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

nat.lenzo@theranostics.com.au

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