SOUTHERN CALIFORNIA
Local doctor steps up prostate cancer fight
Loma Linda physician is involved in treatments showing promise in Germany while awaiting FDA's approval here
By Lori Basheda
Alan Held's scan showed more than 100 metastases.
"They were literally speckled throughout my body, in my bones," said the 64-year-old sales manager.
Doctors told him he had stagefour prostate cancer and that it had spread. They started hormone therapy and chemotherapy tablets. It was September 2018.
Seven months into treatment, Held's cancer was still in his bones. His oldest son, Josh, did some research and found that there was another option, a promising treatment for prostate cancer called "theranostics." Only problem was it was in Germany. His father would have to fly there from his Vacaville home to get it.
Held and his wife, Linda, landed in Frankfurt in September 2019 and drove two hours to Center Clinic in Bad Berka.
The following day, doctors put an IV in his arm for 30 minutes, sending molecular-targeted liquid radiation on a search-and-destroy mission. A follow-up scan showed that 80% of the metastases had vanished.
"It was very emotional," said Held, who returned to Germany in December 2019 for a second treatment, which wiped out more tumors.
A few months after that he flew to Germany for a third treatment.
"It just kept getting better," Held said. "It just kept erasing the cancer."
Nearly two years later, Held has only three small dormant spots in his body. He thanks God, the clinic and Dr. Frankis Almaguel, the director of Molecular Imaging and Therapeutics Research at Loma Linda
Vacaville resident Alan Held was diagnosed with prostate cancer and traveled to Germany to undergo therapy that is in clinical trials at Loma Linda University Cancer Center. Dr. Frankis Almaguel hopes to have FDA approval soon.
University Cancer Center, who was at the Center Clinic in Germany when Held arrived. "He walked up to me and said, 'Are you Alan from California? I'm Frankis from Loma Linda. I'm on this ride with you, my brother.'" Almaguel explained that he had been working to bring theranostics to the Loma Linda Cancer Cente and had some Loma Linda patients flying to Germany for treatment, which is why he was there.
"There's a lot of emotion when you roll though something like this," Held said. "Frankis has been an ally. He's been a lot of support in more ways than one. I'm a believer, and he even prayed with me before the first treatment. What a wonderful experience it was."
According to Almaguel, thousands of men have successfully been treated with theranostics in Germany over the past decade.
He believes the FDA is close to approving theranostics for use in the United States for prostate cancer patients. Global clinical trials are wrapping up.
"We're really close," he said. "The results are really clear. The FDA is going to have a lot of pressure if they don't approve this."
The treatment Theranostics is a mash up of the words therapeutics and diagnostics.
First comes the diagnosis. A small prostate specific cancer marker molecule is labeled with a diagnostic radio isotope and injected into the patient. Like little drones, they move through the body, seeking out tumor receptors and binding to them, lighting them up so that when doctors scan the patient, they can see where the cancer is.
"Then we change the radio isotope from diagnostic to therapeutic," Almaguel said.
This time the the drones are carrying tiny grenades. "They go only to cells that have cancer and detonate that cell," Almaguel said. "It's amazing technology."
It's also very different than current cancer treatments, which are largely trial and error.
"We give a patient chemo and see in three months if it's working," Almaguel said. "Elon Musk is going into space and we're still playing the chance game in cancer."
Also, chemo kills all cells, not just cancer cells.
"You don't have to burn the whole forest down if you know what tree is causing the problem," Almaguel said.
Because it's so precise, theranostics has few, if any, side effects. Held said he had none.
"It's kind of a dream for cancer therapy," Almaguel said.
Loma Linda has a theranostics clinic set up; it's just waiting for FDA approval. Almaguel is hopeful they will be able to offer the treatment by the the beginning of 2022.
In the meantime, Loma Linda is equipped to take patients for the diagnostic part (insurance often covers the imaging). Patients must still fly to Germany for the treatment.
Almaguel has worked with more than 100 prostate cancer patients since 2018, some in trials, others who were approved on a compassionate use basis (something the FDA allows for patients who have run out of options).
Held is one of his best success stories. "He had hundreds of metastases, including a huge one in his spine," Almaguel said. "He was told he could do nothing else but walk, no high-risk impact. Eight months after this therapy he was back skiing at Lake Tahoe." Almaguel has seen others like Held who responded brilliantly, but while some patients have needed only one round of therapy, others require up to a dozen or so.
"I think Alan is going to die of something else, not prostate cancer," Almaguel said.
Held, who was told he had up to five years to live by the first doctors who diagnosed him, agrees.
"Like Frankis said, I'll die of something else. I'm feeling great right now," he said. "I feel this should be here in the U.S."
Almaguel, whose specialties are nuclear medicine and radiation oncology, says theranostics is one more weapon in the cancerfighting arsenal.
"We need different guns to kill the same disease," he said. "So that if the front door is closed we have a side door and if that is closed we have a window."
He is developing molecules at the Loma Linda clinic that he hopes in the future can be sent in to find and treat breast cancer and glioblastomas, currently a death-sentence brain cancer.
"This is exciting. It's very exciting." he said. "We can win this war."
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