%0 Journal Article
%T Challenges in nuclear medicine: innovative theranostic tools for personalized medicine
%A Fran£¿oise Kraeber-Bod¨¦r¨¦
%A Jacques Barbet
%J Frontiers in Medicine
%D 2014
%I Frontiers Media
%R 10.3389/fmed.2014.00016
%X Over the past few years, nuclear medicine has undergone impressive growth with the development of positron emission tomography (PET), especially using 18F-fluoro-deoxy-glucose (18FDG), and new approaches in targeted radionuclide therapy. These developments pave the way for personalized medicine by offering practical solutions, especially in oncology, neurology and cardiology. Novel radiopharmaceuticals targeting relevant biomarkers are powerful patient selection tools for patients who may benefit from targeted therapies, and for early therapeutic response assessment. Moreover, once labeled with beta¨C or alpha emitters, radiopharmaceuticals targeting relevant molecular markers expressed by different solid tumors and hemopathies can be used for radionuclide therapy. The final objective here is to eradicate residual cancer disease by using cytotoxic mechanisms complementary to those of "non-radioactive¡± therapies. PET imaging and targeted radionuclide therapy then come together in the context of the theranostic approach to adapt injected activity for personalized therapy. 18FDG-PET demonstrates the high accuracy and the clinical benefits of non-invasive whole-body imaging. It is used in clinical practice for initial staging and therapy evaluation in several solid tumors and hemopathies. 18FDG-PET is also applied outside oncology to explore dementia, assess myocardial viability, or detect infectious and inflammatory processes. However, 18FDG is not a specific tracer. For example, in solid tumor or lymphoma assessment, 18FDG-PET does not distinguish tumors from inflammation, inducing false positive results, especially after therapies inducing inflammatory or immune reactions. New radiopharmaceuticals are needed to better characterize pathologic processes and to predict and assess response to therapy (Zhao et al., 2009). In oncology, the development of 18FDG-PET is ongoing, particularly for therapy response assessment. Image acquisition and analysis protocols are being further standardized to improve diagnostic accuracy (Wahl et al., 2009). For example, specific criteria have been elaborated to assess lymphoma or solid tumor response to therapy (Wahl et al., 2009; Juweid et al., 2007; Meignan et al., 2012). For tumors with low avidity for 18FDG, other 18F-labeled compounds are being proposed (e.g. 18F-choline in prostate cancer or hepatocellular carcinoma) (Apolo et al., 2008). In addition, phenotype-specific tracers are needed for theranostic applications: 68Ga-labelled somatostatin analogues improve image quality in neuroendocrine tumors in comparison to
%K Nuclear Medicine
%K personalized medicine
%K PET imaging
%K FDG-PET
%K targeted therapies
%U http://www.frontiersin.org/Journal/10.3389/fmed.2014.00016/full