For a Biologist with Stage 4 Cancer, Biology-guided Radiotherapy Brings New Life

When Susanne Kluh learned about SCINTIX therapy from RefleXion, she was uniquely qualified to appreciate the opportunity before her.

THE ONCOLOGIST’S ASSESSMENT of her cancer was dire, but Susanne Kluh wasn’t about to let him have the final word.

“He said, ‘We can’t treat it. Maybe we could do chemotherapy, but wouldn’t you rather have two good years than four bad ones?’ ” Kluh recalls. “He wanted to just prescribe an opioid and send me home to die. I said, ‘I’m only 57. I want to have at least 15 years — and preferably good ones!’ ”

Kluh understood she faced an uphill battle: With five-year survival rates for her metastatic cancer at less than 5%, her treatment options were limited. But as a biologist who had ascended the ranks to become general manager for the Greater Los Angeles County Vector Control District (GLACVCD), she also knew that biomedical progress was proceeding at a rapid clip. So she made an appointment at City of Hope, a leading cancer center in Los Angeles, to see about any option that might enable her to resume the active, happy life she had led with her wife Monica and their three dogs and a cat before it was upended by the unexpected diagnosis.

At City of Hope, Kluh learned about a potentially revolutionary technology that treats cancer by turning the tumor’s biological activity back against itself.

At City of Hope, Kluh learned about a potentially revolutionary technology that treats cancer by turning the tumor’s biological activity back against itself. SCINTIX therapy, from the Hayward, CA-based biotech company RefleXion, is the world’s first external-beam radiotherapy treatment that uses a radioactive tracer in the treatment of metastatic stage 4 cancer — an exciting new technology known as biology-guided radiotherapy. The FDA granted SCINTIX therapy Breakthrough Device designation in 2021, and in 2023 gave clearance to the technology for the treatment of primary or secondary cancers in the lung and bone — the destination of 70% of metastatic tumors. Kluh learned that she was eligible for SCINTIX therapy and was presented with the opportunity to incorporate this new technology as part of her cancer treatment.

Given Kluh’s expertise as a biologist, the decision was a no-brainer.

“What resonated with me was the accuracy of this approach to treatment, it’s a very precise way to treat the tumor while minimizing the radiation that goes to the healthy tissue.”

Susanne Kluh
SCINTIX Therapy Patient

“What resonated with me was the accuracy of this approach to treatment,” she says. “It’s a very precise way to treat the tumor while minimizing the radiation that goes to the healthy tissue.”

SUSANNE KLUH GREW UP in southwest Germany and studied biology at the University of Heidelberg, among the nation’s most prestigious higher-ed institutions. While there, she did a summer internship with the German Mosquito Control Association. The work was so interesting to Kluh that she went on to complete her master’s degree and take a position with the association managing mosquito control efforts in five communities along the Rhine River.

In 1997, Kluh moved to Los Angeles. Drawing on her experience in mosquito and vector control, Kluh joined the GLACVCD staff in 1999 as an assistant vector ecologist. A decade later she was promoted to scientific technical director, and in 2022 she was selected to lead the agency as its general manager.

GLACVCD is charged with countering the threat of mosquito and other vector-borne diseases in an area covering approximately 1,000 square miles across Greater Los Angeles. It’s a critical task at a time when increased international travel leaves the region susceptible to a host of diseases spread by mosquitoes, including the Aedes aegypti mosquitoes that have exploded in Southern California in recent years: West Nile virus, St. Louis encephalitis, Zika, and Dengue fever, to name a few.

“This is great work because you can use your expertise to make an immediate difference,” Kluh says. “Everything we do has direct implications on people’s quality of life and health. I’m a biologist at heart, so I wasn’t sure how I would like the more administrative side, but it’s great to be able to set the course for the agency.”

Outside of work, Kluh was also in a good place. She and her wife led an active life — hiking, canoeing, camping, and enjoying time with their pets in the backyard and on walks.

Then their world changed.

WHEN KLUH BEGAN TO EXPERIENCE back pain in the summer of 2023, she thought nothing of it. “I always had sciatica issues because when I worked in Germany, I lifted a lot of 50-pound sandbags,” she explains.

But when the pain persisted, she decided to go in for an X-ray, which showed a compression fracture. Kluh got a back brace and scheduled a bone density test to try to determine what might have caused it. Before the appointment date, she was sitting on a chair at a friend’s house, leaned forward to reach for a napkin, and fell to the floor. “I should have laughed and gotten up, but I couldn’t,” Kluh says. By now the pain in her neck and back had become excruciating. After trying unsuccessfully to sleep it off, Kluh went to the emergency room. This time, the X-ray showed lesions on her lung and spine.

The diagnosis — non-small cell lung cancer that had metastasized into her spine and neck — came as a shock. “I was never a smoker, I don’t have high blood pressure or diabetes, and I was very active,” Kluh says. “How does this happen?”

After her oncologist’s bleak prognosis, Kluh arrived at City of Hope, where a blood sample revealed that she had a common mutation that would lend itself to Tagrisso®, a biological treatment known as a tyrosine kinase inhibitor that seeks out cells with the mutation and prevents them from dividing. To alleviate the intense back pain, Kluh needed radiation that would stop the progression and begin the calcification of the affected bones. That’s when Kluh’s radiation oncologist, Yufei Liu, MD, PhD, told her about SCINTIX therapy, a new cancer treatment option.

With SCINTIX therapy, a radioactive glucose tracer is injected into the patient, which then interacts with cancer cells to produce light-wave emissions that, using positron emission tomography (PET) technology, show the biological activity of the tumor. Combining PET technology with the linear accelerator that delivers the radiation therapy, SCINTIX therapy automatically directs radiation toward the cancer cells in real time, regardless of whether the tumor, or the patient, moves during the treatment.

“With this technology, the tumor lights up on the PET scan and directs the radiation to it, which is something that no other radiation machine can do.”

Dr. Yufei Liu, MD, PhD
City of Hope Comprehensive Cancer Center

“Normally, we design the radiation plan based on a CT scan taken of the patient during a planning session, and we essentially have to trust that the patient or the tumor won’t move because we can’t actually see the radiation being delivered,” Dr. Liu explains. “With this technology, the tumor lights up on the PET scan and directs the radiation to it, which is something that no other radiation machine can do.”

To account for movement of the patient or tumor, radiation oncologists have traditionally delivered larger radiation volumes, Dr. Liu says. This can potentially lead to more collateral damage to nearby healthy tissue, leading to increased side effects and a longer recovery period. By more precisely targeting the tumor, biology-guided radiotherapy not only spares more healthy tissue, but also opens up the possibility of using radiation for tumors close to sensitive areas such as the intestines, Dr. Liu notes.

City of Hope is one of seven hospitals across the country treating patients using  SCINTIX therapy. Dr. Liu and his colleagues are currently conducting clinical studies to assess the feasibility of offering SCINTIX treatment for other types of tumors outside the lung and bone.

Knowing that Susanne Kluh’s pain would make it difficult for her to hold completely still for the duration of her radiation treatment, Dr. Liu told her she was an ideal candidate to receive SCINTIX therapy for her spine. “As a scientist,” Kluh says, “I was excited to participate in what could be the future for treating cancer when no other good treatment is available.”

KLUH RETURNS for ongoing monitoring approximately every three months. On a recent repeat PET scan, the tumor that had been lighting up on her spine was devoid of any signal, suggesting that the active cancer in that area had completely resolved from the radiation treatment. “Susanne’s response has been excellent,” Dr. Liu says. “Her overall disease status is very stable. Given that we don’t see any evidence of new disease over the last few months, I’m guardedly optimistic.”

Kluh still feels some stiffness in her back as the bones continue to go through the healing process, but she no longer has to wear a brace and the pain has largely subsided. She’s once again able to walk with the dogs and has resumed traveling with Monica. “The impact on my quality of life is relatively little, considering what I was told by my first doctor,” she says. “Overall, I feel very positive and am just enjoying living my life.”

To learn more about SCINTIX therapy and for a complete list of cancer centers offering this breakthrough technology, visit scintixtherapy.com.