New research at Carilion Clinic and Virginia Tech’s Fralin Biomedical Research Institute at VTC is positioning Southwest Virginia as a hub for advanced cancer medicine — and patients are already seeing the benefits.
Patients with brain and urologic cancers will soon have access to a broader array of the latest treatment options, thanks to new clinical trials for targeted radiopharmaceutical therapies.
What is theranostics?
Radiopharmaceuticals — also known as “theranostics” — are a form of precision medicine that uses radioactive isotopes for both imaging and therapy. The approach has shown effectiveness in treating a wide range of tumors and is considered one of the fastest-growing areas in modern oncology.
Bill Kiser, medical director of molecular imaging at Carilion Clinic, said the field has undergone a dramatic transformation.
“This is probably the most growthful area right now — what we’re seeing,” Kiser said. “It used to be what we called nuclear medicine was kind of put in the basement in the dark, nobody cared about it, the pictures were ugly, and now all of a sudden it’s on the forefront of imaging and treatment. So it’s a very exciting time to be in this.”
Kiser has been a leader in this field. He’s been at it for 27 years and said the past five years has changed his life because of what they are able to do now.
“We started out doing three PET scans a day and now we’re doing about 25-30 a day. So, it’s really exploded. We went from one scanner to two scanners, and we have two shifts now. I mean it’s just really growing, growing a lot," Kiser said. They expect to add a third scanner when the Carilion Taubman Cancer center opens.
New trials target brain, urologic cancers
In the pipeline are new theranostic treatment trials for cancer pain, renal cell carcinoma and glioblastoma. They build on the health system’s earlier research in partnership with Blue Ridge Cancer Care, which has attracted patients from across the country and led to FDA approval of therapies in use today, including Pluvicto (Lu177PSMA) and Lutathera (dotatate).
David Buck, president of Blue Ridge Cancer Care, said the partnership has put the region ahead of the curve.
“Our longstanding partnership with Carilion Clinic has allowed us to be early adopters of theranostics,” Buck said. “Through our shared collaboration with industry partners and the SCRI research network, we’re excited to continue to offer these novel, cutting-edge therapies to the patients here in their communities.”
Lana Wahid, M.D., vice chair for research in Carilion Clinic’s Department of Medicine, said access and ambition are driving the expansion.
“The opportunity to expand access to these much-needed, innovative therapies for patients is exciting, and we are aggressively seeking clinical trials that will make Roanoke a destination for cancer research and leading-edge care,” Wahid said.
Hope for patients in underserved communities
For patients in Southwest Virginia — a largely rural region that has historically had limited access to cutting-edge treatments — researchers say the expansion carries significant weight.
Cheng-Chia “Fred” Wu, M.D., Ph.D., an assistant professor involved in the research, said the work is about creating new possibilities where few previously existed.
“This type of research and these types of opportunities are really not available for everyone, and so for this area, for patients who have devastating cancers where radiation medicines can help, it creates new hope and new possibilities,” Wu said.
James Crowley, Carilion imaging services manager, said bringing theranostics beyond major academic health centers has been a central goal of the effort.
“Our overarching goal is to expand access to theranostics beyond larger academic health centers where they have traditionally been offered and into rural areas to benefit Carilion patients in Southwest Virginia,” Crowley said.
Crowley, along with Dustin Osborne, Ph.D., of the University of Tennessee, Knoxville, were awarded the Society of Nuclear Medicine and Molecular Imaging’s $100,000 Mars Shot grant in 2025.
Global researchers gather in Roanoke
Researchers from around the world recently met in Roanoke at the Fralin Biomedical Research Institute to discuss and share findings on these emerging treatments. The gathering was part of the Appalachian Radiotheranostics Coalition workshop, which featured researchers presenting findings on astatine — a promising isotope for use in brain, prostate and other cancers.
The workshop is the second of four ARC is sponsoring as part of SNMMI’s Mars Shot initiative, a national effort to accelerate access to radiotheranostic therapies.
A growing research enterprise
Increasing theranostics-related clinical trials is part of Carilion’s rapidly growing research enterprise, which has prioritized novel therapies as the health system prepares to open the Carilion Taubman Cancer Center in 2028.
In all, Carilion has approximately 150 clinical trials underway in more than 20 specialties, broadening access to innovative therapies and strengthening care quality for patients across Southwest Virginia.
Carilion’s expanding research portfolio — alongside a new regional biotech incubator, an embedded usability consultancy known as Usability Works and other developments — is contributing to continued biotech growth in the region and state, both of which have targeted the sector for economic development.
For more information about clinical trials available at Carilion, visit Research and Clinical Trials at Carilion Clinic.