Radiotheranostics – A Paradigm Shift in Cancer Care

A precision-based approach

Cancer is a leading cause of death worldwide, accounting for nearly 10 million fatalities in 2020 with one in five people at risk of developing cancer in their lifetime¹. By 2040, these numbers are expected to reach 27.5 million new cancer cases and 16.3 million cancer deaths, solely due to the growth and aging of the population².

Radiotheranostics represents an innovative approach, combining diagnostic imaging (RLI) and targeted therapeutics (RLT) using radionuclides to identify and fight cancer, offering precise treatment that preserves healthy tissues^3-6.

Radioligands can be used for both imaging for patient selection and disease staging, as well as therapeutic applications by using specific markers, or receptors, that are highly expressed on a target cell to directly identify and treat the cancer — or a “see it, treat it” approach to cancer care⁵.

Radiotheranostics has the potential to become an essential pillar of cancer care alongside surgery, radiotherapy, chemotherapy, other targeted therapy and immunotherapy^3,7,8,10.

Radioligand therapy is a promising innovation in precision oncology and nuclear medicine

Proof from clinical trials

The benefits of RLTs for patients have been demonstrated in the treatment of gastroenteropancreatic neuroendocrine tumors (GEP-NETs) and in metastatic castration-resistant prostate cancer (mCRPC)^11,12. RLT also shows promise in potentially treating other cancers with extensive research ongoing in other indications, including brain cancer (glioblastoma) and breast cancer¹³.

Targeted treatment

Radioligands can be used for both imaging for patient selection and disease staging, as well as therapeutic applications (known as “theranostics”) by using specific markers, or receptors, that are highly expressed on a target cell to directly identify and treat the cancer – or a “see it, treat it” approach to cancer care⁵.

Limited damage to healthy tissue

RLTs combine a radioisotope with a ligand (i.e., a compound that binds to a specific marker or receptor on a cell) to directly target the cancer cells (or the tumor microenvironment), potentially damaging or destroying them, with the goal of limiting damage to healthy cells^3,5,6.

Demand for RLT treatment is growing. Understanding and addressing systemic barriers can ensure patients in need have access to essential care.

Understanding of RLT

Awareness and understanding of RLT among healthcare professionals, patients, and policymakers must improve to overcome misconceptions and barriers to adoption. Educational campaigns, stakeholder collaborations, and policy roundtables are key to fostering acceptance and integration into cancer care^3,9,12.

Trained workforce

Additional healthcare professionals with tailored training are required - including nuclear medicine physicians, nurses, radiologists and medical physicists - who are able to perform diagnostics and administer RLTs^9,13.

Hospital infrastructure

There are significant geographical variations in access to care, as centers that conduct imaging and administer RLTs are often concentrated in a small number of metropolitan areas or in certain regions, which may require patients to travel significant distances and potentially pay additional out-of-pocket costs to receive treatment⁹.

Real-world clinical data

Additional real-world clinical data in RLT is required to address disparities in availability – globally and regionally^9,12,14. The absence of socioeconomic data on RLT may also further create a barrier to funding and reimbursement within healthcare systems; for example, hospitals may require data on budget impact before agreeing to fund RLT⁹.

Sources

(1) Sung H, Ferlay J, Siegel RL, et al. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2021;71(3):209-249.
(2) American Cancer Society (ACS). Global Cancer Facts & Fig12ures. Accessed June 21, 2023. https://www.cancer.org/research/cancer-facts-statistics/global.html
(3) Bugani V, Battistelli L, Sansovini M, et al. Radioligand therapies in cancer: mapping the educational landscape in Europe [published online ahead of print, 2023 Apr 14]. Eur J Nucl Med Mol Imaging. 2023;1-7.
(4) Uijen MJM, Derks YHW, Merkx RIJ, et al. PSMA radioligand therapy for solid tumors other than prostate cancer: background, opportunities, challenges, and first clinical reports. Eur J Nucl Med Mol Imaging. 2021;48(13):4350-4368.
(5) Burkett BJ, Bartlett DJ, McGarrah PW, et al. A Review of Theranostics: Perspectives on Emerging Approaches and Clinical Advancements. Radiol Imaging Cancer. 2023;5(4):e220157.
(6) Sgouros G, Bodei L, McDevitt MR, Nedrow JR. Radiopharmaceutical therapy in cancer: clinical advances and challenges [published correction appears in Nat Rev Drug Discov. 2020 Sep 7]. Nat Rev Drug Discov. 2020;19(9):589-608.
(7) Siamof CM, Goel S, Cai W. Moving Beyond the Pillars of Cancer Treatment: Perspectives From Nanotechnology. Front Chem. 2020;8:598100.
(8) Shah HJ, Ruppell E, Bokhari R, et al. Current and upcoming radionuclide therapies in the direction of precision oncology: A narrative review. Eur J Radiol Open. 2023;10:100477.
(9) Merkel C, Whicher CH, Bomanji J, et al. Realising the potential of radioligand therapy: policy solutions for the barriers to implementation across Europe. Eur J Nucl Med Mol Imaging. 2020;47(6):1335-1339.
(10) Hendifar AE, Mehr SH, McHaffie DR. Best Practices for the Coordinated Care of Patients With Neuroendocrine Tumors Undergoing Peptide Receptor Radionuclide Therapy. Pancreas. 2022;51(3):213-218.
(11) Ramnaraign B, Sartor O. PSMA-Targeted Radiopharmaceuticals in Prostate Cancer: Current Data and New Trials. Oncologist. 2023;28(5):392-401.
(12) Health System Readiness. What is health system readiness? Accessed July 17, 2023. https://www.healthsystemreadiness.com/
(13) Bly R. Radiation safety of current European practices of therapeutic nuclear medicine: survey results from 20 HERCA countries. J Radiol Prot. 2023;43(1):10.
(14) Prager GW, Braga S, Bystricky B, et al. Global cancer control: responding to the growing burden, rising costs and inequalities in access. ESMO Open. 2018;3(2):e000285