From the October 2018 issue of HealthCare Business News magazine
Supply of theranostic compounds remains another significant roadblock to widespread adoption. Some experts, using conservative models, predicted an annual need of around 30,000 doses of Lutathera for NET and around 160,000 doses of 177Lu-PSMA for prostate cancer patients. Based on 250 work days per year this results in an average of 760 doses per day and, including a safety margin, the need to produce 800-1000 doses per day. However, the current production infrastructure as well as the 177Lu-supply are far from ready to meet this demand. This crisis provides an opportunity for industry, insurances, health care providers and health care professionals to come up with mutually beneficial solutions.
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As outline above, the demand for theranostics will be high. However, with the development and emergence of additional novel theranostics the demand is likely to become even higher. These new compounds will be applicable to NET and other somatostatin receptor expressing tumors (177Lu-Satoreotide), neurotensin-1 receptor ligands, possibly for pancreactic cancer among others (177Lu-3BP-227), CD37-binding antibodies for hematological malignancies (Betalutin) and the recently approved 131MIBG (Azedra) for neuroblastoma and pheochromocytoma. More recently introduced ligands targeting tumor stroma (Fibroblast Activation Protein (FAPI)) may find even wider application in various cancers.
In summary, theranostics provides unique new opportunities and challenges for nuclear medicine and industry regulators, insurances and healthcare systems. But there is no time to hesitate – the future is now!
About the authors: Ken Herrmann and Wolfgang P. Fendler work in the department of Nuclear Medicine, Universitätsklinikum Essen, Essen, Germany. Ken Herrmann is also associated with the Ahmanson Translational Imaging Division, Department of Molecular and Medical Pharmacology, UCLA, Los Angeles, California.
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