Skip to main content

Advertisement

SpringerLink
Log in

Current Status and Growth of Nuclear Theranostics in Singapore

  • Perspective
  • Published:
Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

Abstract

The concept of theranostics, where individual patient-level biological information is used to choose the optimal therapy for that individual, has become more popular in the modern era of ‘personalised’ medicine. With the growth of theranostics, nuclear medicine as a specialty is uniquely poised to grow along with the ever-increasing number of concepts combining imaging and therapy. This special report summarises the status and growth of Theranostic Nuclear Medicine in Singapore. We will cover our experience with the use of radioiodine, radioiodinated metaiodobenzylguanidine, peptide receptor radionuclide therapy, prostate specific membrane antigen radioligand therapy, radium-223 and yttrium-90 selective internal radiation therapy. We also include a section on our radiopharmacy laboratory, crucial to our implementation of theranostic principles. Radionuclide theranostics has seen tremendous growth and we hope to be able to grow alongside to continue to serve the patients in Singapore and in the region.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Verburg FA, Heinzel A, Hänscheid H, Mottaghy FM, Luster M, Giovanella L. Nothing new under the nuclear sun: towards 80 years of theranostics in nuclear medicine. Eur J Nucl Med Mol Imaging. 2014;41(2):199–201. https://doi.org/10.1007/s00259-013-2609-2.

    Article  PubMed  Google Scholar 

  2. Taieb D, Hicks RJ, Pacak K. Nuclear medicine in cancer theranostics: beyond the target. J Nucl Med. 2016;57(11):1659–60. https://doi.org/10.2967/jnumed.116.178343.

    Article  CAS  PubMed  Google Scholar 

  3. Parmeswaran R. Multidisciplinary care for well differentiated thyroid cancer. 2016. http://emss.org.sg/wp-content/uploads/2017/10/Thyroid-Cancer-Consensus-SG-Quick-Reference-Guide.pdf. Accessed 26 December 2018.

  4. Klimstra DS, Modlin IR, Coppola D, Lloyd RV, Suster S. The pathologic classification of neuroendocrine tumors. Pancreas. 2010;39(6):707–12. https://doi.org/10.1097/MPA.0b013e3181ec124e.

    Article  PubMed  Google Scholar 

  5. Strosberg J, El-Haddad G, Wolin E, et al. Phase 3 trial of 177 Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376(2):125–35. https://doi.org/10.1056/NEJMoa1607427.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Sadowski SM, Neychev V, Millo C, et al. Prospective study of 68Ga-DOTATATE positron emission tomography/computed tomography for detecting gastro-entero-pancreatic neuroendocrine tumors and unknown primary sites. J Clin Oncol. 2016;34(6):588–96.

    Article  CAS  PubMed  Google Scholar 

  7. Zaknun JJ, Bodei L, Mueller-Brand J, et al. The joint IAEA, EANM, and SNMMI practical guidance on peptide receptor radionuclide therapy (PRRNT) in neuroendocrine tumours. Eur J Nucl Med Mol Imaging. 2013;40(5):800–16. https://doi.org/10.1007/s00259-012-2330-6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Kwekkeboom DJ, Krenning EP, Lebtahi R, et al. ENETS consensus guidelines for the standards of Care in Neuroendocrine Tumors: peptide receptor radionuclide therapy with radiolabeled somatostatin analogs. Neuroendocrinology. 2009;90(2):220–6. https://doi.org/10.1159/000225951.

    Article  CAS  PubMed  Google Scholar 

  9. Thang SP, Lung MS, Kong G, et al. Peptide receptor radionuclide therapy (PRRT) in European neuroendocrine tumour society (ENETS) grade 3 (G3) neuroendocrine neoplasia (NEN) - a single-institution retrospective analysis. Eur J Nucl Med Mol Imaging. 2017 Nov;20.

  10. Kao YH, Hock Tan AE, Burgmans MC, et al. Image-guided personalized predictive dosimetry by artery-specific SPECT/CT partition modelling for safe and effective 90Y radioembolization. J Nucl Med. 2012;53(4):559–66.

    Article  CAS  PubMed  Google Scholar 

  11. Kao YH, Steinberg JD, Tay YS, et al. Post-radioembolization yttrium-90 PET/CT – part 1: diagnostic reporting. EJNMMI Res. 2013;3(1):56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Kao YH, Steinberg JD, Tay YS, et al. Post-radioembolization yttrium-90 PET/CT – part 2: dose-response and tumor predictive dosimetry for resin microspheres. EJNMMI Res. 2013;3(1):57.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Yan SX, Lim GK. Optimizing reconstruction algorithm to improve quality of post-PRRT Yittrium-90 PET scan. Neuroendocrinology. 2018;106(suppl 1):1–301.

    Google Scholar 

  14. Rodriguez LS, Thang SP, Li H, et al. A descriptive analysis of remnant activity during (90)Y resin microspheres radioembolization of hepatic tumors: technical factors and dosimetric implications. Ann Nucl Med. 2016;30(3):255–61.

    Article  PubMed  Google Scholar 

  15. Tong AK, Kao YH, Too CW, et al. Yttrium-90 hepatic radioembolization: clinical review and current techniques in inteventional radiology and personalized dosimetry. Br J Radiol. 2016;89(1062):20150943.

    Article  PubMed  PubMed Central  Google Scholar 

  16. NCC website: https://www.nccs.com.sg. Accessed 26 December 2018.

  17. Lam WWC, Goh C, Chua MLK, Tan J. 270P 68Ga prostate-specific membrane antigen positron emission tomography for evaluation of biochemical recurrence of prostate cancer - our local experience. Ann Oncol. 2017;28(suppl_10). https://doi.org/10.1093/annonc/mdx662.009.

  18. Beer TM, Armstrong AJ, Rathkopf D, Loriot Y, Sternberg CN, Higano CS, et al. Enzalutamide in men with chemotherapy-naive metastatic castration-resistant prostate cancer: extended analysis of the phase 3 PREVAIL study. Eur Urol. 2017;71(2):151–4.

    Article  CAS  PubMed  Google Scholar 

  19. Scher HI, Fizazi K, Saad F, Taplin ME, Sternberg CN, Miller K, et al. Increased survival with enzalutamide in prostate cancer after chemotherapy. N Engl J Med. 2012;367(13):1187–97.

    Article  CAS  PubMed  Google Scholar 

  20. Parker C, Nilsson S, Heinrich D, Helle SI, O'Sullivan JM, Fossa SD, et al. Alpha emitter radium-223 and survival in metastatic prostate cancer. N Engl J Med. 2013;369(3):213–23.

    Article  CAS  PubMed  Google Scholar 

  21. de Bono JS, Oudard S, Ozguroglu M, Hansen S, Machiels JP, Kocak I, et al. Prednisone plus cabazitaxel or mitoxantrone for metastatic castration-resistant prostate cancer progressing after docetaxel treatment: a randomised open-label trial. Lancet. 2010;376(9747):1147–54.

    Article  CAS  PubMed  Google Scholar 

  22. Ryan CJ, Smith MR, Fizazi K, Saad F, Mulders PF, Sternberg CN, et al. Abiraterone acetate plus prednisone versus placebo plus prednisone in chemotherapy-naive men with metastatic castration-resistant prostate cancer (COU-AA-302): final overall survival analysis of a randomised, double-blind, placebo-controlled phase 3 study. Lancet Oncol. 2015;16(2):152–60.

    Article  CAS  PubMed  Google Scholar 

  23. Ahmadzadehfar H, Rahbar K, Kurpig S, et al. Early side effects and first results of radioligand treatment with (177)Lu-DKFZ-617 PSMA of castrate-resistant metastatic prostate cancer: a two-centre study. EJNMMI Res. 2015;5:114.

    PubMed  Google Scholar 

  24. Rahbar K, Ahmadzadehfar H, Kratochwil C, et al. German multicenter study investigating 177Lu-PSMA-617 radioligand therapy in advanced prostate cancer patients. J Nucl Med. 2017;58:85–90.

    Article  CAS  PubMed  Google Scholar 

  25. Kratochwil C, Giesel FL, Stefanova M, et al. PSMA-targeted radionuclide therapy of metastatic castration-resistant prostate cancer with 177Lu-labeled PSMA-617. J Nucl Med. 2016;57:1170–6.

    Article  CAS  PubMed  Google Scholar 

  26. Yadav MP, Ballal S, Tripathi M, et al. 177Lu-DKFZ-PSMA-617 treatment in metastatic castration resistant prostate cancer: safety, efficacy, and quality of life assessment. Eur J Nucl Med Mol Imaging. 2017;44:81–91.

    Article  CAS  PubMed  Google Scholar 

  27. Heck MM, Retz M, D‘Alessandria C, et al. Systemic radioligand therapy with (177)Lu labeled prostate specific membrane antigen ligand for imaging and therapy in patients with metastatic castration resistant prostate cancer. J Urol. 2016;196:382–91.

  28. Kulkarni HR, Singh A, Schuchardt C, et al. PSMA-based radioligand therapy for metastatic castration-resistant prostate cancer: the bad Berka experience since 2013. J Nucl Med. 2016;57(suppl 3):97S–104S.

    Article  CAS  PubMed  Google Scholar 

  29. Baum RP, Kulkarni HR, Schuchardt C, et al. 177Lu-labeled prostate-specific membrane antigen radioligand therapy of metastatic castration-resistant prostate cancer: safety and efficacy. J Nucl Med. 2016;57:1006–13.

    Article  CAS  PubMed  Google Scholar 

  30. Fendler WP, Reinhardt S, Ilhan H, et al. Preliminary experience with dosimetry, response and patient reported outcome after 177Lu-PSMA-617 treatment for metastatic castration-resistant prostate cancer. Oncotarget. 2017;8:3581–90.

    Article  PubMed  Google Scholar 

  31. Hofman MS, Violet J, Hicks RJ, et al. 177Lu-PSMA-617 radionuclide treatment in patients with metastatic castration-resistant prostate cancer (LuPSMA trial): a single-centre, single-arm, phase 2 study. Lancet Oncol. 2018;19(6):825–33.

    Article  CAS  PubMed  Google Scholar 

  32. Yordanova A, Linden P, Hauser S, Meisenheimer M, Kürpig S, Feldmann G, et al. Outcome and safety of rechallenge [177Lu]Lu-PSMA-617 in patients with metastatic prostate cancer. Eur J Nucl Med Mol Imaging. 2018. https://doi.org/10.1007/s00259-018-4222-x.

  33. Heck MM, Tauber R, Schwaiger S, Retz M, D'Alessandria C, Maurer T, et al. Treatment outcome, toxicity, and predictive factors for radioligand therapy with 177Lu-PSMA-I&T in metastatic castration-resistant prostate cancer. Eur Urol. 2018. https://doi.org/10.1016/j.eururo.2018.11.016.

Download references

Acknowledgements

We wish to acknowledge the invaluable contributions of our radiopharmaceutical laboratory staff, nurses, nuclear medicine technologists and managers, without whom, none of our nuclear theranostic efforts will be possible.

Author information

Authors and Affiliations

  1. Department of Nuclear Medicine and Molecular Imaging, Singapore General Hospital, 1 Outram Road, Singapore, 169608, Singapore

    Hian Liang Huang, Aaron Kian Ti Tong, Sue Ping Thang, Sean Xuexian Yan, Winnie Wing Chuen Lam, Kelvin Siu Hoong Loke, Charlene Yu Lin Tang, Lenith Tai Jit Cheng, Gideon Su Kai Ooi, Han Chung Low, Butch Maulion Magsombol, Wei Ying Tham, Charles Xian Yang Goh, Colin Jingxian Tan, Yiu Ming Khor, Sumbul Zaheer, Pushan Bharadwaj, Wanying Xie & David Chee Eng Ng

  2. Duke-NUS Graduate Medical School, 8 College Road, Singapore, 169857, Singapore

    Hian Liang Huang, Aaron Kian Ti Tong, Sue Ping Thang, Sean Xuexian Yan, Winnie Wing Chuen Lam, Kelvin Siu Hoong Loke, Wei Ying Tham, Charles Xian Yang Goh, Yiu Ming Khor, Sumbul Zaheer, Pushan Bharadwaj, Wanying Xie & David Chee Eng Ng

Authors
  1. Hian Liang Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Aaron Kian Ti Tong
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sue Ping Thang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sean Xuexian Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Winnie Wing Chuen Lam
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kelvin Siu Hoong Loke
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Charlene Yu Lin Tang
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Lenith Tai Jit Cheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Gideon Su Kai Ooi
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Han Chung Low
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Butch Maulion Magsombol
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Wei Ying Tham
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Charles Xian Yang Goh
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Colin Jingxian Tan
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Yiu Ming Khor
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Sumbul Zaheer
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Pushan Bharadwaj
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Wanying Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

  19. David Chee Eng Ng
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hian Liang Huang.

Ethics declarations

Conflict of Interest

Hian Liang Huang, Aaron Kian Ti Tong, Sue Ping Thang, Sean Xuexian Yan, Winnie Wing Chuen Lam, Kelvin Siu Hoong Loke, Charlene Yu Lin Tang, Lenith Tai Jit Cheng, Gideon Su Kai Ooi, Han Chung Low, Butch Maulion Magsombol, Wei Ying Tham, Charles Xian Yang Goh, Colin Jingxian Tan, Yiu Ming Khor, Sumbul Zaheer, Pushan Bharadwaj, Wanying Xie and David Chee Eng Ng declare no conflict of interest.

Ethical Statement

Ethical approval is not required for this work.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Huang, H.L., Tong, A.K.T., Thang, S.P. et al. Current Status and Growth of Nuclear Theranostics in Singapore. Nucl Med Mol Imaging 53, 96–101 (2019). https://doi.org/10.1007/s13139-019-00580-3

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13139-019-00580-3

Keywords

Search

Navigation