It is one of the evolutions of the concept of precision medicine: radioligand therapy consists of releasing radiation directly into neoplastic cells wherever they are present, therefore acting in a highly specific way. Not only effective, but also capable of reducing hospitalization times and, consequently, also generating savings for the healthcare system, as was underlined today in Rome during the 50th Congress of the Italian Association of Medical Oncology (Aiom ). Yet, despite the great potential of this approach, in Italy only around 30 centers are able to provide it. The reason? Only dedicated multidisciplinary teams are able to guide this type of care, which must be conducted in reference nuclear medicine centers. The consequence, however, is that the availability of the therapy is not at all uniform across the national territory.
Precisely to inform clinicians, patients and institutions, Aiom has created the book “Radioligand therapy 50 questions 50 answers” also signed by the Italian Association of Nuclear Medicine and Molecular Imaging (AIMN), with the non-conditioning contribution of Advanced Accelerator Applications, to Novartis Company. The volume was presented today at the Congress of the scientific society.
What is radioligand therapy and theragnostics
Born in the field of the treatment of neuroendocrine tumors (NETs) – the most widespread are those located in the gastro-entero-pancreatic and affect approximately 2,200 people in Italy every year – today it is, however, demonstrating its effectiveness also in other oncology fields: “Precisely starting from the NET experience – he explains Marcello TucciDirector of Oncology at the Cardinal Massaia Hospital in Asti – today many studies are demonstrating the validity of this approach in various neoplasms, such as breast cancer, pancreatic cancer, lung cancer, melanoma, lymphoma and multiple myeloma, and even in prostate cancer”.
Radioligands allow what doctors call theragnostics, “in which diagnosis and therapy use the same molecule, i.e. the ligand, capable of binding specifically and with high affinity only to neoplastic cells, bringing with it the radioactive particle capable of emitting therapeutic radiation , as Saverio Cinieri, from today president of the Aiom Foundation, explains.
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Still few centers in Italy
As anticipated, the reason why few centers in Italy are able to provide radioligand therapy is that it requires an essential infrastructural adaptation, as recalled Maria Luisa De Rimini, President of AIMN: “There is ample room for improvement to optimize its use, so as to guarantee equal access throughout the national territory to patients with correct clinical indications. Overcoming the inhomogeneity of geographical distribution, increasing the number of Nuclear Medicine Facilities in capable of providing these treatments, will allow us to eliminate the phenomenon of healthcare migration which often forces patients and their families to suffer inconvenience from long journeys”. The objective is to overcome any critical issues in order to make treatments with radioligands available in the future also in pathologies that involve a larger number of patients than today.
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Fear and confusion, even among doctors
More information is also needed: “Citizens tend to confuse this therapy with ‘classic’ radiotherapy, without distinguishing its specificities, mechanisms of action, possible risks and benefits”, he adds Ashes. Not only patients, but often even some doctors have a negative prejudice towards radioactive substances, even though Nuclear Medicine is safe and well tolerated. Even family doctors are not sufficiently trained and informed, as are institutional representatives.
I multidisciplinary team
Precisely due to the characteristics of radioligand therapy, in this more than in other areas the presence in the structure of multidisciplinary teams made up of professionals with all the necessary skills is necessary, including the Nuclear Doctor, as recommended by the National Oncology Plan 2022- 2027, together with oncologists, endocrinologists, gastroenterologists, surgeons, pathologists, medical physics specialists and radiologists. The added value of multidisciplinary teams has been clearly demonstrated in the case of rare tumors, typically in neuroendocrine tumors (NETs), where it is more necessary than ever to bring together specific expertise.
“This management model – he underlines Massimo Di Maio, President-elect AIOM – is an indispensable requirement for the standard of quality of care for patients with NET. The most recent AIOM-ItaNET Guidelines also underline the importance of sharing therapeutic choices and the need to include the patient in an integrated and dedicated path, managed by a multidisciplinary team. And since radioligand therapy cannot be provided by all hospitals – he concludes – it is even more important that the multidisciplinary teams of the peripheral centers are enabled to work as closely as possible with the central expertise of the structures that are in able to take care of patients”.