Radionuclide therapy: The new wonder weapon against prostate cancer

The x-ray images are the dream of oncologists. Before the treatment, is seen on the recordings of the German cancer research center a of metastases through the body , after the treatment, only much smaller tumors or no visible evidence of the cancer.

A memorable Moment

Martina Benešová can still remember the Moment when the results of their work and that of your colleagues were, for the first Time known around the world. The 30-year-old radio chemist worked between 2012 and 2015 at the Heidelberg cancer research center, a therapeutic agent for patients with prostate cancer in advanced stage.

2015 the international society for nuclear medicine drew the pictures taken in Heidelberg, Germany due to the Work of a team of experts and Benešovás Dissertation, as the”Image of the Year”. A remarkable success for the professors and for Martina Benešová, who had applied to her master’s work in Prague for a PhD position in Heidelberg.

12.000 Deaths per year

The daughter of a mineralogist from the osttschechischen Ostrava was passionate about early on, for radio-active substances. With your ambition, you will fit in well with the team of experts was involved in the development of the therapy. A number of high profile researchers.

Recently, the researchers, Matthias Eder, Michael Eisenhut, Uwe Haberkorn and Klaus Kopka received for their work in the fight against prostate cancer, the Erwin-Schrödinger prize of the Helmholtz Association of German research centres.

The molecule is used in University hospitals in patients whose prostate cancer to conventional therapies is not responsive. 12,000 men die each year in Germany, growths, and the malignant cells in the prostate gland.

Many of them could be treated, if not cured, at least so far, that the pain and the life expectancy of months to years increases the hope of the researcher. Martina Benešovás task was to optimize the active substance for the therapeutic application.

Radioactive radiation destroys tumor cells

In the treatment it comes to locks, radio active atoms in tumors to fight cancer, close-up, without damaging the surrounding tissue. The experts make use of the fact that the molecule PSMA (prostate-specific membrane Antigen) accumulates at 85 to 90 percent of all patients in a high concentration in tumors.

The researchers developed a molecule PSMA-617-attach itself to these antigens. It binds to the low-level radioactive Gallium-68 to the molecule, it is during the investigation by positron-Emission-tomography visible, so that the Doctors can easily detect whether and where tumors grow. The diagnostic success was the expert on the therapeutic potential of hope.

Success they had, finally, with the radionuclide Lutetium-177. It is also integrated into PSMA-617. The molecule attaches to cancer cells, the radioactivity of the Lutetium isotope to exactly where it is needed, and destroys tumor cells.

Again and again the results were not convincing

The fine-tuning of the Theranostikum was a challenge for inventors. “Easy wasn’t it, again and again, the results were convincing,” recalls Martina Benešová. Changes the active compound that you synthesized was stable, but collapsed. Time he accumulated in healthy tissue.

Euphoria and self-doubt are in the research and omnipresent, but a bad counselor. “During the whole time I had to really pay attention to it, to remain with the feet on the ground,” recalls Benešová.

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Incredible Results

The success seems to justify the scientific effort. Doctors who use the procedure, reports of amazing results. “One of our patients came in a wheelchair to the first treatment,” says Peter Bartenstein, Director of the polyclinic for nuclear medicine at the University of Munich.

“After four doses of PSMA-617, he could not only run again, but felt fit enough for the garden work.” At about a quarter of the patients, the therapy does not suggest, a further quarter could be stabilized by PSMA-617, and in the rest of the sick the Doctors recorded each half good and very good results .

Unexplained Immune Response

It is unclear how often the treatment can be repeated. So far, no severe side effects occurred. The saliva will be damaged glands, so that the patients will suffer persistent dryness of the mouth.

Bartenstein does not want to, however, exclude the possibility that the kidney will be drawn on the long term. A prediction on the obtained life time is not difficult, because the physicians understand the immune processes, the treatment triggers.

During the cancer of some patients continues to progress, he goes back in the case of other stronger-than-expected. Bartenstein reported from a man, whose tumors showed little PSMA. Actually, he had expected that the radionuclides, these ulcers could harm them.

They shrank but still, possibly because the treatment of the remaining tumors on the surface of plenty of PSMA found that the immune system of the man helped on the jumps.

Only critical cases will be dealt with

The irradiation by injection is considered to be an individual healing attempt, and will only be used in patients who have nothing more to lose. Otherwise, have to fear the doctors in case of complications Damages. Bart stone, but some believe that the procedure comes in the future much earlier.

Even today, patients are pushing cases to be with the new procedures, although not all other therapies are exhausted. They fear especially the consequences of the default is carried out, hormone withdrawal, such as impotence and weight gain.

More data need to be collected

Experts warn, however, before that, the radio ligand therapy, before all the conventional options have been exhausted. Christian Wülfing of the German society of urology, indicates that the diagnosis with PSMA-deliver 617 sometimes incorrect results.

In addition, he says, is the previous data on the therapy with PSMA-617 poor. In fact, according to estimates by Uwe Haberkorn, from the German cancer research center have been treated worldwide, probably a few Thousand patients – a large-scale study in the patients according to clearly defined selection criteria to be included, have not given it yet.

The changes now. The US company Endocyte has acquired the license to lead the therapy to practice maturity. On the basis of the United States, the world selected the 750 patients with the new drug treated.

In the best case, the US could allow the food and drug administration FDA for the therapy before 2020. The Endocyte Management will be happy to have a sales potential in the billions. The Patent on PSMA-617 also Martina Benešová and her colleagues benefit from the use of the molecule. “I was at the right time in the right place, had the right theme and good luck,” she says.

Hope also for other types of cancer?

Health insurance companies will cover the cost of the therapy, which presently amount to several Thousand euros per treatment today in special cases. With the approval by the FDA, chances are good that the therapy will also be included in the performance catalogue of the funds.

Martina Benešová is busy with new projects. You will be happy that the PSMA has enabled the method of the radiology to of a Renaissance. Why, she asks, should not the promise of similar therapeutic approaches for other types of cancer success?