THERANOSTICS:
MOLECULAR IMAGING DRIVING
TARGETED THERAPY
Dr Nat Lenzo BSc BMedSci(Hons) MBBS MMed EMBA FRACP FAANMS
Clin. Assoc. Prof. in Medicine - Dept. of Medicine, University of WA
Fellow in Medicine - Macquarie University, Sydney NSW
General Physician & Nuclear Physician
Disclosures
• Founding Director:
• Theranostics Australia
• PI
• Ipsen sponsored Lu-177 OPS201 trial
• Lutetium-177 satareotide in metastatic neuroendocrine
tumours (carcinoid, paraganglioma,
phaeochromacytoma)
Outline
• What is Theranostics?
• Gallium-68/Lutetium-177 Theranostic Pair
Paradigm
• Gallium-68 PSMA Imaging in Prostate Cancer
• Lutetium-177 PSMA Treatment in Prostate
Cancer
• Future
FREMANTLE HOSPITAL
OUTPATIENT RADIOPEPTIDE AND
RADIOIMMUNOTHERAPY CENTRE
Prof Harvey Turner – Fremantle Hospital 2014
Theranostics (Theragnostics)
Theranostics
• First used by PharmaNetics president and CEO John
Funkhouser
• developing diagnostic tests directly linked to the application of a
specific therapies.
• PharmaNetics - point of care coagulation tests supporting
coagulation therapies
• September 25, 1998 - key day
• FDA granted simultaneous approval for Genentech’s Herceptin®
for the treatment of Stage IV breast cancer and Dako’s
HercepTest® for diagnosis of Her2 overexpression
Theranostics in Nuclear Medicine
• Not a new paradigm
• Dr S Seidlin (1895-1955) Montefiore Hospital New York
City 1943
• Radioactive iodine (I-131) for metastatic thyroid cancer
• Tracer dose followed by therapeutic dose
• Low dose I-131 or I-123 still used
Thyroid Cancer
Ablative Dose Image1 year later
Thyroid Cancer
I-131 F18-FDG
Tuttle RT et al. (2007) Radioactive iodine therapy in poorly differentiated thyroid cancer Nat Clin Pract Oncol 4: 665–668 doi:10.1038/ncponc0979
131I post-therapy scan.
Tuttle RT et al. (2007) Radioactive iodine therapy in poorly differentiated thyroid cancer Nat Clin Pract Oncol 4: 665–668 doi:10.1038/ncponc0979
131I post-therapy transaxial single-photon-emission CT.
Positron Emission Tomography
Biochemical/Molecular
Changes
PET
MR
Spectroscopy
Physiological Changes Nuclear
Medicine
Functional
MRI/CT
Anatomical Changes MRI/multislice
CT
Perth Cyclotron Installation
DECEMBER 2002
SIR CHARLES GAIRDNER HOSPITAL
PERTH
JUNE 2003
SIR CHARLES GAIRDNER HOSPITAL
PERTH
Gallium PET Radiotracers
Germanium - Gallium 68 Generators
Gallium-68 Products
• Gallium Citrate
• Gallium MAA
• Gallium DTPA
• Gallium Octreotate
• Gallium PSMA
• Gallium Pentixafor
• Gallium Herceptin
• Gallium Exendin
• Gallium Satareotide
• Etc.
PERSONALISED MEDICINE, THERANOSTICS &
RADIOPEPTIDE THERAPY (RPT)
Therapy Diagnostics
TheranosticsGa68
Lu177 Molecular
receptor
Targeted
therapy
Ga-68/Lu-177 octreotate
Radionuclide Therapy
Ga-68 octreotate PET-CT
Primary NET lesion Secondary liver mets
Radionuclide Therapy
13 JAN 2010 3 FEB 2010
68Ga OCTREOTATE 177Lu OCTREOTATE
Courtesy: Prof Harvey Turner
MULTIMODALITY RADIOPEPTIDE177Lu-OCTREOTATE THERAPY NET
7.8 GBq 4 CYCLES @ 8 WEEKS
+
CAPECITABINE
750 mg/m2 bd DAY - 5 to DAY 10
+/-
TEMOZOLOMIDE
200 mg /m2 per DAY DAY 5 to DAY 10
Metastatic Insulinoma Treated with Lu-177 octreotate
A.Initial B. 4 months C. 9 months after treatment
(Ong, Henley, Hurley, Turner et al. Eur J Endocrinol May 1, 2010 162 1001-1008)
ORR PRRT PANCREATIC G1/2 NETS
Lu-OCTREOTATE + CAPECITABINE + TEMOZOLOMIDE (n = 38)
Courtesy: Prof Harvey Turner
PRRT PANCREATIC G1/2 NETS
Lu-OCTREOTATE + CAPECITABINE + TEMOZOLOMIDE
median PFS 4 years, OS not reached
Courtesy: Prof Harvey Turner
DURABLE COMPLETE RESPONSE
OBJECTIVE: CT (RECIST 1:1)
METABOLIC: 177Lu-OCTREOTATE
SYMPTOMATIC: COMPLETE REMISSION
7th Nov 2012 13th Nov 2014
AAA Netter I Study
• Lu-177 octreotate vs sandostatin
Jonathan Strosberg et al. J Nucl Med 2016;57:629
(c) Copyright 2014 SNMMI; all rights reserved
NETTER-1 Trial
October 30, 2017 Advanced Accelerator Applications Announces $3.9 Billion All Cash Proposed Tender Offer by Novartis
September 29, 2017 Advanced Accelerator Applications Announces European Approval of Lutetium (177Lu) Oxodotreotide (Lutathera®) for Gastroenteropancreatic Neuroendocrine (GEP-NET) Tumors – Completes First Thera(g)nostic Radiopharmaceutical Pairing in Oncology
January 26, 2018 Advanced Accelerator Applications/Novartis Announces US FDA Approval for Lutathera® for US Market (Already approved in Europe/UK/NZ)
Radionuclide Therapy
• Benefits
• Higher radiation dose deposited directly to target tissue
(10-100x greater than external beam)
• Decreased toxicity to adjacent tissue – short pathway
• Selective targeting possible – e.g. anti-CD20,
somatostatin receptor (SSTR), PSMA receptor
• Dosimetry possible
• Can combine with chemotherapy, external beam
radiotherapy and potentially other radionuclides
• Various isotopes, energy and method of administration
Radionuclide Therapy
Ga-68 PSMA PET Imaging
34
• 2009/2010 – first publications of Ga-68 PSMA targeting PSMA receptor for Prostate Cancer imaging (Germany)
• July 2014:• Wesley Hospital Brisbane performed first clinical Ga-68 PSMA PET
CT for prostate cancer in Australia (16th July 2014)• Peter MacCallum Victoria performed their first clinical Ga-68 PSMA
PET CT in July 2014
• May 2015:• Oceanic Molecular Hollywood performed 1st Ga PSMA PET scan
(3rd site in Australia)
• Feb 2018:• 5 sites in Perth & approx. 40 sites in Australia providing Ga PSMA
PET – mostly private radiology practices• Fastest growing imaging test in Australia; no Medicare funding
• Some sites doing 20+ scans per week; $650-$1250 AUD per scan (average $900 AUD)
• Public hospitals in Perth and some Eastern States public hospitals do not charge
• NZ - $2300 NZD; Singapore - $2500 SGD; USA $3500 USD
Why the explosion?
35
• Prostate cancer• Approx. 20 000 cases diagnosed annually in
Australia
• Most common cancer diagnosis in Australia (more than breast, lung and melanoma)
• 1/3 will show biochemical relapse (PSA) within 10 years
• More men die per year from prostate cancer (>3000) in Australia than women die from breast cancer
• No major advance in therapeutic options in last 15yrs• Surgery/brachytherapy/radiotherapy
• ADT/pelvic irradiation
• 2nd line ADT/Docetaxel/2nd line chemo (cabazitaxel)
• Radium (palliation)
• Overall survival benefit of 2nd line therapies modest at best
Status of PCa treatments –EJNM 2015
Prostate cancer imaging with PSMA-ligands
• PSMA: prostate-specific membrane antigen
• cell surface protein with overexpression in prostate cancer
• transmembraneous localization including large extracellular part
• promising target for prostate cancer specific imaging and therapy
• recently: development of various PSMA-ligands for PET imaging
• e.g. 68Ga-PSMA: Glu-NH-CO-NH-Lys-(Ahx)-[68Ga(HBED-CC)] (only for 68Ga) andPSMA I&T (TUM/Scintomics), suitable for M3+ labeling (68,67Ga, 177Lu, 90Y, 111In…)
Detection rate with [68Ga]PSMA-Ligand:
73 patients
PSA: median 3.04 ng/ml
(range 0.2 – 1000 ng /ml)
mixed PET/CT and PET/MR imaging
[68Ga]PSMA-Ligand PET in recurrent prostate cancer
41.67%
54.55%
94.74%16.67%
36.36%
5.26%
0%
25%
50%
75%
100%
PSA < 1ng/ml PSA 1-≤2 PSA ≥2
high confidence low confidence
Courtesy: Eiber M 2013; Dept. Nucl Med, TU Munich;
Courtesy: Eiber M (NuklMed) and T.Maurer (Urology) at Technische Universität München
Asokendaran, Henderson, Meyrick, Wester, Lenzo. ANZSNM 2016
Detection rate with [68Ga]PSMA-Ligand (all pts with negative CT +/- bone scan):
102 pts; Age range 45-84 years. PSA range 0.04-100 ng/ml, 67/102 positive scans
15/67 (22%) recurrence confined to prostatic bed; lowest positive scan 0.17 ng/ml
[68Ga]PSMA-Ligand PET in recurrent prostate cancer
25
67
92
5
41
63
0
10
20
30
40
50
60
70
80
90
100
<0.5 0.5-1.5 >1.5
PSA Level (ug/L)
Detection Rates According to PSA Levels (%)
Diagnostic CT
P= 0.0017
P= 0.056
P<0.0001
Gallium PSMA PET
Ga-68 PSMA PET CT
• Rising PSA following definitive therapy for prostate
cancer and negative CT +/- bone scan:
• Data similar to European counterparts with
• Very high sensitivity if PSA >1.5 (~90%)
• Decreased sensitivity if PSA <0.5 (~25%) and minimal value if PSA
<0.2
• 1/5th had recurrence in prostate bed; mostly pelvic or abdominal
nodes
• Often nodal disease just out of field of treatment from pelvic
radiotherapy
• Smallest node detected (literature): 2.4mm
Ga-68 PSMA PET CT in Primary Staging
• 70 patients - results:
• PSMA-avid disease outside of the prostate gland (distant) detected:
• Gleason 7 or below: 18.2% (4/22)
• Gleason 8: 31.6% (6/19 - all PSA 10 or more)
• Gleason 9 and above: 47.8% (11/23)
• PSA less than 5: 9% (1 /11)
• PSA 5-10: 25% (6/24)
• PSA less than 10: 20% (7/35);
• PSA over 10: 45.7% (16 /35)
• 11 patients had both a PSA over 10 and Gleason 9 or more:
• 7 of these (63.6%) had distant PSMA-avid disease. Of these 7 positive
subjects: 5 to lymph nodes, 1 to skeleton and 1 to skeleton + lymph
nodes.
Meyrick, Asokendaran, Skelly, Lenzo, Henderson. Nuc Med Comm 2017
Mr B
• 70 yo man with Gleason 9 prostate cancer. PSA 24.
Standard preop inx.
• CT pelvis – localised disease.
• Bone scan - NAD
Mr B
Mr B
Mr B
Ga-68 PSMA PET CT in Primary Staging
• Conclusions:
• 68Ga-PSMA PET CT appears to have the potential for improving staging of
primary prostate cancer.
• In high risk patients (Gleason 9+ and PSA>10) PSMA avid disease was found
distant to the prostate in 64% of this group. This may have significant impact in
patient management.
Meyrick, Asokendaran, Skelly, Lenzo, Henderson. Nuc Med Comm 2017
Ga-68 PSMA PET in DXRT Planning
Ga-68 PSMA PET in DXRT Planning
Mr C
• 63 yo man pT3a Gleason 7 margin -ve prostate cancer. Had RP 22/5/2008.
Post-op PSA nadir 0.07. Slowly rose to 0.21 March 2010 & 0.33 June 2010. Re-staging investigations -NAD.
Salvage XRT to prostatic bed alone in Oct 2010. PSA dropped to nadir of 0.08 Oct 2012.
• Since then PSA slowly rising. Last PSA=1.87 in June 2015. Had various staging scans last 2 years and all NAD. NEVER had ADT during the follow up.
Mr C
Mr C
SBRT in 2015
PSMA scan 8/8/16
Role of Ga-68 PSMA in Prostate Cancer –
EANM 2018 Consensus Statement
I. Biochemical recurrence following definitive therapy –
PSA >0.5 ug/L
II. Primary staging in newly diagnosed high risk prostate
cancer (PSA>10; Gleason >8)
III. For radiotherapy planning
IV. For possible aid in guiding site of targeted biopsy –
STILL UNDER INVESTIGATION
V. Monitoring treatment response - STILL UNDER
INVESTIGATION – Pro-PSMA Trial Australia
Lu-177 PSMA in Ga-68 PSMA Avid Metastatic PCa
Systemic radioligand therapy with 177Lu-PSMA-I&T in
patients with metastatic castration-resistant prostate cancer.
H. Wester & M. Schwaiger Munich March 2016
Material and Methods
22 mCRPC patients treatment failure with both chemotherapy and novel androgen-
receptor targeted therapy treated 8-weekly with up to 4 cycles of 177Lu-PSMA-I&T.
Results
First 3 patients treated with a lower activity of 3.7 GBq in their first cycle. Due to a
favourable safety profile the activity was increased to 7.4 GBq in 19 subsequent patients
who completed a total of 40 cycles.
With higher activity no grade 3/4 toxicities were observed. Main non-hematologic and
hematologic grade 1/2 toxicities were dry mouth in 7 (37%), anemia in 6 (32%) and
thrombopenia in 5 (25%) patients.
Proportion of patients achieving a maximum PSA-decline of ≥ 30%, ≥ 50% and ≥ 90% was
56%, 33% and 11%, respectively. Combined assessment of bone and soft-tissue
metastases showed a complete remission in 5%, stable disease in 63% and
progressive disease in 32% of patients.
ECOG performance status improved or was stable in 74% of patients. Of men with bone
pain, 58% achieved complete resolution or reduced pain.
Conclusion
Radioligand therapy with 177Lu-PSMA-I&T appears to be safe and active in heavily
pretreated mCRPC patients.
Lu-177 PSMA in Treatment
58
• 177Lu-PSMA has been used safely in advanced metastatic prostate cancer
patients (>3000 worldwide – mostly Germany) with promising results.
• Theranostics Australia – Hollywood Private Hospital and Macquarie
University Hospital Sydney - ~150 patients treated. Currently treat 10
patients a week. Compassionate basis under TGA SAS.
• Number of studies now published: largest >500 patients in castrate
resistant metastatic prostate cancer who have failed ALL treatment options.
After 3-4 cycles Lu-177 PSMA:
• 40% show >50% reduction in PSA
• 30% show 0-50% reduction in PSA
• 30% show progression despite treatment
• Progression free survival of 6-21 months
• Overall survival benefit of 6-14 months
Lu-177 PSMA Side Effects
59
• 10-15% nausea (day after therapy for up to 3-4 days)
• 10-15% bone flare – especially if widespread bone
disease – treat with 7-10 days steroids
• Transient mouth dryness – lasts 1-2 weeks but 8-10%
permanent if >4 cycles of therapy
• Tiredness – from few days to few weeks
• Bone marrow suppression – dependent on previous
treatments and extent of bone marrow involvement
Mr J
• 82 yo man. Dx prostate cancer in 2004 (Gleason 8).
• Rising PSA July 2008 - ADT & prostatic bed radiation (74 Gy)
• Further PSA rise. CT and bone scan August 2015 no metastatic disease.
• PSMA PET scan Sir Charles Gardner Hospital September 2015 - extensive
PSMA avid nodal metastasis.
• Previous ADT- very symptomatic – memory, depression, fatigue.
• Last PSA= 40 ng/ml Oct 2015. PSMA nodal and prostatic bed disease.
• Renal impairment eGFR 35 ml/min – not a chemotherapy candidate
• Treated with 3 cycles 6.5 GBq, 5.5 GBq, 5 GBq Lu-177 PSMA (last dose May
2016)
• Unwell after 1st cycle – reviewed on request of oncologist – E. Coli UTI
(stricture)
Mr J – 3 cycles: 17 GBq
Mr J – 3 cycles: 17 GBq
Mr J – 3 cycles: 17 GBq
Mr J – 3 cycles: 17 GBq
Mr J
• 82 yo man. Dx prostate cancer in 2004 (Gleason 8).
• Rising PSA July 2008 - ADT & prostatic bed radiation (74 Gy)
• Further PSA rise. CT and bone scan August 2015 no metastatic disease.
• PSMA PET scan Sir Charles Gardner Hospital September 2015 -
extensive PSMA avid nodal metastasis.
• Previous ADT- very symptomatic – memory, depression, fatigue.
• Last PSA= 40 ng/ml Oct 2015. PSMA nodal and prostatic bed disease.
• Renal impairment eGFR 35 ml/min – not a chemotherapy candidate
• Treated with 3 cycles 6.5 GBq, 5.5 GBq, 5 GBq Lu-177 PSMA (last dose
May 2016)
• Unwell after 1st cycle – reviewed on request of oncologist – E. Coli UTI
(stricture)
• eGFR now 41 ml/min; PSA 1.6 ng/ml.
• Has had stricture repair Jan 2017
• Has had spinal surgery (stenosis) May 2017 and ankle repair Sept 2017
Mr Y
• 65 yo Singapore based Japanese businessman
• Gleason 9 prostate ca 2004; radical prostatectomy –undetectable PSA
• 2007 rising PSA- commenced ADT
• 2013 second line ADT – bicalutamide/nicalutamide
• 2015 radiotherapy
• 2015-2016 Docetaxol – peripheral neuropathy
• Refused further chemotherapy
• July 2017 - Weight loss, nocturnal tumour fever
• PSA 3900, Hb 97
• Treated with 3 cycles Lu-PSMA: 4 GBq Aug 7, 4 GBq Sep 17, 5 GBq Nov 17
Mr Y
Mr Y
3352
3901.483791.26
6369.92
5749.9
3631.07
3106
2569.745
1886.246
0
1000
2000
3000
4000
5000
6000
7000
01-Jul-17 01-Aug-17 01-Sep-17 01-Oct-17 01-Nov-17 01-Dec-17 01-Jan-18 01-Feb-18 01-Mar-18
PSAPatient 1
Baseline Post Cycle 1 Post Cycle 3Post Cycle 2
Cycle 228-Sep-17
Cycle 1 03-Aug-17
Cycle 316-Nov-17
Mr G
• 70 yo Californian businessman
• Diagnosed with metastatic prostate ca Sep 2014
• ADT then second line ADT then chemotherapy
• Rising PSA
• PSMA PET scan: Diffuse bone involvement, extensive
adenopathy, PSMA disease in prostate
• November 2016 PSA 395
• 2 cycles of Lu-177 PSMA in Germany
• 3rd cycles of Lu-177 PSMA at Theranostics Australia
Sydney
Mr G
395.47
131.35
17.392.7 0.64 0.57 0.18 0.14
0
50
100
150
200
250
300
350
400
450
1/11/2016 1/12/2016 1/01/2017 1/02/2017 1/03/2017 1/04/2017 1/05/2017 1/06/2017 1/07/2017 1/08/2017 1/09/2017 1/10/2017 1/11/2017
PSAPatient 2
Cycle 1 (Germany)
Cycle 2 (Germany)
Cycle 3 (TA - Sydney)
First U.S. Multi-center Investigational Clinical Trial of 177 Lu PSMA-
617 Targeted Radioligand Therapy in Metastatic Castration Resistant
Prostate Cancer Receives FDA Clearance
February 06, 2017 06:00 ET | Source: RadioMedix Inc.
November 2017 Endocyte Announces Exclusive Worldwide License of
Phase 3 Ready PSMA-Targeted Radioligand Therapy for Development
in Prostate Cancer
January 2018 ANZUP Australian TheraP Trial: A Randomised Phase 2 Trial of 177Lu-PSMA617 Theranostic Versus Cabazitaxel in Progressive Metastatic Castration Resistant Prostate Cancer (ANZUP Protocol
1603)http://www.anzup.org.au/content.aspx?page=lutetiumprostatecancertrial
Lu-177 PSMA in Treatment
72
• 177Lu-PSMA in small series appears well tolerated with minimal short term side-
effects
• 177Lu-PSMA can be provided safely in an outpatient private hospital setting with
improvements in most patients on PSA and molecular imaging criteria.
• More clinical trials required to determine clinical utility
• THERA-P Trial: Lu-177 PSMA vs Cabazetaxel chemotherapy
PSA 55 ng/ml PSA 4 ng/ml
Oct 2015 May 2016
FUTURE - Actinium-225 PSMA
Before After
Lu-177 PSMA failure
PSA 420 PSA <0.1
FUTURE - Actinium-225 PSMA
Lu-177 PSMA failure
PSA 3000 PSA <0.1
Future: ? Ga/Lu-PSMA in Glioblastoma
Ga/Lu-PSMA in Glioblastoma
Lu-PSMA in Glioblastoma
Ga-68/Lu-177 octreotate
• A number of tumours exhibit somatostatin receptor (SSTR)
overexpression
• Neuroendocrine tumours
• Meningioma**
• Merkel cell tumours
• Small cell lung cancer
• Thymic cancer
• Hepatocellular carcinoma
• Sarcoma
• Some Lymphoma
• Some Squamous cell cancers
• Some Medullary and Follicular thyroid cancers and Hurthle cell
tumours
• Some Breast cancers
Ga-68/Lu-177 Octreotate in Merkel Cell Tumour
FDG PET Ga-Octreotate PET
Mr R
• 70 yo businessman – skin lesion removal June 2016. Pathology-
Merkel cell. Wide local excision and axillary SLN biopsy – small
volume nodal disease July 2016 (Average survival metastatic merkel
cell 9 months)
• Radiotherapy to site and axilla.
• 6 cycles Pembrolizumab immunotherapy Sept 2016-Feb 2017.
• Mass in right axilla – FDG and Ga octreotate PET revealed mets in
axilla and sternum
• 3 cycles of Lu-octreotate: March 3.6 GBq, May 7.3 GBq, July 7.3 GBq
• Complete remission on FDG and Ga octreotate
• Repeat scans Nov 2017 – new subcut deposit and recurrence at
sternum; FDG reveals several new FDG avid liver mets
• For 3 cycles Lutate + capecitabine + temozolamide with lanreotide
(drives SSTR expression). 1st cycle Dec 2017; 2nd cycle Feb 2018
Mr R – January 2018
Summary• Long history of theranostics in nuclear medicine (I-131)
• Molecular targets coupled with standardised and simplified
production of diagnostic and therapeutic
radiopharmaceuticals is expanding potential imaging and
therapeutic options
• Ga-68 octreotate/Lutate for NET is now an established
theranostic paradigm
• Ga-68 PSMA becoming standard imaging test for prostate
cancer & Lu-177/Act-225 PSMA promising new targeted
treatments
• Gallium-68/Lutetium-177 combination offers great promise
for theranostic approaches to a number of cancers
• Theranostics Australia with Genesis Care starts at
Waratah Private Hospital in March 2018
Questions:1. Which imaging modality is most sensitive for carcinoid tumour staging
a. CT scanb. Ultrasoundc. FDG PETd. Gallium octreotate PET scan
2. Which patient is suitable for Lutetium-octreotate treatment:a. Metastatic colon cancer b. Metastatic kidney cancerc. Metastatic carcinoid (neuroendocrine tumour)d. Metastatic prostate cancer
3. Which imaging modality is most sensitive for restaging prostate cancer in the setting of biochemical recurrence
a. CT scanb. FDG PETc. MRI pelvisd. Gallium PSMA PET scan
4. The THERA-P Trial is an Australian phase III study:a. Assessing Lutetium-177 PSMA in early prostate cancer recurrenceb. Assessing Lutetium-177 PSMA in end stage prostate cancerc. Assessing Lutetium-177 PSMA vs Cabazetaxel chemotherapy in patients
who have failed docetaxeld. Assessing Lutetium-177 PSMA in metastatic carcinoid tumours
Metastatic Gastro-pancreatic NET
Acknowledgements:
• Prof Harvey Turner & Dr Phil Claringbold (Fremantle)
• Mr Philip Calais – Physicist (Fremantle Hospital & FSH)
• Dr Joe Cardaci, Dr Danielle Meyrick, Dr Sharon Yeo, Ms Julie Crouch
• Oceanic Molecular/Perth Radiological Clinic Team - in particular Dr
Andrew Henderson www.perthradclinic.com.au
• Ms Laura Skelly and Dr Marcus Askondrian
• Dr Tee Sin Lim and Genesis Care
• Prof Hans Wester, Munich & Dr Ken Herrmann, Wurzburg
• Mr Peter Eu – Pharmatopes Melbourne
• ANSTO
www.theranostics.com.au
FREMANTLE HARBOUR