Exploring the Future of Radiopharmaceutical Therapy in Oncology

In a special edition of RadOnc on the Run, Brandon Mancini, MD, MBA, FACRO, hosts a roundtable discussion focusing on the expanding use of radiopharmaceutical (RPT) therapy in cancer care. He is joined by colleagues Mallika Marar, MD, MBA, and Neil K. Taunk, MD, MSCTS. They detail how RPT is moving into earlier treatment settings, discuss the rapid expansion of the RPT pipeline, and share practical considerations for integrating RPT modalities into a real-world treatment plan.

The conversation begins with an overview of how the RPT field has gradually evolved, with Taunk highlighting key agents such as lutetium Lu 177 dotatate (Lutathera), the prostate-specific membrane antigen (PSMA)-targeted lutetium Lu 177 vipivotide tetraxetan (Pluvicto), and I-131 MIBG (Azedra) across different patient populations. Furthermore, Marar notes that personalization of RPT-based care involves optimal patient selection and the identification of an appropriate treatment sequence, with future innovations potentially including the ability to adjust individual regimens by extending cycles or integrating rechallenge strategies.

According to Marar, alpha-emitting therapies such as actinium-225 PSMA may represent another promising area for those with prostate cancer. Taunk also describes the possibility of repurposing existing agents to manage new indications, such as using dotatate-based therapies to treat patients with refractory meningiomas.

As part of educating clinicians on the use of RPT and other advanced modalities, Marar emphasizes the need to include comprehensive theragnostic experience in standard radiation oncology residency training. Furthermore, Taunk says that trainees should seek out high-volume centers and form connections with nuclear medicine colleagues to learn more about how to leverage novel RPTs.

Mancini is the medical director at Bold Advanced Medical Future Health, a clinical associate professor in the Department of Radiology at Michigan State University College of Human Medicine, and the editor at large for RadOnc Review, a supplement of the journal ONCOLOGY®. Marar is a clinical assistant professor of Radiation Oncology - Radiation Therapy, a clinical assistant professor of Radiology - Rad/Nuclear Medicine, and a director of Theragnostics in the Department of Radiation Oncology at Stanford University. Taunk is an associate professor of Radiation Oncology, as well as director of Brachytherapy and Procedural Radiation, the director of Imaging Sciences, and the chief of Breast and Gynecologic Radiation Services at the University of Pennsylvania School of Medicine.