A new generation of image-guided treatments uses radioactive material to target and destroy cancer cells with fewer side effects than standard cancer treatments. Radioligand therapies are approved to treat advanced prostate cancer, neuroendocrine tumors, thyroid cancer, and non-Hodgkin lymphoma, and clinical trials are underway to expand this therapeutic approach to more cancer types.
Who is a candidate for radioligand therapies, and why are they so effective? In our ongoing Conversations in Cancer series, Diane Reidy-Lagunes, MD, a medical oncologist at Duke Health who specializes in neuroendocrine tumors, talks to Hannah McManus, MD, a medical oncologist who treats prostate cancer, about this “smart bomb” approach and the promises it holds for the future.
Learn more about PLUVICTO and other radioligand therapies.
What Is Radioligand Therapy?
Radioligand therapy is one of the newest advances in nuclear medicine known as radiotheranostics. Radioactive tracers have been used for years to detect cancer and, in some cases, treat it. Radioligand therapy uses imaging to target cancer cells, then delivers radioactive material via a small, targeted molecule called a ligand, which binds to and destroys the cancer cells.
In prostate cancer, the radioligand therapy PLUVICTO® targets a protein called prostate-specific membrane antigen (PSMA), found on the surface of most prostate cancer cells. For certain neuroendocrine cancers, the radioligand therapy LUTATHER® targets somatostatin receptors (SSTRs), which are found on the surface of many neuroendocrine tumor cells.
What Are the Benefits of Radioligand Therapy?
Because radioligand therapy delivers radiation directly to cancer cells, it limits radiation exposure and damage to healthy tissue. This targeted approach is associated with fewer side effects commonly associated with cancer treatments like chemotherapy, such as nausea, vomiting, and hair loss.
While radioligand therapy is not considered a cure for advanced prostate cancer, studies show that PLUVICTO can help people with advanced prostate cancer live longer and delay disease progression, even in later stages, by substantially shrinking tumors and slowing the growth and spread of cancer in some people.
Who Is a Candidate for Radioligand Therapy like PLUVICTO?
As an FDA-approved therapy, there are specific indications for when and how PLUVICTO is used to treat prostate cancer. You must be diagnosed with metastatic prostate cancer that has continued to grow despite standard hormonal therapy with or without chemotherapy treatment. Your cancer must also produce large amounts of PSMA, the protein that PLUVICTO targets.
Doctors use a PSMA PET scan to determine who is eligible and likely to benefit. This scan shows where the cancer is located and whether it has enough PSMA to respond to treatment.
How Is PLUVICTO Given?
PLUVICTO is given as an IV infusion once every 6 weeks for up to 6 treatments.
What Are the Side Effects of PLUVICTO?
Some of the more common side effects include dry mouth and dry eyes, which can persist after treatment. PLUVICTO can also cause fatigue, lower blood counts, and decreased kidney function.
Regular blood tests watch for potential side effects, and PSMA PET scans are done during and after treatment to monitor how the cancer responds. Because every person and cancer responds differently, this monitoring is important to help the care team adjust the dose amount or timing of treatment to minimize side effects while maintaining effectiveness.
How is Radioligand Therapy Being Studied?
Researchers are working to make radioligand therapies more effective and help more people.
Many clinical trials are investigating new types of radioligand therapy in prostate cancer, neuroendocrine cancer, lymphomas, and other cancers. Hopefully, more treatment options will be available in the future.
In prostate cancer, research is focused on improving the effectiveness of radioligand therapies. Studies are looking at combining PLUVICTO with other promising therapies, as well as new types of radioligand therapy, including targeted alpha particle therapy, for prostate cancer.
Learning to predict who will benefit from PLUVICTO using PSMA PET scans and other tools is another important area of research. Research is also looking to identify who would benefit from strategies to combine PLUVICTO with another agent or when to consider another treatment approach.
Broadly, the question we want to answer is: can we identify ways to expand the treatment's effect to make it work better and for more people?
Looking ahead, we may see PLUVICTO used earlier in the treatment of aggressive prostate cancer to shrink tumors to very low levels. This is an ongoing area of investigation.
Why Is it Important to Seek Care at a Cancer Center like Duke for Radioligand Therapy?
Radioligand therapy requires a highly coordinated team with specialized expertise and access to the most sophisticated equipment and technology available.
Duke nuclear medicine specialists have extensive expertise in interpreting PSMA PET scans, which play a critical role in determining who is likely to benefit from PLUVICTO and in planning treatment. The quality of the imaging and the expertise of the doctors interpreting it can make a difference in ensuring this treatment is given safely and effectively.
Our team of specialists includes medical oncologists with years of experience using these agents from their early development, nuclear medicine physicians, radiation safety specialists, nurses, and pharmacists who work closely together. The specialists meet regularly to review cases and make recommendations based on the latest evidence and clinical experience.
Finally, our team includes dedicated coordinators who manage the logistical and operational aspects of treatment. From insurance approval through all the appointments before, during, and after treatment, they ensure you receive comprehensive care throughout this journey.
