Teragnostics: what it is and which radiopharmaceuticals are approved for cancer treatment

"Radiotherapy for the treatment of tumours," adds Luca Tagliaferri, director of the UOC Degenze di Radioterapia at Policlinico Gemelli, "can be carried out using several modalities. External beam radiotherapy, the best known, interventional radiotherapy (brachytherapy), through the introduction of one or more radioactive sources near or inside the tumour, and finally metabolic radiotherapy, using radiopharmaceuticals that bind precisely and selectively to tumours. At our polyclinic we have the possibility of offering all these therapies, and the TOC aims to become a centre of excellence in clinical approach, research and educational activities, in the wake of previous successful similar experiences'.

"Lutetium PSMA (177Lu-PSMA-617 by Novartis)," explains Salvatore Annunziata, medical director of the UOC of Nuclear Medicine and Head of the GSTeP Radiopharmacy Facility, "is the first commercial therapeutic radiopharmaceutical to have come onto the market (a few weeks ago AIFA, Gazzetta Ufficiale and the Lazio Region authorised its reimbursability) and is dedicated to metastatic prostate cancer resistant to the first lines of treatment. It is expected to have a rapid spread in Italy, which is why all the Nuclear Medicine and Radiodiagnostics and Radiotherapy Departments are equipping themselves with integrated centres to receive a large number of patients who are candidates for these therapies. Gemelli will be one of the first Integrated Centres dedicated to Teragnostics in Italy (TOC) and will be able to accommodate a high number of patients with metastatic prostate cancer, which is the leading male cancer by incidence in Italy and in the world. We anticipate that this therapy will have a very large demand, comparable to and exceeding that of radioiodine for thyroid cancer. Also 177Lu-Dotatate (Novartis®) is already available in clinical practice, but it is a more niche therapy, for neuroendocrine tumours'.

Also on the horizon is the arrival of new theragnostic radiopharmaceuticals, targeted against the tumour microenvironment in gastro-enteric and gynaecological malignancies (radiopharmaceuticals against Fibroblast Activation Protein or FAP, proposed by Novartis, Bracco, Bayer, Astra-Zeneca, etc.). Other research innovations will also concern prostate tumours in the future, for which less toxic radiopharmaceuticals than lutetium (so-called 'alpha emitters') are expected, with intense energy on the tumour but no exposure and damage to healthy tissues; effective and safer drugs, even for health professionals and the caregivers and families of patients.

"For several years now, Policlinico Gemelli has represented for many patients, not only in the Lazio region, a point of reference for the quality of care offered in the treatment of the most complex pathologies, such as oncological ones,' emphasised Health Minister Orazio Schillaci in a video message broadcast on the occasion of the TOC inauguration event. 'With the inauguration of this centre, this healthcare reality confirms its ability to keep up with the most innovative therapies and treatments. There is no doubt, in fact, that theragnostics represents one of the most promising branches of medicine'.