UCLA Health is celebrating one year of treating patients with advanced prostate, thyroid and neuroendocrine cancers at its Outpatient Theranostics Center, one of the largest clinics of its kind in the United States. The 3,000-square-foot facility in Westwood, which opened in February 2024, continues the health system’s decade-long legacy of advancing the field of theranostics, which uses advanced imaging and radiopharmaceuticals to target tumors with precision.
“The field of theranostics is booming,” said Jeremie Calais, MD, PhD, director of the Ahmanson Translational Theranostics Division’s clinical research program. “There has been a massive amount of investment from pharmaceutical companies in the past five years, and that translates to many new clinical trials here at UCLA.”
UCLA Health was one of the first sites in the United States to participate in a phase II clinical trial to test the safety and efficacy of the radionuclide therapy, Lutetium-177 vipivotide tetraxetan (Pluvicto). It was later licensed by Novartis and approved by the U.S. Food and Drug Administration for the treatment of adult patients with advanced metastatic prostate cancer who are resistant to other therapies.
“Ten to 15 percent of patients with very aggressive disease have an almost complete response to this therapy,” said Johannes Czernin, MD, chief of the Ahmanson Translational Imaging Division.
Theranostic medicines such as Pluvicto work by delivering radiation directly to cancer cells while minimizing damage to healthy tissue. Patients are first injected with a companion radiotracer (a diagnostic drug), which contains a low amount of radiation. The radiotracer binds to and lights up antigens on the surface of cancer cells on a positron emission tomography (PET) scan, allowing clinicians to see exactly where disease is present and to which degree the antigen is expressed. Patients then receive the therapeutic component of Pluvicto, which attaches to the cancer cells via the same antigen target and emits radiation to kill their DNA.
UCLA Health’s Outpatient Theranostics Center allows clinicians to treat up to 16 patients per day with Pluvicto and other medicines. A dedicated clinical research team of about 20 staff members support the more than one dozen active theranostics clinical trials that are currently in progress at the health system.
“As a nuclear medicine physician,” Dr. Calais said, “the center has given me the opportunity to sit at the table with the other specialists and participate in the forefront of patients’ care.”
Advancing nuclear medicine
The clinical combination of therapy and diagnostic imaging dates back to the 1940s, when radioactive iodine was used to treat thyroid disease. The use of theranostics became more widespread in Europe and Australia in the 1990s.
In the mid-2010s, Dr. Czernin launched the department’s Ahmanson Translational Theranostics Division and German researchers brought their expertise on the burgeoning field of theranostics from Europe to Los Angeles when they joined the Department of Molecular and Medical Pharmacology at the David Geffen School of Medicine at UCLA.
In 2016, Dr. Calais joined the theranostics team at UCLA. The researchers joined forces with a team at UCSF to develop an imaging technique for diagnosing prostate cancer at the whole-body level where the tumors have migrated.
PSMA PET works using a radioactive tracer drug called 68Ga-PSMA-11, which is injected into the body and attaches to proteins called prostate-specific membrane antigens (PSMA). The UCLA-UCSF research teams enrolled approximately 4,000 patients into the trial between 2016 and 2021.
The researchers showed that PSMA PET detected significantly more prostate lesions than fluciclovine PET in men who had undergone a radical prostatectomy and experienced disease recurrence. In 2020, the FDA approved the diagnostic test for men with prostate cancer.
“It was designed to improve the diagnosis and staging of prostate cancer and to detect sites of recurring disease,” Dr. Czernin said. “Now, there are probably about 300,000 PSMA/PET scans per year in the U.S., and the studies at UCLA-UCSF really set the stage for that.”
That clinical research paved the way for UCLA to become one of the first sites in the country to participate in the phase II clinical trial to test the efficacy of Lutetium177-PSMA. In 2018, Novartis took over the study and launched a phase II randomized trial called VISION, for which UCLA also served as a site. The FDA approved Pluvicto in March 2022.
Those early trials also helped UCLA physicians understand the nuances of treating patients to provide the best care, Dr. Calais said. “We learned how to look at the scans, compare the scans to assess the treatment effect and manage the treatment administration process.”
The Ahmanson Translational Theranostics Division has since been designated a Comprehensive Radiopharmaceutical Therapy Center of Excellence by the Society of Nuclear Medicine & Molecular Imaging. The designation acknowledges the UCLA program as one that is “leading the growth in the field” of nuclear medicine in both research and treatment
As the UCLA theranostics team expands the Outpatient Theranostics Center and continues to find ways to intervene even earlier in the treatment process, Dr. Czernin said he is proud of contributions that UCLA has made along the way.
“We typically see patients when they are very late in their disease stage, so when we get good responses, it is really making a difference for people who are very ill and in a lot of pain,” Dr. Czernin said. “These are success stories that didn’t exist before.”
