Targeted Radionuclide Therapy: Practical Applications and Future Prospects

Abstract

In recent years, there has been a proliferation in the development of targeted radionuclide cancer therapy. It is now possible to use baseline clinical and imaging assessments to determine the most effective therapy and to tailor this therapy during the course of treatment based on radiation dosimetry and tumor response. Although this personalized approach to medicine has the advantage of maximizing therapeutic effect while limiting toxicity, it can be challenging to implement and expensive. Further, in order to use targeted radionuclide therapy effectively, there is a need for multidisciplinary awareness, education, and collaboration across the scientific, industrial, and medical communities. Even more important, there is a growing understanding that combining radiopharmaceuticals with conventional treatment such as chemotherapy and external beam radiotherapy may limit patient morbidity while improving survival. Developments in radiopharmaceuticals as biomarkers capable of predicting therapeutic response and targeting disease are playing a central role in medical research. Adoption of a practical approach to manufacturing and delivering radiopharmaceuticals, assessing patient eligibility, optimizing post-therapy follow-up, and addressing reimbursement issues will be essential for their success.

Automated cassette-based production of high specific activity [ 203/212 Pb]peptide-based theranostic radiopharmaceuticals for image-guided radionuclide therapy for cancer

“…(Bartlett, 2016; Iagaru et al, 2016; Kratochwil et al, 2016a; Kratochwil et al, 2016b; Kwekkeboom and Krenning, 2016) Alpha emitters are emerging as an attractive alternative (to α-emitters) due to higher linear-energy transfer (LET) (100 keV/μm) and resultant-significant increase in the intensity of ionizations (primary and secondary) along the relatively short path length that α-particles travel in tissue (compared to β-particles). (Wild et al, 2011; Iagaru et al, 2016; Kratochwil et al, 2016a; Kratochwil et al, 2016b; Otte, 2016; Takahashi et al, 2016; Zukotynski et al, 2016) These properties have been shown to result in an increased incidence of double-strand DNA breaks and improved-localized cancer-cell damage that convey the potential for more effective tumor-cell-specific killing with less damage to adjacent-normal cells ( i.e. , improved relative biological effectiveness; RBE).…”

Targeted Radionuclide Therapy: An Evolution Toward Precision Cancer Treatment

“…Targeted radionuclide therapy (TRT) delivers energetic particles (auger, beta, alpha) in close proximity to tumor deposits that are preferentially selected on the basis of specific biologic features [1–3]. The first application of TRT occurred nearly 75 years ago with the use of radioiodine in thyroid disorders including cancer.…”

Research in imaging/biomarkers for precision medicine in lung cancer: National Cancer Institute funding opportunities

“…However, about 30% of those patients suffered local-regional and/or distant relapses. Imaging and/ or blood-based biomarkers are needed for identifying the subsets of patients destined to suffer relapses and for testing novel interventions that may prevent relapses, such as immune modulation or targeted radionuclides (2).…”