Skip to main content

Introduction: The Case for Radiopharmaceutical Therapy

  • Chapter
  • First Online:
Radiopharmaceutical Therapy

Abstract

Radiopharmaceutical therapy (RPT) is a rapidly growing field with several areas of innovation that will advance the field of precision oncology. Success has already been seen with [131I]I for thyroid cancer, [177Lu]Lu-DOTATATE for neuroendocrine tumors, and [177Lu]Lu-PSMA (prostate-specific membrane antigen) for prostate cancer. Furthermore, the therapeutic efficacy of RPT may be extended with combination treatments due to synergistic effects. The development of new approaches to RPT is possible with new targets and the application of novel radionuclides. In the end, the forward progress of RPT is predicated on both well-designed, step-wise, multicenter prospective clinical trials and specialized endoradiotherapy training programs.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 279.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Seidlin SM, Marinelli LD, Oshry E. Radioactive iodine therapy; effect on functioning metastases of adenocarcinoma of the thyroid. J Am Med Assoc. 1946;132(14):838–47.

    Article  CAS  PubMed  Google Scholar 

  2. Nilsson S, Cislo P, Sartor O, Vogelzang NJ, Coleman RE, O’Sullivan JM, et al. Patient-reported quality-of-life analysis of radium-223 dichloride from the phase III ALSYMPCA study. Ann Oncol. 2016;27(5):868–74.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Lange R, Overbeek F, de Klerk JMH, Pasker-de Jong PCM, van den Berk AM, Ter Heine R, et al. Treatment of painful bone metastases in prostate and breast cancer patients with the therapeutic radiopharmaceutical rhenium-188-HEDP. Clinical benefit in a real-world study. Nuklearmedizin. 2016;55(5):188–95.

    Article  PubMed  Google Scholar 

  4. Fendler WP, Reinhardt S, Ilhan H, Delker A, Böning G, Gildehaus FJ, et al. Preliminary experience with dosimetry, response and patient reported outcome after 177Lu-PSMA-617 therapy for metastatic castration-resistant prostate cancer. Oncotarget. 2017;8(2):3581–90.

    Article  PubMed  Google Scholar 

  5. Hofman MS, Violet J, Hicks RJ, Ferdinandus J, Thang SP, Akhurst T, 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 

  6. Strosberg J, Wolin E, Chasen B, Kulke M, Bushnell D, Caplin M, et al. Health-related quality of life in patients with progressive midgut neuroendocrine tumors treated with 177Lu-Dotatate in the phase III NETTER-1 trial. J Clin Oncol. 2018;36(25):2578–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Marinova M, Mücke M, Fischer F, Essler M, Cuhls H, Radbruch L, et al. Quality of life in patients with midgut NET following peptide receptor radionuclide therapy. Eur J Nucl Med Mol Imaging. 2019;46(11):2252–9.

    Article  CAS  PubMed  Google Scholar 

  8. Waissi F, Kist JW, Lodewijk L, de Wit AG, van der Hage JA, van Dalen T, et al. Fast-track radioiodine ablation therapy after thyroidectomy reduces sick leave in patients with differentiated thyroid cancer (FASTHYNA Trial). Clin Nucl Med. 2019;44(4):272–5.

    Article  PubMed  Google Scholar 

  9. Fahey FH, Grant FD, Thrall JH. Saul Hertz, MD, and the birth of radionuclide therapy. EJNMMI Phys. 2017;4(1):15.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hertz B. A tribute to Dr. Saul Hertz: the discovery of the medical uses of radioiodine. World J Nucl Med. 2019;18(1):8–12.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Luster M, Clarke SE, Dietlein M, Lassmann M, Lind P, Oyen WJG, et al. Guidelines for radioiodine therapy of differentiated thyroid cancer. Eur J Nucl Med Mol Imaging. 2008;35(10):1941–59.

    Article  CAS  PubMed  Google Scholar 

  12. Strosberg J, El-Haddad G, Wolin E, Hendifar A, Yao J, Chasen B, et al. Phase 3 trial of 177Lu-Dotatate for midgut neuroendocrine tumors. N Engl J Med. 2017;376(2):125–35.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Kaemmerer D, Prasad V, Daffner W, Hörsch D, Klöppel G, Hommann M, et al. Neoadjuvant peptide receptor radionuclide therapy for an inoperable neuroendocrine pancreatic tumor. World J Gastroenterol. 2009;15(46):5867–70.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sansovini M, Severi S, Ambrosetti A, Monti M, Nanni O, Sarnelli A, et al. Treatment with the radiolabelled somatostatin analog Lu-DOTATATE for advanced pancreatic neuroendocrine tumors. Neuroendocrinology. 2013;97(4):347–54.

    Article  CAS  PubMed  Google Scholar 

  15. Ezziddin S, Lauschke H, Schaefers M, Meyer C, van Essen M, Biersack HJ, et al. Neoadjuvant downsizing by internal radiation: a case for preoperative peptide receptor radionuclide therapy in patients with pancreatic neuroendocrine tumors. Clin Nucl Med. 2012;37(1):102–4.

    Article  PubMed  Google Scholar 

  16. Delpassand ES, Samarghandi A, Zamanian S, Wolin EM, Hamiditabar M, Espenan GD, et al. Peptide receptor radionuclide therapy with 177Lu-DOTATATE for patients with somatostatin receptor-expressing neuroendocrine tumors: the first US phase 2 experience. Pancreas. 2014;43(4):518–25.

    Article  CAS  PubMed  Google Scholar 

  17. van Schaik E, van Vliet EI, Feelders RA, Krenning EP, Khan S, Kamp K, et al. Improved control of severe hypoglycemia in patients with malignant insulinomas by peptide receptor radionuclide therapy. J Clin Endocrinol Metab. 2011;96(11):3381–9.

    Article  PubMed  Google Scholar 

  18. Herrmann K, Schwaiger M, Lewis JS, Solomon SB, McNeil BJ, Baumann M, et al. Radiotheranostics: a roadmap for future development. Lancet Oncol. 2020;21(3):e146–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Hofman MS, Lawrentschuk N, Francis RJ, Tang C, Vela I, Thomas P, et al. Prostate-specific membrane antigen PET-CT in patients with high-risk prostate cancer before curative-intent surgery or radiotherapy (proPSMA): a prospective, randomised, multicentre study. Lancet. 2020;395(10231):1208–16.

    Article  CAS  PubMed  Google Scholar 

  20. Kim YJ, Kim YI. Therapeutic responses and survival effects of 177Lu-PSMA-617 radioligand therapy in metastatic castrate-resistant prostate cancer: a meta-analysis. Clin Nucl Med. 2018;43(10):728–34.

    Article  PubMed  Google Scholar 

  21. Fendler WP, Rahbar K, Herrmann K, Kratochwil C, Eiber M. 177Lu-PSMA radioligand therapy for prostate cancer. J Nucl Med. 2017;58(8):1196–200.

    Article  CAS  PubMed  Google Scholar 

  22. Sartor O, de Bono J, Chi KN, Fizazi K, Herrmann K, Rahbar K, et al. Lutetium-177-PSMA-617 for metastatic castration-resistant prostate cancer. N Engl J Med. 2021;385(12):1091–103.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Kim C, Subramaniam D, Liu S, Giaccone G. P2.12-03 phase I/II trial of 177Lu-DOTA0-Tyr3-Octreotate (Lutathera) and nivolumab for patients with extensive-stage small cell lung cancer (ES-SCLC). J Thorac Oncol. 2018;13(10):S791.

    Article  Google Scholar 

  24. Kim C, Liu SV, Subramaniam DS, Torres T, Loda M, Esposito G, et al. Phase I study of the 177Lu-DOTA0-Tyr3-Octreotate (lutathera) in combination with nivolumab in patients with neuroendocrine tumors of the lung. J Immunother Cancer. 2020;8(2):e000980.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Prasad V, Zengerling F, Steinacker JP, Bolenz C, Beer M, Wiegel T, et al. First experiences with 177Lu-PSMA therapy in combination with pembrolizumab or after pretreatment with olaparib in single patients. J Nucl Med. 2021;62(7):975–8.

    Article  CAS  PubMed  Google Scholar 

  26. Sandhu S, Joshua AM, Emmett L, Spain LA, Horvath L, Crumbaker M, et al. PRINCE: phase I trial of 177 Lu-PSMA-617 in combination with pembrolizumab in patients with metastatic castration-resistant prostate cancer (mCRPC). JCO. 2022;40(16_suppl):5017.

    Article  Google Scholar 

  27. Nicolini S, Bodei L, Bongiovanni A, Sansovini M, Grassi I, Ibrahim T, et al. Combined use of 177Lu-DOTATATE and metronomic capecitabine (Lu-X) in FDG-positive gastro-entero-pancreatic neuroendocrine tumors. Eur J Nucl Med Mol Imaging. 2021;48(10):3260–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  28. Ballal S, Yadav MP, Damle NA, Sahoo RK, Bal C. Concomitant 177Lu-DOTATATE and capecitabine therapy in patients with advanced neuroendocrine tumors: a long-term-outcome, toxicity, survival, and quality-of-life study. Clin Nucl Med. 2017;42(11):e457–66.

    Article  PubMed  Google Scholar 

  29. Ashwathanarayana AG, Biswal CK, Sood A, Parihar AS, Kapoor R, Mittal BR. Imaging-guided use of combined 177Lu-DOTATATE and capecitabine therapy in metastatic mediastinal paraganglioma. J Nucl Med Technol. 2017;45(4):314–6.

    Article  PubMed  Google Scholar 

  30. Bartolomei M, Bodei L, De Cicco C, Grana CM, Cremonesi M, Botteri E, et al. Peptide receptor radionuclide therapy with (90)Y-DOTATOC in recurrent meningioma. Eur J Nucl Med Mol Imaging. 2009;36(9):1407–16.

    Article  CAS  PubMed  Google Scholar 

  31. Savelli G, Zaniboni A, Bertagna F, Bosio G, Nisa L, Rodella C, et al. Peptide Receptor Radionuclide Therapy (PRRT) in a patient affected by metastatic breast cancer with neuroendocrine differentiation. Breast Care (Basel). 2012;7(5):408–10.

    Article  PubMed  Google Scholar 

  32. Mak IYF, Hayes AR, Khoo B, Grossman A. Peptide receptor radionuclide therapy as a novel treatment for metastatic and invasive phaeochromocytoma and paraganglioma. Neuroendocrinology. 2019;109(4):287–98.

    Article  CAS  PubMed  Google Scholar 

  33. Jaiswal SK, Sarathi V, Memon SS, Garg R, Malhotra G, Verma P, et al. 177Lu-DOTATATE therapy in metastatic/inoperable pheochromocytoma-paraganglioma. Endocr Connect. 2020;9(9):864–73.

    Article  PubMed  Google Scholar 

  34. Mirvis E, Toumpanakis C, Mandair D, Gnanasegaran G, Caplin M, Navalkissoor S. Efficacy and tolerability of peptide receptor radionuclide therapy (PRRT) in advanced metastatic bronchial neuroendocrine tumours (NETs). Lung Cancer. 2020;150:70–5.

    Article  PubMed  Google Scholar 

  35. Raveenthiran S, Esler R, Yaxley J, Kyle S. The use of 68Ga-PET/CT PSMA in the staging of primary and suspected recurrent renal cell carcinoma. Eur J Nucl Med Mol Imaging. 2019;46(11):2280–8.

    Article  PubMed  Google Scholar 

  36. Kesler M, Levine C, Hershkovitz D, Mishani E, Menachem Y, Lerman H, et al. 68Ga-PSMA is a novel PET-CT tracer for imaging of hepatocellular carcinoma: a prospective pilot study. J Nucl Med. 2019;60(2):185–91.

    Article  CAS  PubMed  Google Scholar 

  37. Hirmas N, Leyh C, Sraieb M, Barbato F, Schaarschmidt BM, Umutlu L, et al. 68Ga-PSMA-11 PET/CT improves tumor detection and impacts management in patients with hepatocellular carcinoma. J Nucl Med. 2021;62(9):1235–41.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Herrmann K, Schottelius M, Lapa C, Osl T, Poschenrieder A, Hänscheid H, et al. First-in-human experience of CXCR4-directed endoradiotherapy with 177Lu- and 90Y-labeled pentixather in advanced-stage multiple myeloma with extensive intra- and extramedullary disease. J Nucl Med. 2016;57(2):248–51.

    Article  CAS  PubMed  Google Scholar 

  39. Kircher M, Herhaus P, Schottelius M, Buck AK, Werner RA, Wester HJ, et al. CXCR4-directed theranostics in oncology and inflammation. Ann Nucl Med. 2018;32(8):503–11.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  40. Schottelius M, Herrmann K, Lapa C. In vivo targeting of CXCR4-new horizons. Cancers (Basel). 2021;13(23):5920.

    Article  CAS  PubMed  Google Scholar 

  41. Altmann A, Haberkorn U, Siveke J. The latest developments in imaging of fibroblast activation protein. J Nucl Med. 2021;62(2):160–7.

    Article  CAS  PubMed  Google Scholar 

  42. Dendl K, Koerber SA, Finck R, Mokoala KMG, Staudinger F, Schillings L, et al. 68Ga-FAPI-PET/CT in patients with various gynecological malignancies. Eur J Nucl Med Mol Imaging. 2021;48(12):4089–100.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Kratochwil C, Flechsig P, Lindner T, Abderrahim L, Altmann A, Mier W, et al. 68Ga-FAPI PET/CT: tracer uptake in 28 different kinds of cancer. J Nucl Med. 2019;60(6):801–5.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Sollini M, Kirienko M, Gelardi F, Fiz F, Gozzi N, Chiti A. State-of-the-art of FAPI-PET imaging: a systematic review and meta-analysis. Eur J Nucl Med Mol Imaging. 2021;48(13):4396–414.

    Article  PubMed  Google Scholar 

  45. Schulz J, Rohracker M, Stiebler M, Goldschmidt J, Stöber F, Noriega M, et al. Proof of therapeutic efficacy of a 177Lu-labeled neurotensin receptor 1 antagonist in a colon carcinoma xenograft model. J Nucl Med. 2017;58(6):936–41.

    Article  CAS  PubMed  Google Scholar 

  46. Baum RP, Singh A, Schuchardt C, Kulkarni HR, Klette I, Wiessalla S, et al. 177Lu-3BP-227 for neurotensin receptor 1-targeted therapy of metastatic pancreatic adenocarcinoma: first clinical results. J Nucl Med. 2018;59(5):809–14.

    Article  CAS  PubMed  Google Scholar 

  47. Langbein T, Weber WA, Eiber M. Future of theranostics: an outlook on precision oncology in nuclear medicine. J Nucl Med. 2019;60(Suppl 2):13S–9S.

    Article  CAS  PubMed  Google Scholar 

  48. Roosenburg S, Laverman P, van Delft FL, Boerman OC. Radiolabeled CCK/gastrin peptides for imaging and therapy of CCK2 receptor-expressing tumors. Amino Acids. 2011;41(5):1049–58.

    Article  CAS  PubMed  Google Scholar 

  49. Sauter AW, Mansi R, Hassiepen U, Muller L, Panigada T, Wiehr S, et al. Targeting of the cholecystokinin-2 receptor with the minigastrin analog 177Lu-DOTA-PP-F11N: does the use of protease inhibitors further improve in vivo distribution? J Nucl Med. 2019;60(3):393–9.

    Article  CAS  PubMed  Google Scholar 

  50. Chastel A, Vimont D, Claverol S, Zerna M, Bodin S, Berndt M, et al. 68Ga-radiolabeling and pharmacological characterization of a kit-based formulation of the Gastrin-Releasing Peptide Receptor (GRP-R) antagonist RM2 for convenient preparation of [68Ga]Ga-RM2. Pharmaceutics. 2021;13(8):1160.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Debordeaux F, Chansel-Debordeaux L, Pinaquy JB, Fernandez P, Schulz J. What about αvβ3 integrins in molecular imaging in oncology? Nucl Med Biol. 2018;62–63:31–46.

    Article  PubMed  Google Scholar 

  52. Rangger C, Haubner R. Radiolabelled peptides for positron emission tomography and endoradiotherapy in oncology. Pharmaceuticals (Basel). 2020;13(2):E22.

    Article  Google Scholar 

  53. Minamimoto R, Karam A, Jamali M, Barkhodari A, Gambhir SS, Dorigo O, et al. Pilot prospective evaluation of (18)F-FPPRGD2 PET/CT in patients with cervical and ovarian cancer. Eur J Nucl Med Mol Imaging. 2016;43(6):1047–55.

    Article  PubMed  Google Scholar 

  54. Li L, Ma L, Shang D, Liu Z, Yu Q, Wang S, et al. Pretreatment PET/CT imaging of angiogenesis based on 18F-RGD tracer uptake may predict antiangiogenic response. Eur J Nucl Med Mol Imaging. 2019;46(4):940–7.

    Article  PubMed  Google Scholar 

  55. Modak S, Kramer K, Gultekin SH, Guo HF, Cheung NK. Monoclonal antibody 8H9 targets a novel cell surface antigen expressed by a wide spectrum of human solid tumors. Cancer Res. 2001;61(10):4048–54.

    CAS  PubMed  Google Scholar 

  56. Kaplon H, Muralidharan M, Schneider Z, Reichert JM. Antibodies to watch in 2020. MAbs. 2020;12(1):1703531.

    Article  PubMed  Google Scholar 

  57. Yerrabelli RS, He P, Fung EK, Kramer K, Zanzonico PB, Humm JL, et al. IntraOmmaya compartmental radioimmunotherapy using 131I-omburtamab-pharmacokinetic modeling to optimize therapeutic index. Eur J Nucl Med Mol Imaging. 2021;48(4):1166–77.

    Article  CAS  PubMed  Google Scholar 

  58. Morgenstern A, Apostolidis C, Kratochwil C, Sathekge M, Krolicki L, Bruchertseifer F. An overview of targeted alpha therapy with 225Actinium and 213Bismuth. Curr Radiopharm. 2018;11(3):200–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  59. Garske-Román U, Sandström M, Fröss Baron K, Lundin L, Hellman P, Welin S, et al. Prospective observational study of 177Lu-DOTA-octreotate therapy in 200 patients with advanced metastasized neuroendocrine tumours (NETs): feasibility and impact of a dosimetry-guided study protocol on outcome and toxicity. Eur J Nucl Med Mol Imaging. 2018;45(6):970–88.

    Article  PubMed  PubMed Central  Google Scholar 

  60. Eberlein U, Cremonesi M, Lassmann M. Individualized dosimetry for theranostics: necessary, nice to have, or counterproductive? J Nucl Med. 2017;58(Suppl 2):97S–103S.

    Article  CAS  PubMed  Google Scholar 

  61. Czernin J. Toward independent nuclear medicine, molecular imaging, and theranostic programs. J Nucl Med. 2019;60(8):1037.

    Article  PubMed  Google Scholar 

  62. Hussain M, Carducci MA, Clarke N, Fenton SE, Fizazi K, Gillessen S, et al. Evolving role of prostate-specific membrane antigen-positron emission tomography in metastatic hormone-sensitive prostate cancer: more questions than answers? J Clin Oncol. 2022; https://doi.org/10.1200/JCO2200208.

  63. Hotta M, Gafita A, Czernin J, Calais J. Outcome of patients with PSMA-PET/CT screen failure by VISION criteria and treated with 177Lu-PSMA therapy: a multicenter retrospective analysis. J Nucl Med. 2022; https://doi.org/10.2967/jnumed.121.263441.

  64. Kiess AP, Hobbs RF, Bednarz B, Knox SJ, Meredith R, Escorcia FE. ASTRO’s framework for radiopharmaceutical therapy curriculum development for trainees. Int J Radiat Oncol Biol Phys. 2022. https://www.sciencedirect.com/science/article/abs/pii/S0360301622002516.

  65. Meredith R, Howell R. RPT radiobiology, theranostics pharmacokinetics [Internet]. Available from: https://bluetoad.com/publication/?i=780120&article_id=4490646&view=articleBrowser.

  66. Dierckx R, Herrmann K, Hustinx R, Lassmann M, Wadsak W, Kunikowska J. European Association of Nuclear Medicine (EANM) response to the proposed ASTRO’s framework for radiopharmaceutical therapy curriculum development for trainees. Eur J Nucl Med Mol Imaging. 2022;50(1):1–3.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ken Herrmann .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Pomykala, K.L., Herrmann, K. (2023). Introduction: The Case for Radiopharmaceutical Therapy. In: Bodei, L., Lewis, J.S., Zeglis, B.M. (eds) Radiopharmaceutical Therapy. Springer, Cham. https://doi.org/10.1007/978-3-031-39005-0_1

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-39005-0_1

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-39004-3

  • Online ISBN: 978-3-031-39005-0

  • eBook Packages: Biomedical and Life Sciences

Publish with us

Policies and ethics