Exploring the Challenges of Radiopharmaceuticals in Prostate Cancer
Jeffrey Wong, MD, discusses the unmet needs in prostate cancer treatment, especially in regard to radiopharmaceuticals.
In an interview with Targeted OncologyTM, Jeffrey Wong, MD, radiation oncologist and co-director of the Center for Theranostic Studies at City of Hope, discusses the unmet needs in prostate cancer treatment, particularly with regard to the use of radiopharmaceuticals.
Currently, prostate membrane-specific antigen (PSMA)-targeted radiopharmaceuticals like are primarily approved for use in later stages of prostate cancer after failure of other treatments like androgen receptor inhibitors and chemotherapy.
There is a growing need to explore the efficacy and safety of these therapies in earlier disease settings, such as high-risk localized or biochemically recurrent prostate cancer, to potentially delay disease progression and improve long-term outcomes. Clinical trials are underway to investigate this.
However, while PSMA is an excellent target expressed in a majority of prostate cancers, a subset of patients may have tumors with low or heterogeneous PSMA expression, limiting the effectiveness of PSMA-targeted radiopharmaceuticals. Research is ongoing to identify and validate other molecular targets expressed in prostate cancer to broaden the applicability of radiopharmaceutical therapy to a wider range of patients. Targets like gastrin-releasing peptide receptors (GRPRs) are being explored.
Additionally, novel approaches to enhance the delivery of radionuclides to tumor cells while minimizing off-target toxicity are needed. Nanoparticle-based delivery systems and the use of alpha-emitting isotopes like Actinium-225, which have higher energy and shorter range, are being investigated to improve tumor cell killing and reduce damage to healthy tissues.
Furthermore, identifying synergistic combinations of radiopharmaceutical therapy with other treatment modalities, such as immunotherapy, chemotherapy, and targeted therapies, is an important area of research to improve treatment efficacy and overcome resistance.
Finally, ensuring adequate production and supply of radiopharmaceuticals and expanding the number of centers and physicians qualified to administer these therapies are crucial to improve patient access. The supply chain for radionuclides needs to be robust.
Addressing these unmet needs through ongoing research and clinical trials will be essential to further optimize the use of radiopharmaceutical therapy and improve outcomes for men with prostate cancer across different disease stages.
