PSMA therapy falls under the category of “theranostics,” a new oncology paradigm combining “therapy” and “diagnostics.” This means that the same type of process used in diagnostics is also used in treatment. In other words, PSMA therapy is similar to PSMA PET imaging, just with a different type of radiation that can damage cells.
PSMA therapy, also called PSMA-targeted radioligand therapy, uses a small molecule called a ligand to bind to the PSMA on cells. Attached to this ligand is a radioactive isotope called lutetium-177, which releases once the ligand latches to the protein, delivering small doses of cancer-killing radiation exactly where it’s needed most.
PSMA therapy can also damage healthy tissue because some noncancerous cells in the body express PSMA, but this harm is minimal, and unlike EBRT and chemo, it doesn’t typically cause significant side effects. “The amount of PSMA expression determines how much radiation is going to be delivered,” Iravani says. “At the same time, normal tissues tend to clear PSMA faster than tumor tissues because the tumor tissues hold on to the compound.”
Daniel Sentana Lledo, MD, a medical oncologist with the Dana-Farber Cancer Institute, believes that “this is only the beginning of a revolution in how we treat cancer.”
Future therapies may make this type of treatment even safer by using a different target protein than PSMA or a different radiation molecule, he says. “This is a field that is rapidly growing, and in many ways, it’s the future of oncology. There are many other therapeutic classes out there, and I think this is the first of many compounds.”
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