Dr John Buscombe
Past President, British Nuclear Medicine Society
Radioligand therapy is a rapidly developing field of cancer treatment which combines a tumour killing radio-nuclide with a ligand which targets the cancer cell. However, there are concerns over equitable access to these treatments in the UK.
Over the past decade a new form of anti-cancer treatment has been developed which combines the best of chemotherapy, radiotherapy and immunotherapy. This technique uses a targeting molecule called a ligand, which is designed to latch onto a particular target on the cancer cell. The ligand is also attached to a radioactive element which can then destroy the cancer cell.
If the present inequitable access to radioligand therapy continues, thousands of patients across the UK will miss out.
Patient based treatment
To ensure this kind of treatment can work, the same ligand is attached to a radioactive element which can be converted into an image by a gamma camera or PET machine. If there is uptake in the cancer seen on the scan, there is a significant chance that the radioligand will work. An example of this has been the use of Ga-68 DOTATOC and Lu-177 DOTATATE* in treating metastatic neuroendocrine cancer. In a large international clinical trial, it was shown that by using this combination the chance of the cancer growing is reduced by 82%.
Funded but not available
The results of this trial were so good that Lu-177 DOTATATE was approved by NICE and funded by NHS England. Therefore, all patients with this cancer type who fit the criteria for treatment should receive it.
The British Nuclear Medicine Society received reports this was not the case and conducted a survey which was presented at their recent scientific meeting. The survey flagged that the chance of receiving this treatment is dependent on where the patient lives, with good provision in the South and North but poor provision throughout the Midlands.
Does this matter?
It could be argued that neuroendocrine cancers are rare and that the number of patients affected is small, but a range of new radioligands are about to arrive in the UK which will treat common cancers. Next year may see the approval of a new radioligand therapy for metastatic prostate cancer patients which fail radiotherapy. If the present inequitable access to radioligand therapy continues, thousands of patients across the UK will miss out.