Today available only in 30 Italian hospitals and used for rare neuroendocrine tumors, they are also proving effective for prostate and other types of cancer
They are used to diagnose the tumor, but also to treat it with extreme precision. I am as effective and powerful as radiation, which are however administered intravenously. THE radioligandsdrugs already used today to effectively treat some neoplasms, are, in practice, molecules capable of attaching themselves to diseased cells which are first “sent” to find them and then are “loaded” with a radioactive dose that destroys them with precision. To correctly inform clinicians, patients and institutions, the Italian Association of Medical Oncology (Aiom) has created the book «Radioligand therapy: 50 questions 50 answers» also signed by the Italian Association of Nuclear Medicine and Molecular Imaging (Aimn), presented in recent days during the national congress of the scientific society in Rome.
Theragnostics: therapy and diagnosis together
To better understand what it is, we need to start from the concept, currently little known, of theragnostics: «A new frontier of precision medicine in which diagnosis and therapy use the same molecule, the so-called “carrier”, the vector or transporter (i.e. the ligand), which is able to bind specifically and with high affinity only to neoplastic cells , bringing with it the radioactive particle capable of emitting therapeutic radiation – explains Saverio Cinieri, president of the Aiom Foundation —. In short, the ligand is able to recognize tumor cells and ensure that a radiopharmaceutical (i.e. the radioisotope) joins only with them to eliminate them with radioactive particles, but without damaging healthy cells». It is the most significant evolution of the concept of theragnostics, which also brings savings for the healthcare system: «No other strategy is able to outline with as much accuracy and predictivity whether, how much and how the tumor target can be affected even before starting therapy – continues Cinieri -. There increasingly high personalization of treatments thanks to this approach it can contribute to a better use of resources, with a reduction in costs and hospitalization times (one-maximum two days every six/eight weeks, for a total of 4 cycles), thus improving the quality and effectiveness of care and the governance of healthcare spending».
Neuroendocrine tumors, of the prostate and beyond
This strategy derives from iodine 131 therapy, used for decades for thyroid cancer: now, with the new generation of radioligands, multiple opportunities are opening up for the diagnosis and therapy of other pathologies. Radioligands, for now, are already used in Italy to treat neuroendocrine tumors (neuroendocrine tumorsNETs in English), a heterogeneous group of rare neoplasms derived from neuroendocrine cells, scattered practically everywhere in the human body, where it has been shown to improve the survival and quality of life of patients. And they are demonstrating also effective in metastatic prostate cancer, resistant to castration (i.e. treatment with hormone therapy), for which they have already received approval in the United States and Europe, but there are already indications of an advantage even in earlier phases, with excellent results on survival, disease control and quality of life. «The clinical experience of using radioligands derives precisely from the treatment of neuroendocrine tumorswhich in most cases present themselves in the metastatic phase – he says Marcello Tucci, director of Oncology at the Cardinal Massaia Hospital in Asti —. They are present in numerous organs such as lungs, bronchi, intestine, rectum, appendix and pancreas. The most widespread, located in the gastro-entero-pancreatic tract, are recorded every year around 2,200 new cases in Italy and require a complex diagnostic-therapeutic path. Starting from NETs, numerous international studies have evaluated the potential of radioligands in the diagnostic and therapeutic phase in various tumors such as breast, pancreas, lung, prostate, melanoma, lymphoma and multiple myeloma».
Only 30 Centers in Italy (for now)
In Italy around thirty centers are able to provide radioligand therapy: only dedicated multidisciplinary teams are able to guide this type of care, which must be conducted in reference nuclear medicine centres. Therefore, to make this innovation accessible to all patients who can benefit from it, it is necessary to improve its availability by overcoming administrative and organizational obstacles, as recalled Maria Luisa De Riminipresident of Aimn: «Radioligand therapy, in its many aspects of management, requires an indispensable infrastructural adaptation, essential so that its delivery and so that the opportunity is accessible uniformly throughout the territory. Overcoming the uneven geographical distribution by increasing the number of nuclear medicine facilities capable of providing these treatments will make it possible to eliminate the phenomenon of healthcare migration which often forces patients and family members to inconvenience long journeys.” It is therefore necessary an expansion of nuclear medicine centers, so that they have sufficient specifically trained personnel. «And that the nuclear doctor is always part of the multidisciplinary team that must follow the patient, even more looking at the arrival of the radioligands – adds De Rimini –, as recommended by the National Oncology Plan 2022-2027».
The added value of multidisciplinary teams has been clearly demonstrated in the case of rare tumors, therefore also in neuroendocrine tumors (NETs), where it is more necessary than ever to bring together specific expertise. A team of specialists dedicated to NETs, simultaneously focused on the individual clinical case, represents the premise for the best diagnostic and therapeutic approach. On this basis, over the years, the reference centers have equipped themselves with groups dedicated to these specific pathologies, which include nuclear doctors, oncologists, endocrinologists, gastroenterologists, surgeons, pathologists, medical physics specialists and radiologists. «This management model is an indispensable requirement for the quality standard of care for patients with NETs, required for certification by the European Neuroendocrine Tumors Society and promoted by ItaNETwhich since 2010 has brought together doctors belonging to the various specialties dealing with the management of neuroendocrine tumors – concludes Massimo Di Maio, president-elect Aiom —. The most recent Aiom-ItaNET guidelines also highlight the importance of sharing therapeutic choices and the need to include the patient in an integrated and dedicated path, managed by a multidisciplinary team. Radioligand therapy cannot be provided by all hospitalsfor this reason it is even more important that the multidisciplinary teams of the peripheral centers are enabled to work as closely as possible with the experience of the structures that are able to take care of the patients”.
November 17, 2023 (modified November 17, 2023 | 08:33)
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