higher-dosage radiopharmaceutical drug, Pluvicto, is used to kill the cancer.

The process is repeated six weeks apart, typically in the form of six infusion rounds and imaging scans. The goal is to achieve controlled remission of the cancer rather than complete elimination.

Until now, Scripps’ imaging has been conducted with traditional nuclear medicine gamma cameras that indicate where the drug is in the body, but not how much of the dose ends up being retained. As a result, dosage levels are applied uniformly for all patients.

That is expected to change within the next six months with Starguide, a molecular imaging system that shows both the location and level of radiation retention. The equipment was purchased this spring, making Scripps the first health system in San Diego County and one of the few in the United States to acquire it so far.

Starguide will be at the Scripps Clinic John R. Anderson V Medical Pavilion on the campus of Scripps Memorial in La Jolla. Infusions will continue being performed at Scripps Mercy Hospital San Diego.

Dr. Nikunj Patel, program director of oncologic imaging with the Scripps Cancer Center in La Jolla, said the new technology was cleared by the U.S. Food and Drug Administration a couple of years ago but was in development for over a decade.

With Starguide’s information in hand, doctors will be able to customize the dose of infusions to each patient’s needs, said Patel, who calls the treatments “molecular-level individualized medicine.”

“All these disease states often come back to patients’ DNA and their genetic makeup,” Patel said. “And we know, even though we have therapies, certain therapies work better in certain patients than in other patients.

“There may be patients that require a different therapy or a different amount of therapy. … Using technology such as this … we can give specific amounts and cater to specific individuals.”

Though the origin of targeted theranostics can be traced to 2018, when the practice was approved for neuroendocrine tumors, it wasn’t until March this year that the FDA approved Pluvicto as a “second-line” treatment rather than a “third-line” treatment.

Before that, it could be administered only after patients were given hormone treatment and chemotherapy.

“This makes a lot more patients eligible for this therapy prior to receiving chemotherapy,” Patel said. “And as a result of that change, we’ve had twice the number of patients [become] eligible to use this advanced therapy. And the results have been, I think, more promising.”