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Zachary Klaassen: My name is Zach Klaassen. I'm a Urologic Oncologist at the Georgia Cancer Center in Augusta, Georgia. I'm delighted to be joined on your show today by Doctor Luke Nordquist, who is CEO of Xcancer and a Medical Oncologist. Luke, thanks so much for joining us today.

Luke Nordquist: Zach, good to be here. Thanks for the invite.

So this is a website that we came up with a couple of years ago, myself and Oliver Sartor. And the concept TheranosticTrials.org. It's a global website that's very much about education for patients, for physicians, and for industry, about this whole world of theranostics. But also, a little bit like clinicaltrials.gov, allows you to search every global ratiopharm theranostic trial that's out there today. And so with the search engine, you put in your type of cancer.

When we started this, about two years ago, there were about 150 trials for 12 types of cancer. Today, there's over 600 for 35 types of cancer. And if you put in the type of cancer, prostate, all the clinical trials pop up here globally. These have fancy logos next to them because these are sponsors of the site. Down here, these are not yet.

But if you click on these, it's very basic. Takes you to clinicaltrials.gov links and basic information about the trial. But for these other ones, it'll tell you if it's an imaging study, a treatment study, a treatment and imaging, what the setting is, what countries the trial is being conducted in. You can filter it by isotope or sponsor that's out there. You click on a particular trial, and the company enters this information now.

So that's what's nice about it. They're updating in real time what the isotope, target, chelator, ligand. They can put videos on how the drug works, major inclusion exclusion criteria. If there's a poster presentation, or a slide presentation, or a manuscript, they can put a direct link to that or put a poster on here that pops up. And then it lists all the sites where the trial is being conducted at.

So that's the main purpose of the trial. Like I said, it's for many cancers now, 35 different types. For the rest of this—how to navigate—it's different if you're a patient, or physician, or industry. So for a lot of education, and I'll go to this first. If we talk about how radiation works for patients, that's a scary word for a lot of people. This couple-page document here goes through a lot of it.

The half-life, the decay mode, if it's alpha, beta, gamma, positron, what's the difference between Curie and Becquerel, or Rem and sievert. The US always has to be a little different, right? But there's a lot of education that puts radiation very basic here. And then the same thing about theranostics. And I'll spend a moment here because that's our topic here. But the different parts of the theranostics—we talk about ligand, linker, chelator, isotope, target.

So how I explain it very well—very easily, I think—I'll show you another picture here, a cartoon.

So you have the targets on a cancer cell. That's like a tattoo on someone's skin. And let's say a certain biker gang has a certain tattoo on their shoulder. We can identify them just like that. Certain cancers, of course, have different targets, and we can identify them. And the more unique they are to that cancer, the better.

Then you have the ligand, which is like the truck. We set that to a GPS. That could be a small molecule, an antibody, a protein that we set to find a certain target. And then we have the isotopes, which would either be the light bulbs or the bombs, so to speak.

The ligand we talked about. But then it's different. So then we have a linker, which connects it. And some of these drugs don't have a very good linker, and they could potentially break loose and not bring the isotope to the target, to the cancer, where we want it. So when I start explaining how people have different proprietary linkers, Clarity has a bivalent like a double hitch on it.

And then you have the chelator, which is like the trailer or the strap downs that hold it in place. So again, if it's not being held in place, we're learning now, I think higher doses of theranostics at the tumor for longer periods of time, less to the rest of the body, like the marrow and the kidney, probably better.

And so what we put on here, and more on a scientific level, we list every target. So this is every target today listed that's being studied globally. What type of cancer it is? Or you can search a certain cancer, say breast cancer. It's going to list all the targets that are currently being listed. As the new ones come out, we update it. It lists every isotope, Astatine-211, coming up in the near future.

But Copper-67, -64, it'll tell you if it's a beta or gamma, like a therapeutic or a positron, if it's in the decay daughters, and if it's FDA-approved or not. So it lists the isotopes. And then it gives you a little bit of information about the ligands. What's the difference between a small molecule, peptide, small protein, or an antibody? So that's important.

Some of the other neat things on this website are the trial stats. So as of today, there's 639 trials here. These are the treatment isotopes, the most common. These are the most common imaging isotopes, F-18 being the most common. Obviously, most of the trials are positron or PET imaging trials today. The most common cancer types. These are our current site sponsors.

The conferences for radiopharmaceuticals around the world are updating this as they come out. Distinguished investigators around the country that are doing a lot of these radiopharmaceuticals, like Dr. Fizazi in France, et cetera. So there's a lot of information on here. And this is another component I like. The RLT Connect.

So there's a lot of people that go into making theranostics happen. You have the couriers, the RDMOs or CDMOs that develop the isotopes, obviously, the sponsors and the CROs that run clinical trials, and you have the venture capitalists. So we started creating a connection, like a LinkedIn center, for all the different categories of people, dosimetry programs, et cetera, so they can put up anything they want on here about their company.

So if another company is looking for a CDMO or RDMO, they can go to those. Like, our RLS as a distributor. So this is a neat site. It's meant to be an all-in-one for patients to have education and access to trials, for the physicians to learn more about the difference between alpha and beta, and learning the trials to the industry that can have more awareness of these and more ability to network with other people.

Zachary Klaassen: That's wonderful. And again, just for our listeners, TheranosticTrials.org, correct?

Luke Nordquist: That is correct. Yes.

Zachary Klaassen: Fantastic. I think this is beautiful. It's almost like clinicaltrials.gov on extreme steroids for theranostic. It's great. Do you have breakdown about what percentage of visitors or patients versus physicians or providers?

Luke Nordquist: We're starting to look at all those metrics now. I don't yet. We're getting it right now about 5,000 hits a month. And they're from pretty much every continent, minus Antarctica. But from South America, Africa, Asia, Australia, Europe, all the US, Canada. So it's just starting to grow now more. I'm having more people bring it up or send in requests, or companies are starting to come to us and say, how can I get on there?

And the nice thing is they don't have to submit a trial to us. They have a login where the companies can get on, upload the information. It's all drop-down menus. They pick the link, pick the isotope, pick the cancer types, et cetera. In about 15 minutes, they hit Submit, and their trial is out there to the rest of the world.

Zachary Klaassen: Fantastic. Luke, any take-home messages before we wrap things up?

Luke Nordquist: So much out there. I just say, stay tuned. It's such an exciting area or time in theranostics right now because, first, we're just excited about an isotope and a target. And now we're finding more targets. We're going to be doing first-in-world coming up on a new target called STEEP2 for prostate cancer. All the new isotopes.

We haven't even started touching some of the newer ones, like ytterbium or astatine-211. As the linkers, there's companies out there now that are just making covalent bonding to keep the isotopes at tumor longer. This is a very exciting time from the therapeutic. But also, as we mentioned for this trial, the imaging.

Zachary Klaassen: Yeah, absolutely. Luke, great discussion on your show today. Thanks so much for your time and expertise.

Luke Nordquist: Anytime, Zach. Appreciate it. Thank you.