Radiopharmaceuticals: Driving a Paradigm Shift in Cancer Treatment

Fred Ashbury: Cancer therapy has changed dramatically in the last decade away from one-size-fits-all toward precision oncology. Can you comment on the emergence of radiopharmaceuticals in this paradigm shift?

Joe McCann: Over the past 50 years, there has been a significant reliance on surgery, external radiation and chemotherapy as the main treatment modalities for cancer.

More recently, the introduction of genomic-guided therapies, including novel immuno-oncology agents and targeted therapies, have provided improved efficacy and life extending benefits for patients versus chemotherapy options. Targeted biomarker-based therapies such as Radioligand treatments (RLTs) represent a new mechanism of action in the treatment of many cancers by enabling the precision delivery of powerful energy particles capable of damaging tumor DNA, targeted using receptors found on the tumor.

While Nuclear medicine is a proven field with a decades long history of success, recent treatments like Xofigo and Lutathera, along with PSMA targeted treatments, have ignited additional interest in the field. Many patients are also proactively seeking access to RLTs in conversation with their oncologists, due to the widespread use of RLT therapies in Germany and Australia, along with recent activity in North America including POINT’s 177 Lu phase three treatment for mCRPC’s (SPLASH trial) and Novartis’ VISION trial.

FA: How will cancer practices prepare for the influx of Targeted Radiopharmaceutical Drugs?

JM: RLTs can be very straight forward treatments, and there are many highly trained nuclear medicine technicians working today with the skills to safely administer RLTs. For example, community based Nuclear Cardiac diagnostic centers actually have the infrastructure and expertise to broadly deploy radiopharmaceuticals. GenesisCare is an excellent group who are creating multidisciplinary teams to deliver RLTs based on their expertise in cardiac imaging. What this means is that cancer practices, including community oncology programs, have experienced centers to look to and can quickly come up to speed to handle both patient and regulatory demand. Looking back at the last few decades of medical technology and pharmaceutical innovation, the oncology community has increased practice billings by offering expanded services to their patients. While RLTs will bring some new regulatory thresholds to the practice, accommodating these treatments is certainly a worthwhile investment given patient demand and the anticipated higher price points of these therapies.

FA: Creating a radioligand product is no small feat. Can you say a bit about your approach to make RLTs more readily usable in community practice?

JM: I have been working in this field for over a decade and have seen firsthand the transformative power of radioligand therapies. When developing these products, we also needed to think about patient care and logistics. For this reason, we are building one of the world’s largest RLT manufacturing facilities in Indianapolis, a key transportation hub in the US allowing for the quick transport of drugs all over the US.

FA: What advice/insights can you give to community oncology practices if they choose to participate in this treatment modality and build a next generation infusion program?

JM: This is an incredibly exciting time for nuclear medicine and oncology. POINT has several community-based sites participating in our clinical trial and the feedback has been very positive. Offering patients access to next generation cancer therapies while keeping patients in their home community is a win-win situation. Many clinics have already begun establishing radiopharmaceutical infusion spaces. There are also now consultants which can help facilitate setup and licensing for clinics who do not have previous experience with radiopharmaceuticals.

FA: Concluding Remarks

VieCure’s advanced clinical practice guidelines, AI-based clinical decision support capability and fully integrated smart EMR will support patient selection for these next generation treatments and provide providers and patients with continued safe and comparatively efficacious therapeutic alternatives to more toxic chemotherapy agents. As RLTs become more widely available, and patients openly advocate for these treatments, clinics will be differentiated by their ability to adapt and build operations into their current capabilities and thereby attract and retain these patients in community settings.

Fredrick D. Ashbury, PhD

Chief Scientific Officer, VieCure Professor (Adj), Department of Oncology University of Calgary Professor (Adj), DLSPH, University of Toronto

Joe McCann, PHD

Chief Executive Officer, Point Biopharma