What Is Theranostics? A Breakthrough in Cancer Care with Dr. Brandon Mancini, MBA, FACRO

What if doctors could see exactly where cancer is located and then deliver treatment directly to those cancer cells with precision?

In this episode of Take Care, Melody Mulaik is joined by Dr. Brandon Mancini, Medical Director at BAMF Health, to discuss theranostics: an innovative and rapidly growing approach to cancer treatment that combines diagnostics and therapy into one personalized treatment strategy.

Dr. Mancini explains how theranostics works, why it’s creating so much excitement in the cancer world, and how it’s already helping patients with prostate cancer and neuroendocrine tumors live longer with a better quality of life.

They also discuss the role of PET scans, how radioactive therapies specifically target cancer cells, the patient treatment journey, access to care through telehealth, and why this approach may become a major pillar of cancer care in the future.

Whether you’re a patient, caregiver, healthcare professional, or simply curious about the future of medicine, this episode offers an easy-to-understand introduction to one of the most promising breakthroughs in cancer treatment today.

What You’ll Learn in This Episode:

• What theranostics means and how it works
• How PET scans help identify cancer targets
• Why Theranostics is changing prostate cancer treatment
• The difference between theranostics and chemotherapy
• Who may qualify for theranostic therapies
• What patients can expect during treatment
• How telehealth is improving access to cancer specialists
• The future of personalized cancer care and clinical trials

Timestamps:

• [00:02:00] What theranostics is and how it combines therapy and diagnostics
• [00:04:00] Who qualifies for theranostic treatment for prostate cancer
• [00:07:00] Inside BAMF Health and the future of theranostics centers
• [00:13:00] What patients experience during treatment and recovery
• [00:23:00] Why theranostics may become a major pillar in cancer care

Resources Mentioned:

• BAMF Health Official Website - Learn more about theranostics and cancer treatment options

If you found this episode helpful, please share it with someone navigating cancer care or looking to learn more about emerging treatment options.

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Transcript

Grace 0:13

Today on the Take Care Podcast, Melody sits down with Dr. Brandon Mancini, a board-certified radiation oncologist and Medical Director at BAMF Health. Dr. Mancini specializes in theranostics, an innovative approach to cancer care that combines advanced imaging with targeted therapies designed to personalize treatment for each patient. His work focuses on metastatic prostate cancer and neuroendocrine tumors, and he is actively involved in groundbreaking clinical research helping shape the future of oncology. He completed his medical degree at Wayne State University School of Medicine, his Radiation Oncology residency at Yale School of Medicine where he served as Chief Resident, and also earned an MBA in Healthcare Administration from the Yale School of Management. In this episode, Melody and Dr. Mancini explore the evolving landscape of cancer treatment, the promise of theranostics, and what these advancements could mean for patients and families navigating cancer care. Please welcome, Dr. Brandon Mancini.

Melody 1:13

All right. Well, welcome everybody to this latest episode of Take Care. It is my pleasure very much to have with us Dr. Brandon Mancini. I know you just heard a little bit about or a lot about his great background and why we're having this session together, so I'm going to go ahead and start with the big word and the big question is what is theranostics?

Dr. Brandon 1:34

Yeah. Well, first of all, thank you so much for having me. It's an honor to be here. And yeah, happy to talk about theranostics. So what theranostics is, is kind of this buzz term that literally combines the terms therapy and diagnostics. And so it's a form of cancer care right now, cancer treatment, where the therapy and the diagnostic both literally bind to the same target on cancer cells or in the cancer's microenvironment, to either give us a signal and tell us where the cancer is located. That's the diagnostic. People might have heard of things like PET scans that are used a lot within cancer care. And interestingly enough, the therapy, after you identify that the target is present is injected at a later time point. And that goes and literally binds just to the target that we proved existed on the tumor with that diagnostic PET scan in the past. And so, it's truly this see what you treat, treat what you see, this lock and key type of treatment, and it's personalized targeted therapy to the extreme. And so, it's really been taking over a lot of the kind of systemic therapy realm for prostate cancer and some others over the last couple of years. And really a lot of buzz within the cancer world.

Melody 2:46

Yeah. So you mentioned prostate. Is that the primary thing that, that's treated? Are there other types of cancers that it maybe is promising for as well?

Dr. Brandon 2:54

Yeah, it's pretty interesting. I mean, actually, a form of theranostics people might be familiar with is actually the radioactive iodine pill that people take for thyroid disorders or thyroid cancer. That actually came about in 1941, so we're many many decades later obviously from that. But as far as modern theranostics with again, these unique PET scans and kind of the injections and the things that we do. There's two kind of approved, FDA-approved products, and that's for neuroendocrine tumor and prostate cancer. A neuroendocrine tumor is kind of a more rare tumor that can develop in the gut. It affects approximately 12,000 Americans each and every year. And then there's prostate cancer that's about 330,000 new diagnoses per year. And so the number of patients that receive theranostics treatments in the United States, it's kind of like a 90/10 distribution between prostate cancer and neuroendocrine. And then the neat part right now is there's over 100 clinical trials looking for new targets. So new disease sites that can be impacted by this because the prostate cancer neuroendocrine therapy success has led to such investment in the scientific expansion of this specialty.

Melody 4:02

Is there a particular candidate, like with prostate cancer in particular. Is everybody a candidate for it, or is there certain characteristics that would make them a candidate?

Dr. Brandon 4:10

Yeah, that's a great question. I think when you look back, just like most new therapies in the United States, they go through a really rigorous process to kind of prove that they're both safe and that they work the same or better than other standard of care options. And so for prostate cancer, when it was officially approved back in March of'22, that was based on a large clinical trial where they actually gave it to patients that were kind of running out of options. And it had been what we call heavily pre-treated. And what they found was that it was very safe and very effective at extending quantity of life and improving quality of life. Even for patients that have been through therapies for years and years and years. And so when it was first released back in'22, patients had to have had anti-hormone medicines for their prostate cancer control. At that time, had to have had chemotherapy as well. And what happened though is they simultaneously launched some other clinical trials moving this medicine earlier and earlier in the prostate cancer journey. And so now it still requires previous treatment with anti-hormone pills or injections, but patients no longer have to go through chemotherapy to have access to it. And that's been a huge shift because chemotherapy obviously still has its place. It's still very effective and can be very helpful, but it's typically associated with a lot more side effects. And with the medicine, like these theranostics medicines, there are some mild side effects that are possible. But like I said, I mean, it improves quality of life and quantity of life at the same time. And so it's a very aggressive treatment but it works really well, and people can kind of maintain their lifestyle. And so it's definitely moving earlier and earlier. Both of these treatments are currently for patients where the cancer has spread outside of the origination site. So it is for patients with prostate cancer that it spread into the lymph nodes or bones. It is for those neuroendocrine tumors that spread also lymph node or other organs. So again, these are life-prolonging therapies with a high quality of life associated with it.

Melody 6:09

Gotcha. So, if somebody's listening and they're thinking,"Well, you know, my father has prostate cancer. He's been through some of these things," or, you know, anyone that they know, how would they go about finding somewhere, and you can specifically talk about where you are and why you built the organization that you're involved with. Where could they go?

Dr. Brandon 6:26

Yeah. I know, that's a great question. I think throughout the United States, luckily access is becoming a lot, lot better a lot more quickly. As of us sitting here right now today, I mean, there are actually 800 centers in the United States that have at least kind of signed up for or been approved to give the prostate cancer drugs specifically. And so it would be kind of talking with their oncologist and the hope would be with that volume of potential centers that there would be one located within a reasonable distance. And it might even be at their hospital or in close proximity to where they live. Where I work is a facility called BAMF Health, B-A-M-F. It stands for Bold Advanced Medical Future. And this is just a dedicated theranostics center. And so I'm a radiation oncologist by background, and did some additional work just in theranostics in Germany for a period prior to starting this role. But we've kind of fully in-immersed ourselves in our kind of treatment focus just on patients that would benefit from these therapies. And so we have a 60,000 square foot facility in downtown Grand Rapids. We produce the PET tracers and actually do the PET imaging, that helps kind of diagnose and confirm that these therapies are applicable to someone. And so really any patient with cancer needing a PET scan can come through and so forth. And then we have a whole dedicated clinic where we could treat up to 30 patients per day with these theranostics treatments on our second floor. And so, what you'll see over the upcoming several years is you're going to see a lot more advancements from an infrastructure perspective, meaning a lot more of these bigger centers that are dedicated solely to the theranostics treatment. It's super important because it's a little bit different than infusions of chemotherapy or other infusions people might be used to. This is the handling of radioactive materials. And that includes the injections and some of the precautions immediately for patients, family members and staff. It also means handling of radioactive waste and being able to do this in a safe kind of high level when it's all said and done. So, it's definitely a super interesting evolving subspecialty of medicine. But the center that we're at here is going to continue to, you'll see a lot of these pop up throughout the United States over the next five to 10 years.

Melody 8:38

So, if somebody wanted to come to your facility, I guess depending on, do they usually come from their medical oncologist or their urologist? Is it a combination? How do they get to you?

Dr. Brandon 8:47

Yeah, that's a great question. I think depending on where people are treated. You have different strategies. Sometimes the urologists for prostate cancer will manage the anti-hormone medicines, while other times it'll be a medical oncologist that does so. And so we definitely have referrals from both of those specialties. We also accept self-referrals. And so, last year we were lucky enough, we treated patients from 26 different states, as well as Canada and Italy, interestingly enough. That's a good story. But yeah. So I mean, self-referral wise, that's a very quick kind of in that way. I have license not only in the state of Michigan, but five other states where we do a lot of virtual consultations. And that allows us to reach more people for specifically not only standard of care but clinical trials. But locally, if a patient's undergoing ongoing care for both the neuroendocrine or prostate cancer, definitely their medical oncologist or urologist would be a super good source for that referral.

Melody 9:40

Yeah. You just mentioned the telehealth piece of it. I was Dr. Hawkins and I in a previous episode, he's interventional radiology. And he was talking a similar thing about how do you get into a specialist if you're in an area whether you're in a rural area or in an underserved. I won't just say underserved, but we know a lot of the places across the country. I think I saw statistics, I was at a conference. It was international conference last November and they put out a statistics that said 70% of all counties in the United States do not have an oncologist.

Dr. Brandon 10:08

Wow.

Melody 10:08

And you know, I'm not sure if that's 100% accurate, but it sounded pretty accurate. And so when you start thinking about the patients that could be diagnosed with cancer in one of those, you know, 70% of the counties out there, that whole issue of being able to have a consultation with you remotely. Meaning we could be just like we're doing right now, having a visit and you determining whether or not that patient is a candidate really takes away the stress of somebody feeling like they have to come to Michigan or they have to go to another location for that. How would people find out about that? Would that be something they could go to your website and there's information for prospective patients on there, and they kind of go through a journey that way?

Dr. Brandon 10:44

Yeah. If you go to bamfhealth.com, there's a patients tab. And you can kind of initiate a consultation. Actually, something would pop up, and you can fill out some additional information. If someone has prostate cancer or neuroendocrine tumor, that would go straight to kind of our referral specialist. And we'd process the information, we gather all the records, make sure we have everything that we need both from pathology reports and the medical notes and the images and all the things like that. That only takes a few business days, so it is pretty expeditious when it's all said and done. If someone does not have prostate cancer or neuroendocrine tumor, it actually gets kind of funneled to our clinical trials team'cause we do have clinical trials in this theranostic space both imaging and therapy. That cover about 15 other tumor types. And so we want to make sure that if someone is going to kind of move forward with a consultation, they're aware if we might have anything to offer. At that point, we gather records, do a nice in-depth kind of pre-screening or review of any trials that they may qualify for. And then they actually get a phone call or an email from our clinical trials team to ensure that there's something available and, and might apply to their situation before we move forward. So try to just be super proactive, gather those records, make sure people have access and kind of want to elect to move forward, when it's all said and done. And I think the piece about the virtual, I mean, that's huge'cause even in Michigan here, I mean, if you just go, two, three hours away, I mean, those are big, long drives for a lot of people. And if you can be in the comfort of your own home and either do it on a smartphone or a computer, I mean, we've seen that make such a difference. And the neat part about these theranostics treatments, even though I said there's about 800 centers and access is expanding. Even if someone had to drive a couple of hours, these treatments are every six weeks or every eight weeks. And so the transportation burden if someone wanted to go to a certain center, wouldn't be overly, not too many visits over a short period of time.

Melody 12:39

I don't know.

Dr. Brandon 12:40

Yeah, so they can definitely navigate that and we kind of assist. But yeah, I mean, telehealth is super, super important. You can just expedite every type of visit and just ease the whole process, when it's all said and done. So that's something we've valued for a long time.

Melody 12:55

Especially with your winters up in Michigan. That can be a little brutal up there, right? And people don't want to have to get out and drive in them.

Dr. Brandon 13:00

Very true.

Melody 13:01

Well, let's talk about it from a patient standpoint or caregiver standpoint. Let's say you have that visit, and you've identified, you've looked at their medical records, you've had the conversation, and that patient is a candidate. Tell me a little bit about their journey. What happens? What happens when they come for like you mentioned, treatments every six weeks or so? What occurs during that? And then what happens immediately afterward as well?

Dr. Brandon 13:21

Yeah, that's a great question. So, I think there's a little bit different of a journey for prostate versus neuroendocrine, as far as kind of the time which they spend in our center. And so for a prostate cancer situation, someone comes in. The visits are relatively brief. They're about 40 to 60 minutes for a treatment. But as I'll explain, we actually see them two days in a row for about that same period of time. But for the treatment visit, they come in. We give them two bottles of water. They have their own private room, private bathroom. There's a TV there. Welcome to have someone with them. Usually that person kind of sits immediately outside of our individual patient rooms just to make sure there's distance with the radiation moving back and forth and as far as the process goes. They start working on that water because for these theranostics medicines, whatever doesn't stick to the cancer actually is primarily filtered through the kidneys, so out through the urine. So drinking a lot of fluids for a couple of days is important. It is all intravenous, meaning you place an IV or a line in their arm. After they've been working on that water, IV's placed. The nuclear medicine technologist rolls in this little cart, and there's a lead-lined box on there. They open that up, and it's literally a little syringe that looks like water, when it's all said and done. Again, for prostate cancer, they hook it up to that IV, little 30 to 60-second push. There's no reaction to the treatment. So no need for things like steroids or Benadryl or no need to kind of suppress the immune system for any sort of allergy or anything like that. After that short injection, they kind of finish up their water, IV comes out, and then they're free to go home. Most people actually don't feel different overnight. As I kind of alluded to, we do encourage them to drink like two to three liters of water, which ends up being four to six standard size water bottles, like if you were to go get a pack of 24 or something from the grocery store. And that's again, just to process everything through quickly. The more we drink, the more we use the bathroom, the more we use the bathroom, the quicker that extra radiation, gets out of the system. And then less potential side effects. Every now and again, someone might have a little sour stomach overnight. And it's really just from like the radiation circulating for the most part. And so that's why drinking that water is super important. And we can give them anti-nausea medicines either at the time of treatment or the next morning when we see them. So again, that whole process of the treatment and getting home, 40 to 60 minutes really no restrictions overnight. We'll talk about the radiation safety aspect of it, as well. But the next day is kind of the neatest part of theranostics when it's said and done. So the treatment itself is giving off therapeutic radiation that we hope is breaking the DNA of the cancer and creating regression and remission and things getting better. But what's really amazing is as the treatment's sitting in the tumor, it's giving off photographic radiation. Meaning the treatment acts like an imaging tracer. And so the next day the patient comes in, they lay down for about a 30 to 40-minute scan called a SPECT scan, which is S-P-E-C-T, SPECT scan. They lay there, non-invasive, they're not getting any more IVs or injections or anything like that. And what that SPECT scan is doing is just absorbing that photographic radiation that's emanating from the cancer spots. Immediately after that, we'll take them back into a consultation room, and we'll plug in our computer. And we can literally show them where their treatment went from the day before. And so again,'see what you treat, treat what you see' is kind of the phrase that people use with theranostics. But it's very empowering because now every six weeks when you're coming in, not only are you getting your prostate number checked, your PSA checked in between. But you can literally see what is happening and get that real-time feedback the day after treatment. And so it really decreases the need to order other tests. You get the immediate feedback. We have a really good conversation about what's going on and what we might anticipate. And sometimes if there's really, really good responses, we can actually pause treatments. If that target disappears, there's really not that much value to continuing a treatment that would then get filtered out through the kidneys. And so it's really a personalized approach for each and every person. And again, a cost-saving approach, a very thoughtful way of kind of doing this. It's not a one-size-fits-all. It's literally each and every patient's so, so different. With Lutathera, which is the medicine for a neuroendocrine tumor, the only difference is that the treatment time is five hours instead of 40 to 60 minutes.

Melody 17:43

That's a big difference.

Dr. Brandon 17:44

Yeah. And so we definitely like people to kind of have someone with them or bring something to read or something to watch. And the difference there is it's the same short infusion of several minutes in this case. But for Lutathera or again, this neuroendocrine medicine, you have an amino acid infusion during the treatment. And what that amino acids are literally in every food we eat, but what they found is that there's a combination that kind of coats the kidneys and does not let the medicine attach to the kidneys. You don't need it for prostate cancer'cause it's not the same way that it works, but you need it for the neuroendocrine tumor. And so that amino acid infusion is four hours, and so that's why it's such a long duration.

Melody 18:25

Gotcha.

Dr. Brandon 18:26

But it same, type of thing after as far as small chance of feeling that sour stomach, and then coming in for the day after scan. Otherwise, we see patients in our center every six weeks for prostate cancer, eight weeks for neuroendocrine. They get some blood work, so we're just looking after their blood counts just in case there's any changes. That can all be done close to home, and we kind of put in those orders to the most convenient lab. And otherwise, like, people are doing pickleball and golf and gardening and all the things the days after. So it's pretty neat that you can get a very aggressive treatment, but you don't feel really yucky for many days, so.

Melody 19:02

Oh, that's amazing. And I was trying to think, I mean, is there any other type of treatment where you could see the effect of it that quickly, looking at something the next day?

Dr. Brandon 19:12

Yeah. I try to think of it each and every day when I'm talking with patients because I don't think there currently is anything like that.'Cause we have our blood tests, right? We have the prostate numbers that can be followed and some other tumors that you can follow on blood tests. But not an immediate ability to assess where that treatment went the day after. And so, hopefully we continue to have advancements, even the ability to image things like immunotherapy, which people might have heard of for certain types of cancers. But yeah, it's super amazing. And again, it's just such a valuable aspect'cause patients get it, families get it. We can talk about it together, whether we're sharing hopefully good news or even not so good news. We can see that together and make a plan no matter what it is, and it just empowers everyone to make quicker decisions and better discussions immediately.

Melody 19:58

Yeah. And how many times would you say is a typical number of times that a patient would need to come back?

Dr. Brandon 20:03

Yeah. So I mean, in the United States for prostate cancer, it's approved to give up to six times total.

Melody 20:09

Okay.

Dr. Brandon 20:10

So we average about 3.3 treatments per patient. That means in a row. And so again, if someone has a really good response, we'll try to hold on to extra treatments until there's something meaningful that would need to be treated in the future. We've had patients that have gone over two years between say, treatment three and treatment four. Because the cancer was very, very sensitive, and it stayed in remission, and it did a really nice job of controlling everything. So six total times over as long as possible. So we try to again, extend that over the longest period. For the Lutathera or the neuroendocrine tumor situation, that's every eight weeks for four times. And that's a situation where you typically do deliver all four. And then that medicine actually continues to work for up to two years. It's pretty remarkable kind of biology behind all that. But that's something where you do everything in a row, and then you kind of continue to see some benefits over months.

Melody 21:04

Well, and I just to kind of reinforce to our listeners, I mean, and you mentioned those labs that you've ordered for the patient, and that that's really kind of how you're monitoring and looking at them, you know, after, I guess, a certain number of doses, so when they need to come back in for certain things as well, which is really good. Now, if I recall didn't you just break ground on a new facility somewhere?

Dr. Brandon 21:24

Yeah. I know, it's exciting. So I mean, Grand Rapids was always the flagship, and that was kind of the proof of principle, proof of concept. And the goal always was to try to solve this infrastructure problem that I kind of alluded to, right? So, in 2025 for prostate cancer again, 46,000 treatments were delivered, but actually 400,000 treatments were needed, right? And so tenfold kind of difference in that. And it's really just an infrastructure problem. And so part of that, we've partnered with Henry Ford, in Southeast Michigan, right in downtown Detroit. You can actually see Ford Field where the Detroit Lions play right from the front kind of porch of where this is going to be located. But that's a really neat partnership because having others believe in the value that you're creating, and in kind of the future of theranostics is really, really powerful. And it again, it's all about access. Because people are running into an inability to treat patients as quickly or as in high volume as is needed. And so you either have super high wait lists, or prolonged wait lists. You have people selecting other treatments because of that. And again, not having access to something that's proven and covered by insurance and in the guidelines and everything like that. When people can feel so good while they're on it, that's something that needs to be solved. And so our goal is to create a solution for that infrastructure problem over the next several years and create many opportunities for similar sites to pop up all over the United States.

Melody 22:49

Oh, that's great. Well, tell me, as we're wrapping up our time together, you already have made such an impact in theranostics as the medical director there and really driving a lot of this and making people aware of it. And there's you mentioned all the clinical trials. What makes you the most excited about this type of treatment for today and in the future?

Dr. Brandon 23:07

Yeah. I mean, I think it's so much different than what I was doing in radiation oncology as a radiation oncologist before this. But I mean, there's not many times in life where, like, a major medical breakthrough comes through and that you can be a part of kind of that journey. And it truly feels like theranostics in the modern era is kind of in its infancy, right? There's this huge investment scientifically to just finding as many new targets, as many new tumor types that can be treated in a similar manner. Because of how personal it is, because of how targeted the therapy is. Because it works, because people feel well with it. And so just being a part of that wave and knowing the future, the promise, and the growth that's going to happen over the next 10 to 20 years. I mean, that each and every day wakes me up with more energy than any coffee or caffeine that could do. So, I think it's just the hope, the growth, being part of something bigger than yourself. I mean, each and every day, it's just so, so exciting. So many clinical trials, creating hope, trying to make people feel better and impact their lives is just remarkable. And it's been coined by many, that they really truly believe that this theranostics is going to be another major pillar in cancer care for the foreseeable future. And really kind of lay that foundation now to be a part of kind of the beginning of it, is just really exciting.

Melody 24:28

Oh, that's wonderful. So as parting words for our people listening, what would you say to patients who are maybe this is the first time they're hearing about theranostics or they've heard about it. But maybe their doctor is not quite so sure about it or they've got a family member. What words would you say to them to encourage them to look into this further?

Dr. Brandon 24:46

Yeah. I think it's just important to always know your options. I think information is key, information is power. And sometimes physicians might have some general awareness. But they're doing a lot of other things too. And so sometimes advocating for yourself is super, super important. So I would definitely encourage people to go to bamffhealth.com, look into it more, even just googling the word, theranostics and kind of doing a deep dive with credible sources in that space and learning more. But understanding, I mean, no matter the type of tumor that the person or the family member, the friend may have, there is very likely at least a clinical trial option within that space. And so it's super important. Feel free to reach out to us. But advocating, looking things up, and just bringing that awareness to everyone when it's said and done. Yeah. So it's just incredibly exciting and very important and something that will continue to grow and impact a lot of people.

Melody 25:39

That's wonderful. Well, thank you so much for sharing all of your knowledge and expertise with us. Very much appreciate your time.

Dr. Brandon 25:46

Yeah. Thank you so much.