What Do Clinicians Get Right About Radiopharmaceutical Therapy?

In a roundtable discussion for RadOnc on the Run, Brandon Mancini, MD, MBA, FACRO, spoke with Mallika Marar, MD, MBA, and Neil K. Taunk, MD, MSCTS, about how the radiation oncology community currently handles the use of radiopharmaceutical therapy. They touched upon what experts currently get right and what they might misunderstand regarding the modality.

According to Taunk, radiation oncologists can offer “dynamic” radiopharmaceutical options to patients, although rethinking dose fractions and managing subclinical renal and marrow toxicities represent ongoing challenges. Marar noted the need for radiation oncologists to collaborate more thoughtfully with their colleagues in medical oncology to optimize the use of radiopharmaceuticals.

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 the director of Theragnostics in the Department of Radiation Oncology at Stanford University. Taunk is an associate professor of Radiation Oncology and Radiology, as well as director of Brachytherapy, director of Imaging Sciences, and chief of Breast Radiation and Gynecologic Radiation Services at the University of Pennsylvania School of Medicine.

Listen to or watch the full conversation for additional details on the future of radiopharmaceutical therapy in oncology.

Transcript:

Mancini: From your perspective, in the radiation oncology community, specifically, what do you think we get right about radiopharmaceutical therapy, and what do you think we still misunderstand about where the field is going?

Taunk: There’s a number of things I think we get right. Great patient care is one. Radiation oncologists tend to be a bit territorial and patient obsessed, and that’s true of all clinical oncologists, which has been excellent to apply here. Another thing we get right is offering dynamic options for patients. It might be straightforward to offer radiopharmaceutical therapy when indicated, but if you zoom out, some patients might benefit more from metastasis-directed therapy, or even no treatment.

Some challenges in terms of where we have to improve [are that] we have to rethink dose fractions and rethink how we [treat] the whole patient rather than just specific problems because you’re with these patients for maybe 30 weeks, sometimes becoming their primary oncologist. That means rethinking how to manage blood work, subclinical renal and marrow toxicity, and the safety and practical considerations around treatment. There’s a tremendous number of efforts being built toward this, which will be very helpful. I think, more importantly, the community, meaning centers beyond the major academic centers, is leading the charge, and this is growing rapidly within the community.

Marar: Radiation oncologists really are the de facto experts in integrating local therapy with systemic therapy, and that translates neatly to incorporating radiopharmaceuticals into practice. On the flip side, we probably need to start thinking a bit more like medical oncologists in understanding how to apply radiopharmaceuticals as one systemic therapy among a host of others a patient might be eligible for, thinking through when a patient might be better served by a different systemic therapy. Ultimately, if that decision-making comes to us, we need to think critically and collaboratively with our medical oncology colleagues about applying a systemic therapy alongside the local therapy we’ve always provided.