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EANM24: The Age of Theranostics is NOW

EANM '24

The Age of Theranostics is NOW

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The European Association of Nuclear Medicine (EANM) hosted its annual conference, EANM24, from October 19-22, 2024, in Hamburg, Germany. EANM conferences are known for showcasing advancements in nuclear medicine, which can be broadly categorized into key areas:

  • New Targets: Identification of novel proteins and enzymes in different cancers and lesions
  • Novel Ligands: Development of transport molecules with enhanced binding capabilities
  • New Tracers: better more potent radionuclides with a more limited radiation radius to minimize the damage to the surrounding healthy cells
  • Expanded Applications of Known Radioligands: discovery of known proteins / enzymes in other cancers and lesions.

As usual during such professional get-togethers, this year’s conference also focused on how to bring theranostics to patients, addressing technical issues such as clinic setups, doctor training, patient flow, and enhancing the “last mile” delivery. Notably, one presentation from Finland examined the feasibility of outpatient theranostic treatment—something our clinic has been a shining example of. 1

Streamlining and unifying EU-wide regulations would further improve patient access to nuclear medicine therapies, with Austria providing a strong model for efficient practice.

AI and Nuclear Medicine

Artificial intelligence was a prominent topic, with discussions on AI’s potential to enhance nuclear medicine, for example, in interpreting PET scans. AI's ability to improve diagnostics could represent a substantial advancement in accuracy and efficiency.

Applications of PSMA- and DOTATATE-Based Theranostics

PSMA and DOTATATE-based imaging and therapy have become standard-of-care, with over a decade of clinical experience now guiding the development of new tracers and targets, such as FAP. A major theme was expanding PSMA therapy to earlier stages of prostate cancer and addressing resistance issues by shortening treatment intervals — a protocol our clinic has pioneered. Our streamlined protocol consists of three sessions with four-week intervals in contrast to the usual six to eight based on the research of our chief nuclear specialist Prof. Dr. Hartenbach. This regimen reduces cancer’s adaptive potential, yet still remaining tolerable for patients.

The revolutionary impact of PSMA PET/CT in clinical decision-making is being reaffirmed, with numerous studies corroborating its value in improving diagnosis and survival outcomes.2

New research on somatostatin receptors in myelomas and PSMA enzymes in gliomas holds promise for treating these cancers with targeted radionuclide therapy.3

New Targets

Approximately one-third of prostate cancers are PSMA-negative and do not respond to PSMA theranostics, requiring alternative markers. One study revealed high CD13 positivity in PSMA-negative prostate cancer, suggesting the protein CD13 as a viable target for theranostics.4

Emerging Radioligands and Radionuclides

New developments in radioligands include the DOTA-LM3, labelled with 161Terbium ([161Tb]Tb-DOTA-LM3), which demonstrated a seven-fold increase in tumor absorption compared to [177Lu]Lu-DOTATOC due to its superior two binding points.5

Terbium-161 as such also emerged as a promising radionuclide alternative to an often scarce Lutetium-177. 161Tb offers more concentrated radiation while maintaining favorable biodistribution. This radionuclide emits β- radiation similar to Lutetium-177, while also emitting therapeutically active very short range effective conversion electrons and auger electrons in combination with its low energy γ-ray emission, allowing for imaging via Single Photon Emission Computed Tomography (SPECT).6

Fibroblast Activation Proteins (FAPi)

FAPi warrants special attention. These proteins, characteristic of inflamed fibrous tissues, have been discovered in the microenvironment of most solid tumors, presenting a promising avenue for a universal therapy in stromal cancers. Stroma plays a critical role in cancer proliferation by nurturing tumors and shielding them from the body’s immune response. The oncological reality, however, is vastly more complex and heterogeneous. While FAPi-based imaging has shown success, therapeutic applications continue to face challenges related to suitable ligands.

 

These highlights only scratch the surface of the knowledge shared at EANM24. We will delve deeper into select topics and studies in upcoming publications, focusing on those most relevant to our patient cohort.

 

From EANM ’24 Abstract Book

1 OP-093 “Establishing a 177Lu-PSMA treatment site in an oncology outpatient day-ward”, T. Noponen, A. Saikkonen, L. Kääriä, M. Seppänen, K. Mattila, A. Ålgars

2 OP-423 “PSMA-PET and PROMISE re-define stage and risk in prostate cancer patients”, M. Karpinski, J. Hüsing, K. Claassen, L. Möller, H. Kajüter, F. Oesterling, V. Grünwald, L. Umutlu, H. Lanzafame, T. Telli, A. Merkel-Jens, A. Hüsing, C. Kesch, K. Herrmann, A. Stang, B. Hadaschik, W. P. Fendle

3 OP-359 “Assessing the theranostic potential of SSTR imaging in advanced multiple myeloma patients - the SCARLET trial”, W. Delbart, I. Karfis, M. Vercruyssen, S. Vercauteren, Z. Wimana, N. Meuleman, P. Flamen, E. Woff
OP-514 “First-In-Human Experience of Peptide Receptor Radionuclide Therapy with 177Lu-DOTATATE in Patients with Advanced Multiple Myeloma”, W. Delbart, I. Karfis, M. Vercruyssen, S. Vercauteren, Z. Wimana, N. Meuleman, P. Flamen, E. Woff
EP-0113 “Diagnostic utility of 68Ga-Prostate-Specific Membrane Antigen-11 PET/CT in glioma recurrence - a prospective analysis”, A. Meena, K. Subramanian, R. Kumar, H. Singh, B. Mittal
EP-0653 “68Ga/177Lu-PSMA theranostics in recurrent high-grade glioma - First study results & future perspectives”, A. Karlberg, B. E. Vindstad, E. M. Berntsen, H. Johansen, T.M. Keil, O. Solheim, S. Kjærnes Øen, T. Skeidsvoll Solheim, L.Eikenes

4 OP-424 “CD13 as a Potential Membrane Marker in PSMA-Negative Prostate Cancer: A Complementary or Superior Alternative to PSMA”, Y. Tang, L. Xiao, J. Yang, J. Hou, J. Hong, A. Rominger, K. Shi, S. Hu

5 OP-252 “Therapy with the somatostatin receptor antagonist DOTA-LM3 labeled with terbium-161: Interim results of the Phase 0 Study in patients with gastroenteropancreatic neuroendocrine tumors”, J. Fricke, F. Westerbergh, L. McDougall, C. Favaretto, E. Christ, G. Nicolas, S. Geistlich, F. Borgna, M. Fani, P. Bernhardt, N. van der Meulen, C. Müller, R. Schibli, D. Wild

6 OP-515 “When Lutetium-177 DOTATATE Is Not Available: Insights Into Use of Terbium-161 in the Treatment of Metastatic Paraganglioma”, N. Jacobs, O. Kolade, K. Hlongwa, S. More
OP-529 “Mixed-LET 161Tb-ART-101 radiopharmaceutical enhances therapeutic responses in advanced prostate cancer”, M. Bio Idrissou, J. Tromp, H. Comas Rojas, L. Lambert, A.
Pinchuk, Y. Medina, A. Carston, R. Hernandez
OP-532 “Development of [161Tb]Tb-DOTA-HYNIC-panPSMA for targeted radionuclide therapy of prostate cancer”, C. Morgat, D. Vimont, K. Attia