Targeted radionuclide therapy (TRT) is a modern cancer treatment modality that utilizes radioactive isotopes to selectively destroy malignant cells. The therapy involves the administration of a radiopharmaceutical – a compound containing a radioactive isotope – that binds specifically to receptors expressed on the surface of cancer cells. This targeted approach enables the delivery of radiation directly to diseased tissue, thereby minimizing damage to the surrounding healthy cells.
Step 1. Preparation for Qualification
In order to be considered for radionuclide therapy, the patient is required to provide a complete set of medical records. This includes up-to-date blood test results, reports from previous imaging studies (CT, MRI, scintigraphy – if applicable), and a detailed history of prior oncological treatments, including hospital discharge summaries and information on previously administered therapies.
Step 2. Qualification for Radionuclide Therapy
Based on the submitted medical documentation, the nuclear medicine team assesses the patient’s eligibility for a PET scan using a PSMA tracer. The purpose of this assessment is to determine whether the scan is clinically justified, taking into account the patient’s medical history and the results of previous imaging studies. If the evaluation is positive, the patient is referred for a PSMA PET scan, which enables the assessment of PSMA expression in tumor lesions. This scan is a prerequisite for considering radionuclide therapy.
Step 3. Signing the Agreement
At this stage, an agreement is signed outlining the terms of service, scope of procedures, and scheduling details. During the meeting, all organizational aspects and formal requirements necessary for the smooth progression of the process are discussed. The prepayment amount, payment method, and any additional requirements are also determined. The goal of this step is to ensure full transparency and mutual understanding between both parties before proceeding further.
Step 4. Radiopharmaceutical Injection
The prepared radiopharmaceutical is administered intravenously under controlled conditions. It circulates through the patient’s bloodstream until it binds to the appropriate receptor on the surface of cancer cells. This selectivity limits its accumulation in healthy tissues. Upon binding to the tumor cell, ionizing radiation (most commonly beta or alpha particles) is emitted, which damages the DNA structure, inhibits cell proliferation, and ultimately leads to cell death. The precise action of the radiopharmaceutical allows for minimization of systemic side effects.
Step 5. Evaluation of Therapeutic Response
Upon completion of the treatment cycle, therapy efficacy is evaluated using advanced imaging techniques, including positron emission tomography combined with magnetic resonance imaging (PET/MR) and positron emission tomography combined with computed tomography (PET/CT). These imaging studies are complemented by laboratory tests assessing organ function parameters and tumor marker levels. Integrated analysis of these results forms the basis for clinical decision-making regarding treatment continuation, modification, or implementation of alternative therapeutic strategies.
¹⁷⁷Lu-PSMA
Therapy based on the PSMA ligand labeled with the radioisotope lutetium-177 represents an innovative treatment option for prostate cancer patients exhibiting high PSMA antigen expression. ¹⁷⁷Lu-PSMA (vipivotide tetraxetan) is a radiopharmaceutical provided as a clear, colorless to pale yellow solution for injection or infusion, with an activity concentration of 1 000 MBq/ml. Its mechanism of action relies on the emission of β-radiation, which damages the genetic material of cancer cells while exerting relatively low impact on healthy tissues. The drug is administered intravenously at specialized centers, with a standard dose of 7.4 GBq every six weeks, for a maximum of six treatment cycles. The therapeutic effect is achieved through β-radiation-induced DNA damage in tumor cells, minimizing harm to surrounding healthy tissue.
The use of this therapy is only possible after prior confirmation of PSMA ligand uptake through imaging with a PET scan employing radiotracers such as ⁶⁸Ga-PSMA or ¹⁸F-PSMA. Additionally, patient eligibility requires a diagnosis of progressive, metastatic castration-resistant prostate cancer (mCRPC), confirmed PSMA expression, and prior treatment with androgen receptor signaling pathway inhibitors as well as taxane-based chemotherapy.
Due to the advanced technology and high production costs of the active substance, the overall cost of the therapy is substantial. At the time of this report, the treatment is not yet covered by the public reimbursement system in Poland, meaning that expenses related to the therapy are borne by patients or insurance institutions. Currently, initiatives are underway to assess the cost-effectiveness of this therapy and its potential inclusion in the package of guaranteed health services.
The therapy is administered at six-week intervals, typically in cycles consisting of four to six doses. Each administration, costing approximately 115 000 PLN, is preceded by an evaluation of blood morphology parameters, kidney and liver function, as well as an assessment of treatment efficacy. In the case described, treatment was initiated according to the established schedule, and initial clinical results indicate a positive response from the patient’s body.
The Implementation of Isotope Therapy in the Podlaskie Voivodeship
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Edyta Roszczenko
Key Account Specialist
Tel. +48 85 686 46 02
Email: roszczenko@bioskaner.eu
