What if identifying cancer and deciding how to treat it could happen in the same step? Theranostics makes this possible by uniting diagnosis and therapy around the same cancer-specific target, allowing clinicians to see how cancer behaves and act on that insight immediately. This cutting-edge approach is already bringing greater precision and confidence to cancer care at MCW. As momentum builds, leaders across the institution are focused on supporting the next phase of innovation.
“This is the lead-up to a wave. Theranostics is about to change how we treat cancer by letting us see what the disease is doing and respond in a much more targeted way,” said William Hall, MD, Professor and Chair of Radiation Oncology.
At its core, theranostics brings diagnosis and treatment into closer alignment using radiopharmaceuticals, drugs designed to travel through the body and attach to cancer cells. Doctors first use a specialized scan to see whether cancer cells respond to that signal and light up on imaging. When they do, it shows the treatment has a clear path to the disease. That same signal can then be used to deliver radiation directly to those cancer cells.
This capability reshapes how decisions are made. Instead of relying on averages or indirect clues, clinicians gain a clearer picture of how an individual patient’s disease is likely to respond before treatment begins. That insight supports earlier intervention, more personalized care, and more confident decisions across the care team.
Years of progress in cancer biology, imaging, and radiochemistry are now converging, moving theranostics from promise to practice. As more therapies advance through clinical trials, cancer centers are seeing growing demand and new opportunities to integrate the approach with existing treatments. At MCW, that focus is translating into action, as clinical expertise, advanced imaging and dosimetry, and cross-disciplinary collaboration come together to move theranostic advances into patient care.
When Imaging Is a Guide, Not a Snapshot
For some patients, theranostics is no longer a future promise. At the Cancer Center, patients with metastatic prostate cancer and neuroendocrine tumors are already benefiting from FDA-approved therapies that use radioactive drugs to deliver radiation directly to cancer cells, guided by advanced imaging.
“We are now able to verify that a patient’s cancer expresses the biological target before we treat it. That ability changes how confident we can be in the care we provide,” said Michael Holt, MD, Chief and Assistant Professor of Nuclear Medicine.
Two of these therapies are now part of standard care nationwide. Lutetium-177 PSMA-617 is used for certain patients with advanced prostate cancer, while lutetium-177 DOTATATE is used to treat neuroendocrine tumors. Both have demonstrated survival benefits in large Phase 3 clinical trials published in The New England Journal of Medicine.
At MCW, clinicians have treated more than 350 patients, delivering over 1,200 doses of these therapies to date. That experience reflects not only early adoption, but the clinical systems, coordination, and expertise required to deliver theranostics safely and consistently.
“It’s not just about having the drug. It’s about having the imaging, the expertise, and the infrastructure to deliver it correctly,” said Dr. Holt.
As success has grown in prostate cancer and neuroendocrine tumors, theranostics has expanded into new areas. Imaging agents are already approved for certain breast cancers, and Phase 2 and 3 imaging trials are underway in colorectal, lung, ovarian, head and neck, liver, gastric, and other cancers. Additional studies are exploring theranostic approaches in multiple myeloma, sarcoma, and in measuring response to immunotherapy.
Seeing Deeper, Measuring Smarter
As theranostics expands, imaging becomes central not just to diagnosis, but to how treatments are developed, tested, and refined. Understanding where these therapies travel in the body, how long they remain in tumors, and how surrounding tissue is affected is essential to delivering care that is both effective and safe.
At the Cancer Center, that precision is supported by advanced preclinical imaging through the Translational Metabolomics Shared Resource (TraMSR). Led by Amit Joshi, PhD, Technical Director of Preclinical Imaging, this resource gives researchers the ability to study theranostic agents in living systems before they ever reach patients.
Using platforms such as the IVIS SpectrumCT system, researchers combine detailed CT scans with sensitive optical imaging to study how theranostic agents behave in living systems. This makes it possible to track where a therapy travels, how tumors respond over time, and how dose is distributed in tissues, all without invasive procedures. Those insights help guide safer dosing strategies and accelerate the translation of promising therapies from the lab to patients.
“This technology allows us to follow the entire journey of a theranostic agent. From where it goes in the body to how the disease changes, we can generate the data needed to guide smarter decisions,” noted Dr. Joshi.
By pairing high-resolution imaging with precise dose measurement, MCW teams can see which tumors respond, how resistance emerges, and how treatment can be adjusted for individual patients, while protecting healthy tissue. That depth of insight strengthens clinical trials, accelerates learning, and helps move theranostic discoveries toward patient care.
Staying Ahead of the Wave
At the MCW Cancer Center, readiness for theranostics is already taking shape. Experience with FDA-approved theranostic therapies, combined with advanced imaging, dosimetry, and translational research, has created a strong foundation for continued growth. Radiation oncology, nuclear medicine, biomedical engineering, and imaging science are working together to ensure new approaches can be developed and delivered safely, effectively, and at scale.
Looking ahead, leaders see theranostics expanding across cancer types and increasingly intersecting with other treatments, including systemic therapies and immunotherapy. Imaging will guide not only whether a therapy is used, but how it is timed, combined, and tailored for each patient.
For MCW, the focus is readiness with purpose. By investing in infrastructure, expertise, and translational pipelines, the Cancer Center is positioned to move with the next wave of theranostics and help shape its impact on cancer care.
“This is an exciting moment,” said Dr. Hall “We’re seeing theranostics mature in real time, and we’re in a position to help shape how it’s used and where it has the greatest impact for patients.”