Can the tailoring of drug dosage improve the effectiveness of radiopharmaceutical therapy (RPT) for cancer patients? The Journal of Nuclear Medicine has issued a new supplement addressing both the rapid progress and the challenges in applying patient-specific radiation dosimetry to guide RPT.
Although patient-specific dosimetry has been used in the past for RPT with good results, it may not be necessary or effective for all radiopharmaceuticals. However, with new nuclear medicine therapies approved or under review by the U.S. Food and Drug Administration and achieving pass-through status with the Centers for Medicare and Medicaid Services, further discussion is warranted. When does dosimetry improve outcomes? How can it be accommodated in current practice? What commercial tools are available? How about reimbursement?
“The time to hesitate is through—there is much to do,” said supplement guest editors Richard L. Wahl, MD, and John Sunderland, PhD. “We are hopeful these articles will provide a useful starting point and review for sites considering implementing dosimetry in their clinical practice or research operations. There is great interest and opportunity.”
Articles in the supplement include:
- Radiopharmaceutical Dosimetry for Cancer Therapy: From Theory to Practice
Richard L. Wahl and John Sunderland
Wahl and Sunderland introduce this special JNM supplement designed as a snapshot in time addressing both the rapid progress and challenges in applying patient-specific radiation dosimetry to guide radiopharmaceutical therapies. - Dosimetry for Radiopharmaceutical Therapy: Current Practices and Commercial Resources
Jacek Capala, Stephen A. Graves, Aaron Scott, George Sgouros, Sara St. James, Pat Zanzonico, and Brian E. Zimmerman
Capala and colleagues provide an overview of the state of the art of patient-specific dosimetry for radiopharmaceutical therapy, including current methods and commercially available software and other resources. - Tumor Response to Radiopharmaceutical Therapies: The Knowns and the Unknowns
George Sgouros, Yuni K. Dewaraja, Freddy Escorcia, Stephen A. Graves, Thomas A. Hope, Amir Iravani, Neeta Pandit-Taskar, Babak Saboury, Sara St. James, and Pat B. Zanzonico
Sgouros and colleagues elucidate factors affecting the absorbed dose–versus–response relationship for radiopharmaceutical agents, including inflammation- or immune-mediated effects, theranostic imaging, radiobiology, differences in dosimetry methods, pharmacokinetic differences, and tumor hypoxia. - Normal-Tissue Tolerance to Radiopharmaceutical Therapies, the Knowns and the Unknowns
Richard L. Wahl, George Sgouros, Amir Iravani, Heather Jacene, Daniel Pryma, Babak Saboury, Jacek Capala, and Stephen A. Graves
Wahl and colleagues look at the knowns and unknowns of dose– toxicity relationships in radiopharmaceutical therapies, including irradiation mechanisms, specific pharmacokinetics, secondary malignancies and side effects, and gaps in understanding, with key recommendations for the future. - An International Study of Factors Affecting Variability of Dosimetry Calculations, Part 1: Design and Early Results of the SNMMI Dosimetry Challenge
Carlos Uribe, Avery Peterson, Benjamin Van, Roberto Fedrigo, JakeCarlson,JohnSunderland,Eric Frey,andYuniK.Dewaraja
Uribe and colleagues detail initial results from a 177Lu dosimetry challenge designed to collect data from the global nuclear medicine community to identify, understand, and quantitatively characterize the consequences of sources of variability in dosimetry. - Reimbursement Approaches for Radiopharmaceutical Dosimetry: Current Status and Future Opportunities
Stephen A. Graves, Alexandru Bageac, James R. Crowley, and Denise A.M. Merlino
Graves and colleagues from the SNMMI Molecular Imaging Dosimetry Task Force review rationales and workflows for radiopharmaceutical therapy dosimetry, as well as current and suggested future strategies for reimbursement for dosimetryrelated clinical activities. - Dosimetry in Clinical Radiopharmaceutical Therapy of Cancer: Practicality Versus Perfection in Current Practice
Neeta Pandit-Taskar, Amir Iravani, Dan Lee, Heather Jacene, Dan Pryma, Thomas Hope, Babak Saboury, Jacek Capala, and Richard L. Wahl
Pandit-Taskar and colleagues review dosimetric approaches in radiopharmaceutical therapy and clinical trials, including the extent of dosimetry use, pros and cons of dosimetry-based versus fixed activity, and limiting factors in current clinical practice. - Dosimetry for Radiopharmaceutical Therapy: The European Perspective
Michael Lassmann, Uta Eberlein, Jonathan Gear, Mark Konijnenberg, and Jolanta Kunikowska
Lassmann and colleagues summarize recent efforts in Europe targeting standardization of quantitative imaging and dosimetry and the results of several European research projects on practices regarding radiopharmaceutical therapies.
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The JNM Dosimetry Supplement is available at https://jnm.snmjournals.org/content/62/Supplement_3.
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The Journal of Nuclear Medicine (JNM) is the world’s leading nuclear medicine, molecular imaging and theranostics journal, accessed more than 11 million times each year by practitioners around the globe, providing them with the information they need to advance this rapidly expanding field. Current and past issues of The Journal of Nuclear Medicine can be found online at http://jnm.snmjournals.org.
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Journal of Nuclear Medicine