Precision Oncology Through Radiating Bullets: What All We Have Conquered and What All We Have To

Precision oncology refers to personalized or precise oncological care for each patient based on their biomarkers, gene sequencing profile, and disease /receptorspecific imaging status. Precision oncology through theranostics is derived from a diagnostic tool that helps identify a therapeutic tool for a specific disease. In Nuclear Medicine, a radioisotope with suitable imaging characteristics or a tracer labeled ligand is fired to a particular target on a cancer cell. After identification of the target, it is labeled with a tracer having therapeutic characteristics labeled with the same ligand to target the disease. The theragnostic concept was first used in 1964 to treat thyroid cancer with radioiodine I-131 (RAI). With the passage of time, this concept has been refined, and more theragnostic pairs have been added successfully for clinical use. The growth of the theragnostic in India is parallel to the west with the availability of indigenous radiotracers like Lu-177 and others, available from the reactors of Bhabha Atomic Research Centre (BARC). The peptides like DOTATATE and PSMA are also available in a ready-to-use labeled form with an excellent tradesmanship by BARC and Board of Radiation and Isotope Technology (BRIT) We, in India, perform radionuclide therapies for neuroendocrine tumors (NET) and metastatic castration-resistant prostate cancer (mCRPC) regularly. The main constraints about this concept are the cost of treatment and awareness among the clinicians. These are gradually being taken care of by the private health insurance and our participation in disease management group and tumor board meetings. The theragnostic concept has become quite popular over the years and has the potential for further and rapid sustained growth. This article is a living tribute to Prof Kalevi Kairemo, who has a tremendous research interest in radiotargeting and molecular radiotherapy.