Upcoming Applications of Radiopharmaceuticals

Nuclear Medicine utilizes radiopharmaceuticals in small quantities for the diagnosis and treatment of various diseases such as cancers, heart disease, gastrointestinal, endocrine or neurological disorders and other abnormalities. Advantages of nuclear medicine include providing unique information including details on the function and anatomy of body structures that are often unattainable using other imaging procedures, nuclear medicine exams can pinpoint molecular activity, they have the potential to identify disease in its earliest stages and also show whether a patient is responding to treatment.

Nuclear medicine is a simple, safe and non-invasive procedure and there is a tremendous increase in the research and development of nuclear medicine as theranostic agents after the success of Lutathera in treating GEP-NETs. Effectiveness and better results of nuclear medicine in the different applications are attracting small and big companies to invest in the development of new isotopes for unmet or difficult to diagnose or treat applications.

Conventional treatment of cancer and other diseases involves surgery, external-beam radiation therapy and chemotherapy, these conventional techniques has disadvantages, as chemotherapy drugs travel throughout the body, they may impact healthy cells by creating systematic toxicity leading to various side effects such as hair loss, hypertension, heart problem, lung problem, secondary cancer and may damage healthy cells also minute cancer cells and early stage of cancer is difficult to find out using these techniques. Hence, radioisotopes are preferred now due to its minimum side effects. Therapeutic nuclear medicine has the advantage of delivering a highly concentrated dose to the targeted tumor which is minimally invasive and the duration of treatment is shorter when compared to other conventional therapies like chemotherapy. Many therapeutic procedures are palliative, usually to relieve pain. For instance strontium-89, rhenium-186 and samarium-153 are used for the relief of cancer-induced bone pain. Lutetium-177 dotatate or octreotate is used to treat tumors such as neuroendocrine and is effective where other treatments fail.

Various diagnostic radioisotopes are in phase III clinical trials and are expected to be commercialized in the coming years. For instance, Ioflupane (Iodine, I-123) is under phase III clinical trial and is being developed by GE Healthcare for the diagnosis of Parkinsonian Syndrome, Multiple System Atrophy (MSA) and Progressive supranuclear palsy (PSP), Xenon-133 from Cyclomedica Australia PTY Ltd., is an another emerging SPECT isotope for the diagnosis of lung structure determination is under phase III clinical trial.18F-Choline by Shanghai Chest Hospital for the diagnosis of Non-small cell lung cancer, [18F] LBT-999 by Zionexa for the diagnosis of Parkinson Disease and Essential Tremor, Fludeoxyglucose F-18 by Cell Point LLC for the diagnosis of Lymphoma, 68Ga-RM2 by Light point Medical Ltd. for breast cancer imaging and 89Zr-TLX250 (Zirconium-89) for Clear Cell Renal Cell Carcinoma are some of the emerging PET isotopes which are under phase III clinical trial. In the nuclear medicine market, multimodality imaging and the use of new software platforms will see tremendous growth. Improved quality, performance, appropriate results of SPECT and PET cameras enable the segment's fastest growth.

Therapeutic nuclear medicine makes use of radiopharmaceuticals that emit radiation which does not travel as far compared to gamma radiation, the energy gets deposited near to the vicinity of the location of radiopharmaceutical and thereby treating the disease condition. Therapeutic nuclear medicine is segmented into beta radiation therapy (Y-90, I-131, Lu-177, Sm-153, Re-186, Sr-89, Er-169 and others), brachytherapy (I-125, Cs-131, Ir-192, Pd-103 and others) and alpha radiation therapy (Ra-223, Ac-225 and Ra-224) approved for treating various types of cancer such as prostate cancer, thyroid cancer, liver cancer other cancers and bone pain. Lenvatinib (I-131) by Eisai Inc., Donafenib (I-131) by Suzhou Zelgen Biopharmaceuticals Co., Ltd. for the treatment of differentiated thyroid cancer, Iomab-B (I-131) by Actinium Pharmaceutical Inc. for the treatment of Acute Myeloid Leukemia, 177Lu-PSMA-617 by Novartis International AG (Endocyte) and 177Lu-edotreotide PRRT by ITM Solucin GmbH for the treatment of prostate cancer are some of the emerging isotopes for beta radiation therapy. Similarly, Radium-223 mCRPC-PEACE III by the European Organization for Research and Treatment of Cancer and Radium-223 Chloride by VU University Medical Center for the treatment of prostate cancer is the emerging isotopes for alpha radiation therapy. I-125 seed by Shanghai Zhongshan Hospital and BC Cancer Foundation for the Treatment of Hepatocellular Carcinoma, Portal Vein Tumor Thrombus and prostate cancer is the emerging isotope for brachytherapy. In July 2020, at the Society of Nuclear Medicine and Molecular Imaging annual meeting, researchers showcased the first in Human Study, of Cu-64 EBRGD, long-lived positron-emission tomography (PET) tracer, in patients with Glioblastoma. Cu-64 EBRGD is a substitute for Lu-177, Y-90 and Ac-225 for treatment of Glioblastoma. All these emerging isotopes are expected to drive the therapeutic nuclear medicine global market.

Some of the key players offering isotopes are Bayer Group (Germany), Bracco Imaging S.p.A (Italy), Cardinal Health (U.S.), Curium Pharma (France), Fujifilm Holdings Corporation (Japan), GE Healthcare (U.S.), Jubilant Lifesciences (India), Lantheus Medical Imaging (U.S.), Novartis International AG (Switzerland), CDH Investments (Sirtex Ltd.), (China) and other companies.



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