Perspectives for Concepts of Individualized Radionuclide Therapy, Molecular Radiotherapy, and Theranostic Approaches
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Radionuclide therapy (RNT) stands on the delivery of radiation to tumors or non-tumor target organs using radiopharmaceuticals that are designed to have specific affinity to targets. RNT is recently called molecular radiotherapy (MRT) by some advocators in order to emphasize its characteristics as radiotherapy and the relevance of dosimetry-guided optimization of treatment. Moreover, RNT requires relevant radiation protection standards because it employs unsealed radionuclides and gives therapeutic radiation doses in humans. On the basis of these radiation protection standards, the development and use of radiopharmaceuticals for combined application through diagnostics and therapeutics lead to theranostic approaches that will enhance the efficacy and safety of treatment by implementing dosimetry-based individualization.
KeywordsRadionuclide therapy Theranostics Radiopharmaceuticals
The author is grateful to Drs. Yoshiharu Yonekura, Sören Mattsson, Wesley Bolch, Glenn Flux, Darrell Fisher, Stig Palm, Alfred Morgenstern, Kimberly Applegate, Madan Rehani, Colin Martin, Keon Kang, and Reiko Kanda for their great supports in collecting updates on scientific reports.
This work was funded by JSPS KAKENHI Grant Number JP 18K07651, MHLW Health Labour Sciences Research Grant Number 201721015A, and Nuclear Regulation Agency Japan Grant on management of short-lived alpha emitters.
Compliance with Ethical Standards
Conflict of Interest
Makoto Hosono declares that he has no conflict of interest.
This article does not contain any studies with human participants or animals performed by the author.
For this type of study, formal consent is not required.
- 2.Zukotynski K, Jadvar H, Capala J, Fahey F. Targeted radionuclide therapy: practical applications and future prospects. Biomark Cancer. 2016;8:35–8.Google Scholar
- 10.Wagner HN Jr, Wiseman GA, Marcus CS, Nabi HA, Nagle CE, Fink-Bennett DM, et al. Administration guidelines for Radioimmunotherapy of non-Hodgkin’s lymphoma with (90)Y-labeled anti-CD20 monoclonal antibody. J Nucl Med. 2002;43:267–72.Google Scholar
- 11.Wiseman GA, Kornmehl E, Leigh B, Erwin WD, Podoloff DA, Spies S, et al. Radiation dosimetry results and safety correlations from 90Y-ibritumomab tiuxetan radioimmunotherapy for relapsed or refractory non-Hodgkin’s lymphoma: combined data from 4 clinical trials. J Nucl Med. 2003;44:465–74.Google Scholar
- 13.Bexxar KM. Iodine I 131 tositumomab, effective in long-term follow-up of non-Hodgkin’s lymphoma. Cancer Biol Ther. 2007;6:996–7.Google Scholar
- 14.Bodei L, Pepe G, Paganelli G. Peptide receptor radionuclide therapy (PRRT) of neuroendocrine tumors with somatostatin analogues. Eur Rev Med Pharmacol Sci. 2010;14:347–51.Google Scholar
- 18.Hosono M, Ikebuchi H, Nakamura Y, Yanagida S, Kinuya S. Introduction of the targeted alpha therapy (with radium-223) into clinical practice in Japan: learnings and implementation. Ann Nucl Med. 2018 online first.Google Scholar
- 21.Hosono M. Radiation protection in therapy with radiopharmaceuticals. Int J Radiat Biol. 2018 online first.Google Scholar
- 22.ICRP. The 2007 recommendations of the international commission on radiological protection. ICRP Publication 103. Ann ICRP. 2007;37:1–332.Google Scholar
- 23.ICRP. ICRP publication 105. Radiation protection in medicine. Ann ICRP. 2007;37:1–63.Google Scholar
- 24.ICRP. ICRP publication 94. Release of nuclear medicine patients after therapy with unsealed sources. Ann ICRP. 2004;34:1–79.Google Scholar
- 29.Hartung-Knemeyer V, Nagarajah J, Jentzen W, Ruhlmann M, Freudenberg LS, Stahl AR, et al. Pre-therapeutic blood dosimetry in patients with differentiated thyroid carcinoma using 124-iodine: predicted blood doses correlate with changes in blood cell counts after radioiodine therapy and depend on modes of Tsh stimulation and number of preceding radioiodine therapies. Ann Nucl Med. 2012;26:723–9.CrossRefGoogle Scholar
- 36.Nitipir C, Niculae D, Orlov C, Barbu MA, Popescu B, Popa AM, et al. Update on radionuclide therapy in oncology. Oncol Lett. 2017;14:7011–5.Google Scholar
- 37.Kratochwil C, Bruchertseifer F, Rathke H, Hohenfellner M, Giesel FL, Haberkorn U, et al. Targeted alpha-therapy of metastatic castration-resistant prostate cancer with (225)ac-PSMA-617: swimmer-plot analysis suggests efficacy regarding duration of tumor control. J Nucl Med. 2018;59:795–802.CrossRefGoogle Scholar
- 38.Chittenden SJ, Hindorf C, Parker CC, Lewington VJ, Pratt BE, Johnson B, et al. A phase 1, open-label study of the biodistribution, pharmacokinetics, and dosimetry of 223Ra-dichloride in patients with hormone-refractory prostate cancer and skeletal metastases. J Nucl Med. 2015;56:1304–9.CrossRefGoogle Scholar
- 39.Pratt BE, Hindorf C, Chittenden SJ, Parker CC, Excretion FGD. Whole-body retention of radium-223 dichloride administered for the treatment of bone metastases from castration resistant prostate cancer. Nucl Med Commun. 2018;39:125–30.Google Scholar
- 41.Murray I, Chittenden SJ, Denis-Bacelar AM, Hindorf C, Parker CC, Chua S, et al. The potential of (223)Ra and (18)F-fluoride imaging to predict bone lesion response to treatment with (223)Ra-dichloride in castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging. 2017;44:1832–44.CrossRefGoogle Scholar