Recent advances and impending challenges for the radiopharmaceutical sciences in oncology

Abstract

This paper is the first of a Series on theranostics that summarises the current landscape of the radiopharmaceutical sciences as they pertain to oncology. In this Series paper, we describe exciting developments in radiochemistry and the production of radionuclides, the development and translation of theranostics, and the application of artificial intelligence to our field. These developments are catalysing growth in the use of radiopharmaceuticals to the benefit of patients worldwide. We also highlight some of the key issues to be addressed in the coming years to realise the full potential of radiopharmaceuticals to treat cancer.

FIGURE 1:

Illustration of how radiotheranostics are used: imaging scans acquired using a tumour-targeting vector (green hexagon) labelled with a diagnostic radionuclide (yellow) facilitate patient selection, individualized dosimetry, and treatment monitoring for radiopharmaceutical therapy using the same vector labelled with a therapeutic radionuclide (orange).

Figure 2A:

[¹⁸F]FDG-PET scans of a 60-year-old male diagnosed in April 2014 with pancreatic NEN (Ki67 52%) who underwent Whipple surgery, CAPTEM chemo, liver resection, and 4 cycles Lutathera in 2020. Upon recurrence in late 2021, further disease progression was observed despite numerous other treatments. Nearly complete hepatic remission was observed after PRRT with [¹⁷⁷Lu]Lu-DOTA-LM3 (timing of doses shown with blue arrows) and has persisted for 2 years^. Figure 2B: [¹⁸F]FDG-PET scans of a 53-year-old patient diagnosed in 2010 with ovarian adenocarcinoma G3 who underwent surgery and chemotherapy. After recurrence in 2021, progressive disease was observed despite various chemo- and immunotherapies. Complete remission was achieved after tandem [¹⁷⁷Lu]Lu/[²²⁵Ac]Ac-3BP-3940 treatment (timing of doses shown with blue arrows) and is ongoing after 19 months.