Until recently, radiopharmaceutical therapy (RPT) approvals have generally focused on very stringently defined disease states such as second-line therapy for metastatic or unresectable gastroenteropancreatic neuroendocrine tumors or post-chemotherapy, metastatic, castration-resistant prostate cancer. As those indications begin to relax to include broader disease states, we are simultaneously seeing the rise of the idea that both existing agents and those in the RPT pipeline may home to “pan-cancer” targets that are expressed and are agnostic to the cell of origin.
Similar to the paradigm shift that occurred with chemotherapy in prior years, in which the presence of “targetable mutations” became (at least partly) paramount to the type of tumor, RPT will soon be offered to patients who have the right combination of uptake on diagnostic molecular imaging studies and/or the right expression profiles on histologic samples and/or the right set of clinical parameters, regardless of where the cancer originated. In our recent manuscript, we codify that idea as “Theranostics 2.0”. We believe that a dramatic shift in the approach to RPT will:
- Require artificial intelligence to properly employ the flood of agents that is forthcoming
- Enable the emergence of nuclear radiology/nuclear medicine/molecular imaging as a central discipline of oncology
- Dramatically improve the quantity and quality of life of cancer patients
Written by: Steven P. Rowe, MD, PhD, University of Texas Southwestern Medical Center, Dallas, TX, USA.
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