Professor Mike Sathekge, head of the Department of Nuclear Medicine at the University of Pretoria and Steve Biko Academic Hospital, and president and CEO of the South African Nuclear Medicine Research Infrastructure (NuMeRI), has received the Harry Oppenheimer Fellowship Award for research that could make breast cancer more manageable.
Professor Mike Sathekge – head of the Department of Nuclear Medicine at UP and Steve Biko Academic Hospital, and president and CEO of NuMeRI – with his Harry Oppenheimer Fellowship Award at the announcement ceremony at the Brenthurst Library. Image supplied.
Sathekge has been awarded the 2025 Harry Oppenheimer Fellowship Award, a R3m grant from the Oppenheimer Memorial Trust (OMT), to complete his research and make it more widely available.
Breast cancer is the leading type of cancer among women in South Africa and globally.
Too often, it is discovered too late – but a new approach promises better survivability.
The solution, called theranostics, comes from nuclear medicine and combines diagnosis with treatment.
It could turn the tide against breast cancer and, like the fight against HIV/Aids, make it a manageable disease.
Combination
“Theranostics, which brings diagnosis and treatment together, is a combination of early diagnosis with treatment that is personalised and precise down to mere cells, which allows us to exactly detect and assess tumours, devise specific treatment regimens and assessment of treatment response over time,” says Sathekge.
“The earlier the breast cancer is detected, the more accurately it is assessed and the more precise the treatment, the exponentially better the patient’s prognosis.”
In South Africa, however, this is too often not the outcome.
A comprehensive study into the availability of breast cancer services in the public healthcare sector, published recently in the South African Medical Journal, found that 67% of patients were diagnosed at a late stage.
In other words, their cancer had metastasised and spread to other parts of their bodies, and their prognosis was poor.
The study also noted that South Africa is expected to face a substantial rise in cancer cases over the coming decades, driven by population growth, ageing and changing disease patterns.
Harry Oppenheimer Fellowship Award
Sathekge’s nomination for the Harry Oppenheimer Fellowship Award was among 80 nominations received by OMT, spanning a wide range of academic fields.
Finalists shortlisted included proposals on a system for measuring the environment, air and our health; frost exposure in tropical Africa; a model for testing modified gravity; conversion of CO2 into useful products, such as fertilisers; and tissue T-cell response profiling of tuberculosis.
“There were so many excellent applicants for this year’s award, touching on vital issues impacting the world we live in, and worthy of further research and development,” says OMT chairperson Rebecca Oppenheimer.
“This made our selection panel’s final decision all the more challenging, but I believe we have made an exciting choice that will have far-reaching, positive ramifications for South Africa’s public healthcare system and the people who use it.
“In developing a technology that makes diagnosing and treating cancers more effective, affordable and available, Prof. Sathekge and his colleagues hold in their hands the potential for a quantum leap forward in improving South African patients’ health outcomes and human dignity, as well as for beating breast cancer globally. OMT is proud to support his endeavours.”
The Sathekge solution
Sathekge’s solution is, essentially, one whose time has finally come, and it centres on Trop2.
First conceived around 15 years ago, it capitalises on a protein called trophoblast cell-surface antigen 2, or Trop2.
This molecule, found in high levels in breast cancers (and others, including cervical, pancreatic and lung cancers), helps the cancer multiply and makes it stubborn to treat.
Although Trop2 is already recognised as an important target in several cancers, there is still no widely established, clinically scalable way to precisely map its distribution across a patient’s entire cancer burden.
The answer may lie in nanobodies: tiny, engineered antibody fragments designed to bind specifically to Trop2, a protein found on cancer cells.
Their small size allows them to reach tumours rapidly and clear from the bloodstream faster than conventional antibodies, making them particularly attractive for same-day PET imaging, a scan that shows where disease is active in the body.
Through a long-standing collaboration with Professor Frederik Cleeren, assistant professor in the Laboratory for Radiopharmaceutical Research, in the Department of Pharmaceutical and Pharmacological Sciences, and his team at KU Leuven in Belgium and the Joint Research Centre (JRC) in Karlsruhe, Sathekge’s team is combining nanobody engineering and radiolabelling with South Africa’s capabilities in molecular imaging, actinium-225 radiopharmaceutical development and targeted radionuclide therapy.
Together, the collaborators are developing a Trop2-targeted theranostic approach that links diagnosis with treatment.
The first step uses a tiny targeting protein, known as a nanobody, designed to bind specifically to Trop2 on cancer cells.
This nanobody is labelled with fluorine-18, a short-lived radioactive tracer used to help doctors visualise Trop2-positive tumours on a PET/CT scan, a combined imaging test.
PET/CT is an advanced imaging method that uses a small amount of radioactive tracer to show biological activity inside the body. In this case, it could help clinicians map Trop2 expression across a patient’s full cancer burden and monitor changes in the target and treatment response over time.
Where imaging confirms sufficient Trop2 expression, the same targeting strategy can be applied to actinium-225-based treatment, using actinium-225, a powerful alpha-emitting isotope.
Actinium-225 can deliver highly localised radiation over very short distances, concentrating treatment in Trop2-positive cancer cells while limiting radiation exposure to surrounding healthy tissue.
Personalised approach
The ambition is to move beyond treating patients based on limited information from a single biopsy, towards a more personalised approach: seeing the target throughout the body, selecting patients more accurately, and laying the foundation for future Trop2-targeted alpha therapy.
Sathekge’s work puts South Africa at the forefront of worldwide research into effective responses to breast cancer, says the University of Pretoria’s vice-chancellor and principal, Professor Francis Petersen.
“South Africa urgently needs better ways to detect, understand and treat aggressive breast cancer.
“Too many patients still present late, when the disease is more difficult to manage, and treatment options are limited.
“Prof. Sathekge’s work at NuMeRI brings together advanced imaging, radiopharmaceutical science and targeted treatment in a way that could help doctors make more informed, patient-specific decisions.
“The research aims to improve how cancer is identified, how treatment is selected and how response is monitored over time.
“It also demonstrates the depth of scientific talent, innovation and academic rigour in South Africa.
“Through work of this calibre, African researchers are not only responding to local health challenges, but helping to shape the global future of cancer care.
“We look forward to seeing this research strengthen South African capacity and contribute to better outcomes for patients here and internationally,” says Petersen.
For Sathekge, the most exciting element of his work is that it centres on the patient, giving them dignity and the opportunity to live long, fulfilling lives.
“Our goal is not simply to find cancer earlier. It is to understand each patient’s cancer better, select treatment more intelligently, and reduce the uncertainty that patients face when standard treatment no longer works,” he says.
“This award supports a South African-led effort to see the biology of aggressive breast cancer more clearly, select patients more accurately and lay the foundation for targeted treatment.”
