New report – Radioligand therapy: realizing the potential of targeted cancer care
Ahead of the European Commission’s official launch of ‘Europe’s Beating Cancer Plan’, The Health Policy Partnership and an expert-led steering committee met at the European Parliament in Brussels on the 22nd of January 2020 to launch a new report; Radioligand therapy: realizing the potential of targeted cancer care.
Discussions at the launch event revolved around the content of the report; the medical value of radioligand therapy, the barriers to its widespread clinical use, and recommendations to overcome them.
Cancer remains the second highest cause of death globally. With a growing number of people living with the disease and the prediction of rising prevalence, the medical community is increasingly focusing on quality of life (QoL) in addition to efficacy when searching for new therapy options.1,2 Radioligand therapy may be an opportunity to meet both of these outcomes.
Utilizing the structural changes present in cancer cells, radioligand therapy smuggles radioisotopes through the body and delivers them directly to tumors;3-5 for example, the use of 177Lu-prostate-specific membrane antigen (PSMA) radioligand therapy using inhibitors of PSMA to treat metastatic castration-resistant prostate cancer (mCRPC).6
Conventional treatments may be likened to grenades, whereas radioligand therapy is more of a sniper, and hence could offer one solution to the current oncology climate where efficacy and QoL are not optimally achieved. Additionally, the employment of different radioisotopes would allow clinicians to tailor therapy to different types of cancer and potentially other diseases.3-5,7
Further, few clinicians are trained in this kind of therapy, restricting its use to a limited number of centers, and the need for additional and varying – depending on the radioisotopes being used – nuclear waste disposal infrastructure places further blockades in front of the implementation of this treatment.4,10
Radioligand therapy is currently used for the treatment of metastatic neuroendocrine cancers and bone metastases in mCRPC with improvements being seen in both overall survival and QoL for many.11-13
One recent study evaluated the use of 177Lu-PSMA-617 radioligand therapy in 90 mCRPC patients on second-line hormonal therapy and/or docetaxel chemotherapy. The median overall survival and median progression-free survivals were 14 and 11.8 months, respectively. Radioligand therapy-related toxicities were low, with no serious adverse effects.14
With the prospect of reduced side effects and increased efficacy, this a fascinating area. However, being a relatively new treatment option, limited clinical knowledge and poor patient perception of radioactivity have hindered the integration of radioligand therapy into the oncology treatment space.8,9
Authors of the report are calling upon both European and national decision-makers to integrate radioligand therapy as a potential treatment in all cancer plans and health policy frameworks.
As the medical community’s understanding of the complex and diverse group of diseases that is cancer grows, the need for a broad range of versatile and personalizable tools becomes ever more apparent. Radioligand therapy could address some of the current gaps in cancer care. Decision-makers and policy leaders harbor the power to ensure each cancer patient has the best possible arsenal of options at their disposal.
Haberkorn U, Eder M, Kopka K, et al. New Strategies in Prostate Cancer: Prostate-Specific Membrane Antigen (PSMA) Ligands for Diagnosis and Therapy. Clin Cancer Res. 2016; 22(1): 9-15.
Fahey F, Zukotynski K, Capala J, et al. Targeted radionuclide therapy: proceedings of a joint workshop hosted by the National Cancer Institute and the Society of Nuclear Medicine and Molecular Imaging. J Nucl Med. 2014; 55(2): 337-48.
Paganelli G, Sansovini M, Ambrosetti A, et al. 177 Lu-Dota-octreotate radionuclide therapy of advanced gastrointestinal neuroendocrine tumors: results from a phase II study. Eur J Nucl Med Mol Imaging. 2014; 41(10):1845-51.
Fendler WP, Rahbar K, Herrmann K, et al. 177Lu-PSMA radioligand therapy for prostate cancer. Journal of Nuclear Medicine. 2017; 1;58(8):1196-200.
Werner RA, Weich A, Kircher M, et al. The theranostic promise for Neuroendocrine Tumors in the late 2010s – Where do we stand, where do we go? Theranostics. 2018; 8(22):6088-100.
The Health Policy Partnership. Radioligand therapy: realizing the potential of targeted cancer care (2020). Available https://www.radioligandtherapy.com/. Last accessed: 22/01/2020.
Parker C, Lewington V, Shore N, et al. Targeted Alpha Therapy, an Emerging Class of Cancer Agents: A Review. JAMA Oncol. 2018; 4(12):1765-72.
Abbott A, Sakellis CG, Andersen E, et al. Guidance on (177)Lu-DOTATATE Peptide Receptor Radionuclide Therapy from the Experience of a Single Nuclear Medicine Division. J Nucl Med Technol. 2018; 46(3):237-44.
Rahbar K, Afshar-Oromieh A, Jadvar H, et al. PSMA Theranostics: Current Status and Future Directions. Mol Imaging. 2018; 17:1536012118776068.
Khan S, Krenning EP, van Essen M, et al. Quality of life in 265 patients with gastroenteropancreatic or bronchial neuroendocrine tumors treated with [177Lu-DOTA0,Tyr3]octreotate. J Nucl Med. 2011; 52(9):1361-8.
Bodei L, Mueller-Brand J, Baum RP, et al. The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2013;40:800–816.
Yadav MP, Ballal S, Bal C, et al. Efficacy and Safety of 177Lu-PSMA-617 Radioligand Therapy in Metastatic Castration-Resistant Prostate Cancer Patients. Clinical Nuclear Medicine. 2020; 45(1)pp.19-31.
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