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Vogt J, Oeh U, Maringer FJ. Development of the occupational exposure during the production and application of radiopharmaceuticals in Germany. JOURNAL OF RADIOLOGICAL PROTECTION : OFFICIAL JOURNAL OF THE SOCIETY FOR RADIOLOGICAL PROTECTION 2024; 44:011508. [PMID: 38232404 DOI: 10.1088/1361-6498/ad1fdd] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Accepted: 01/17/2024] [Indexed: 01/19/2024]
Abstract
An increasing number of radiopharmaceuticals and proteins are available for diagnosing and treating various diseases. The demand for existing and newly developed pharmaceutical radionuclides and proteins is steadily increasing. The radiation exposure levels of workers in the radiopharmaceutical industry and nuclear medicine field are closely monitored, specifically their effective dose and equivalent dose, leading to the question, of whether the dawn of radiopharmaceuticals affects the occupational exposure level. This development is analyzed and evaluated with data from the German National Dose Register. Data shows that the effective dose in the work categories production and distribution of radioisotopes as well as nuclear medicine slightly decreased from 1997 to 2021. Over the same period, the hand equivalent dose in nuclear medicine increases steadily, with no discernible trend in production and distribution of radioisotopes. Over the past few decades, intentional efforts and measures have been taken to ensure radiation protection. Instruments for monitoring and dose reduction must be continuously applied. Given the low effective dose, the focus in future shall be on dose reduction following theaslowasreasonablyachievable principle. The development of the hand equivalent dose should be carefully observed in the upcoming years.
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Affiliation(s)
- Julius Vogt
- Emergency Preparedness & Response, Federal Office for Radiation Protection, Köpenicker Allee 120 - 130, Berlin 10318, Germany
- University of Vienna, Universitätsstraße 7, Wien 1010, Austria
| | - Uwe Oeh
- Medical and Occupational Radiation Protection, Federal Office for Radiation Protection, Ingolstädter Landstraße 1, Oberschleißheim 85764, Germany
| | - Franz Josef Maringer
- Atominstitut, TU Wien,, Stadionallee 2, Wien 1020, Austria
- University of Natural Resources and Life Sciences (BOKU), Peter-Jordan-Straße 82, Wien 1190, Austria
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Lee HS, Schwarz SW, Schubert EK, Chen DL, Doot RK, Makvandi M, Lin LL, McDonald ES, Mankoff DA, Mach RH. The Development of 18F Fluorthanatrace: A PET Radiotracer for Imaging Poly (ADP-Ribose) Polymerase-1. Radiol Imaging Cancer 2022; 4:e210070. [PMID: 35089089 PMCID: PMC8830434 DOI: 10.1148/rycan.210070] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Fluorine 18 (18F) fluorthanatrace (18F-FTT) is a PET radiotracer for imaging poly (adenosine diphosphate-ribose) polymerase-1 (PARP-1), an important target for a class of drugs known as PARP inhibitors, or PARPi. This article describes the stepwise development of this radiotracer from its design and preclinical evaluation to the first-in-human imaging studies and the initial validation of 18F-FTT as an imaging-based biomarker for measuring PARP-1 expression levels in patients with breast and ovarian cancer. A detailed discussion on the preparation and submission of an exploratory investigational new drug application to the Food and Drug Administration is also provided. Additionally, this review highlights the need and future plans for identifying a commercialization strategy to overcome the major financial barriers that exist when conducting the multicenter clinical trials needed for approval in the new drug application process. The goal of this article is to provide a road map that scientists and clinicians can follow for the successful clinical translation of a PET radiotracer developed in an academic setting. Keywords: Molecular Imaging-Cancer, PET, Breast, Genital/Reproductive, Chemistry, Radiotracer Development, PARPi, 18F-FTT, Investigational New Drug © RSNA, 2022.
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Decristoforo C, Neels O, Patt M. Emerging Radionuclides in a Regulatory Framework for Medicinal Products - How Do They Fit? Front Med (Lausanne) 2021; 8:678452. [PMID: 34124109 PMCID: PMC8192700 DOI: 10.3389/fmed.2021.678452] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022] Open
Abstract
Recent years have seen the establishment of several radionuclides as medicinal products in particular in the setting of theranostics and PET. [177Lu]Lutetium Chloride or [64Cu]Copper Chloride have received marketing authorization as radionuclide precursor, [68Ga]Gallium Chloride has received regulatory approval in the form of different 68Ge/68Ga generators. This is a formal requirement by the EU directive 2001/83, even though for some of these radionuclide precursors no licensed kit is available that can be combined to obtain a final radiopharmaceuticals, as it is the case for Technetium-99m. In view of several highly promising, especially metallic radionuclides for theranostic applications in a wider sense, the strict regulatory environment poses the risk of slowing down development, in particular for radionuclide producers that want to provide innovative radionuclides for clinical research purposes, which is the basis for their further establishment. In this paper we address the regulatory framework for novel radionuclides within the EU, the current challenges in particular related to clinical translation and potential options to support translational development within Europe and worldwide.
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Affiliation(s)
- Clemens Decristoforo
- Department of Nuclear Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Oliver Neels
- Department of Radiopharmaceuticals Production, Institute of Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf, Dresden, Germany
| | - Marianne Patt
- Department for Nuclear Medicine, Radiochemistry, University of Leipzig, Leipzig, Germany
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Kunos CA, Rubinstein LV, Capala J, McDonald MA. Phase 0 Radiopharmaceutical-Agent Clinical Development. Front Oncol 2020; 10:1310. [PMID: 33014772 PMCID: PMC7461940 DOI: 10.3389/fonc.2020.01310] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/23/2020] [Indexed: 01/10/2023] Open
Abstract
The evaluation of antibody-targeted or peptide-targeted radiopharmaceuticals as monotherapy or in oncological drug combinations requires programmatic collaboration within the National Cancer Institute (NCI) clinical trial enterprise. Phase 0 trials provide a flexible research platform for the study of radiopharmaceutical–drug pharmacokinetics, radiation dosimetry, biomarkers of DNA damage response modulation, and pharmacodynamic benchmarks predictive of therapeutic success. In this article, we discuss a phase 0 clinical development approach for human antibody-targeted or peptide-targeted radiopharmaceutical–agent combinations. We expect that early-phase radiopharmaceutical–agent combination trials will become a more tactical and more prevalent part of radiopharmaceutical clinical development in the near-term future for the NCI Cancer Therapy Evaluation Program.
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Affiliation(s)
- Charles A Kunos
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
| | - Larry V Rubinstein
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, United States
| | - Jacek Capala
- Radiation Research Program, National Cancer Institute, Bethesda, MD, United States
| | - Michael A McDonald
- Cancer Imaging Program, National Cancer Institute, Bethesda, MD, United States
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Financial Toxicity Encountered in Therapeutic Radiopharmaceutical Clinical Development for Ovarian Cancer. Pharmaceuticals (Basel) 2020; 13:ph13080181. [PMID: 32764223 PMCID: PMC7464475 DOI: 10.3390/ph13080181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 01/08/2023] Open
Abstract
Financial toxicity or the debt a cancer survivor incurs from the costs of their medical cancer care is an understudied aspect in the clinical development of experimental therapeutic agents. The United States National Cancer Institute (NCI) Cancer Therapy Evaluation Program studies experimental therapeutic agents like radiopharmaceuticals in both early and late phase trials, which provide opportunities to comprehend more clearly the possible sources of financial toxicity incurred by cancer survivors. We reviewed the academic scholarship describing fiscal and social costs involved in the development of therapeutic radiopharmaceuticals. Because many ovarian cancer survivors outlive their disease through initial and, perhaps, multiple treatment courses, these women and their treatments provide context for our discussion on financial toxicity. 16 (27%) of 60 articles discuss financial toxicity incurred by women with ovarian cancer; none described financial toxicity associated with regulatory agency-approved or experimental therapeutic radiopharmaceuticals. Fiscal costs of radiopharmaceutical dose and schedule and social costs of individual productivity loss or asset expenditure arose as primary financial toxicities. The development of radiopharmaceuticals for women with ovarian cancer remains a high priority for the NCI Cancer Therapy Evaluation Program. Weighing radiopharmaceutical clinical benefit against measures of financial toxicity is challenging and warrants further study in prospective radiopharmaceutical clinical trials.
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Cutler CS, Bailey E, Kumar V, Schwarz SW, Bom HS, Hatazawa J, Paez D, Orellana P, Louw L, Mut F, Kato H, Chiti A, Frangos S, Fahey F, Dillehay G, Oh SJ, Lee DS, Lee ST, Nunez-Miller R, Bandhopadhyaya G, Pradhan PK, Scott AM. Global Issues of Radiopharmaceutical Access and Availability: A Nuclear Medicine Global Initiative Project. J Nucl Med 2020; 62:422-430. [PMID: 32646881 DOI: 10.2967/jnumed.120.247197] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 06/15/2020] [Indexed: 12/21/2022] Open
Abstract
The Nuclear Medicine Global Initiative was formed in 2012 by 13 international organizations to promote human health by advancing the field of nuclear medicine and molecular imaging by supporting the practice and application of nuclear medicine. The first project focused on standardization of administered activities in pediatric nuclear medicine and resulted in 2 articles. For its second project the Nuclear Medicine Global Initiative chose to explore issues impacting on access and availability of radiopharmaceuticals around the world. Methods: Information was obtained by survey responses from 35 countries on available radioisotopes, radiopharmaceuticals, and kits for diagnostic and therapeutic use. Issues impacting on access and availability of radiopharmaceuticals in individual countries were also identified. Results: Detailed information on radiopharmaceuticals used in each country, and sources of supply, was evaluated. Responses highlighted problems in access, particularly due to the reliance on a sole provider, regulatory issues, and reimbursement, as well as issues of facilities and workforce, particularly in low- and middle-income countries. Conclusion: Strategies to address access and availability of radiopharmaceuticals are outlined, to enable timely and equitable patient access to nuclear medicine procedures worldwide. In the face of disruptions to global supply chains by the coronavirus disease 2019 outbreak, renewed focus on ensuring a reliable supply of radiopharmaceuticals is a major priority for nuclear medicine practice globally.
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Affiliation(s)
| | - Elizabeth Bailey
- Department of Nuclear Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Vijay Kumar
- Department of Nuclear Medicine and PET, Westmead Hospital and Children's Hospital at Westmead, and University of Sydney, New South Wales, Australia
| | - Sally W Schwarz
- Washington University School of Medicine, St Louis, Missouri
| | - Hee-Seung Bom
- Department of Nuclear Medicine, Chonnam National University Hwasun Hospital, Jeollanam, Korea
| | - Jun Hatazawa
- Department of Quantum Cancer Therapy, Research Center for Nuclear Physics, Osaka University, Osaka, Japan
| | - Diana Paez
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Pilar Orellana
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria
| | - Lizette Louw
- Department of Nuclear Medicine, Charlotte Maxeke Johannesburg Academic Hospital and University of Witwatersrand, Johannesburg, South Africa
| | - Fernando Mut
- Nuclear Medicine Service, Italian Hospital, Montevideo, Uruguay
| | - Hiroki Kato
- Department of Nuclear Medicine and Tracer Kinetics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Arturo Chiti
- Department of Biomedical Sciences, Humanitas University, and Nuclear Medicine Unit, Humanitas Research Hospital-IRCCS, Milan, Italy
| | - Savvas Frangos
- Department of Nuclear Medicine, Bank of Cyprus Oncology Center, Nicosia, Cyprus
| | - Frederic Fahey
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Gary Dillehay
- Department of Radiology, Division of Nuclear Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Seung J Oh
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong S Lee
- Department of Nuclear Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Sze-Ting Lee
- Department of Molecular Imaging and Therapy, Austin Health; University of Melbourne; Olivia Newton-John Cancer Research Institute, and School of Cancer Medicine, La Trobe University, Melbourne, Australia
| | - Rodolfo Nunez-Miller
- Nuclear Medicine and Diagnostic Imaging Section, International Atomic Energy Agency, Vienna, Austria.,Excel Diagnostics and Nuclear Oncology Center, Houston, Texas
| | - Guru Bandhopadhyaya
- Department of Nuclear Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India; and
| | - Prasanta K Pradhan
- Department of Nuclear Medicine, Sanjay Gandhi Post Graduate Institute of Nuclear Medicine, Lucknow, India
| | - Andrew M Scott
- Department of Molecular Imaging and Therapy, Austin Health; University of Melbourne; Olivia Newton-John Cancer Research Institute, and School of Cancer Medicine, La Trobe University, Melbourne, Australia
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