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Targeted radionuclide therapy for patients with central nervous system metastasis: Overlooked potential?
Emilie Le Rhun1, Nathalie L Albert2, Martin Hüllner3
1Department of Medical Oncology and Hematology, University Hospital and University of Zurich, Zurich, Switzerland.
Abstract:
Targeted radionuclide therapy is an emerging therapeutic concept for metastatic cancer that can be considered if a tumor can be delineated by nuclear medicine imaging and also targeted based on the expression of a particular target (thera-nostics). This mode of treatment can also compete with or supplement conventional radiotherapy, for example, if MRI does not fully capture the extent of the disease, including microscopic metastases. Targeted radionuclide therapy for patients with thyroid cancer, with certain somatostatin receptor 2-expressing tumors and with prostate-specific membrane antigen-expressing prostate cancer is approved, and numerous approaches of targeted radionuclide therapy for patients with metastatic cancer are in development (eg, using fibroblast activation protein as a target). Although brain metastases are rare in cancers with approved targeted radionuclide therapies, there is no a priori reason to assume that such treatments would not be effective against brain metastases if the targets are expressed and not shielded by the blood-brain barrier. Here, we discuss the current state of the art and opportunities of targeted radionuclide therapies for patients with brain and leptomeningeal metastases.
Insights
Targeted radionuclide therapy offers a novel approach for metastatic cancer, including brain metastases, by targeting specific tumor markers. This treatment shows promise as an alternative or supplement to conventional radiotherapy.
Area of Science:
- Oncology
- Nuclear Medicine
- Radiotherapy
Background:
- Targeted radionuclide therapy (TRT) is an emerging treatment for metastatic cancer.
- It relies on nuclear medicine imaging to delineate tumors and specific molecular targets for therapy (theranostics).
- TRT can complement or replace conventional radiotherapy, especially when imaging modalities like MRI do not fully capture disease extent.
Purpose of the Study:
- To review the current status and future potential of TRT for brain and leptomeningeal metastases.
- To explore the feasibility of TRT in cases where tumor targets are expressed and accessible across the blood-brain barrier.
Main Methods:
- Review of existing literature on targeted radionuclide therapy.
- Analysis of approved and investigational TRT approaches.
- Discussion of challenges and opportunities for TRT in central nervous system metastases.
Main Results:
- TRT is approved for thyroid cancer, somatostatin receptor 2-expressing tumors, and prostate-specific membrane antigen-expressing prostate cancer.
- Numerous TRT strategies are under development, targeting various markers like fibroblast activation protein.
- While brain metastases are less common in current TRT approvals, the underlying principles suggest potential efficacy if targets are expressed and not blocked by the blood-brain barrier.
Conclusions:
- Targeted radionuclide therapy holds significant promise for treating brain and leptomeningeal metastases.
- Further research is needed to overcome the blood-brain barrier and optimize TRT delivery for these challenging metastatic sites.
