Doctors have used radioiodine therapy, a type of nuclear medicine treatment, since the 1940s. Now, a new generation of radiopharmaceuticals offers expanded treatment options for people with some types of prostate cancer and neuroendocrine tumors (NETs). As a national leader in cancer care, the Fred Hutchinson Cancer Center is making these therapies more widely available and expanding consultation services.
“We are happy to discuss cases and share our multidisciplinary approach to treating patients using radiopharmaceuticals,” says Delphine Chen, MD, Fred Hutch nuclear medicine physician and director of molecular imaging and therapy. “Patients and providers can also contact us for a second opinion on radiology scans and to find open clinical trials.”
Dr. Chen brings a high level of expertise to the prostate cancer and endocrinology tumor boards at Fred Hutch. She has a distinguished track record of research, including leading the first in-human trial of PARP radiotracers to predict which patients will respond to PARP inhibitors.
New patients typically see a medical oncologist or endocrinologist first, depending on the cancer type. If it appears that nuclear medicine may be an option, Dr. Chen, Dr. Amir Iravani or another member of her team, evaluates the patient to confirm their eligibility.
Dr. Chen works collaboratively with her colleagues to monitor for treatment side effects and adjust therapies to maximize response and minimize toxicities. “Our teams have a shared understanding of cancer biology and the response we expect to see during treatment,” says Dr. Chen. “This collective experience gives us confidence in making treatment decisions and helps us achieve the best possible outcomes.”
The main types of radiopharmaceutical therapies offered at Fred Hutch include:
Lutathera combines dotatate, a somatostatin receptor agonist, with the radioisotope Lu 177. Dotatate binds to somatostatin receptors on the NET and delivers Lu 177, which enters the cell and destroys it.
A dotatate PET scan is part of the initial evaluation to determine whether a patient will respond to lutathera. In this test, the patient receives a small dose of dotatate labelled with gallium Ga-68 or copper Cu-64. A PET scan shows whether the radioactive dotatate binds to the tumor.
“A dotatate scan isn’t necessary before referring a patient,” says Dr. Chen. “That is part of our workup at Fred Hutch.” The main indication for lutathera is a dotatate-positive (e.g. somatostatin receptor expressing) grade 1 or 2 well-differentiated gastroenteropancreatic NET that has not responded to other therapies.
Lutathera may also be an option for other NETs, including:
Pluvicto combines Lu 177 with a prostate-specific membrane antigen (PSMA)-targeting ligand. It’s approved for PSMA-positive metastatic castration-resistant prostate cancer in patients who progressed through androgen receptor-directed therapy and taxane-based chemotherapy. Patients must have a positive PSMA PET scan to receive this therapy as the PSMA PET scan helps to predict which patients will respond better to this treatment. FDG PET scans also provide helpful complementary information to better predict who will respond best to pluvicto.
As a major medical center, Fred Hutch has a high volume of patients receiving pluvicto. “This volume will increase as the approved uses for pluvicto expand,” says Dr. Chen. “We're just waiting for FDA approval in other settings.”
Though supply chain and manufacturing optimization for Pluvicto has been a challenge resulting in limited supply, it has shown noteworthy commercial promise. Active industry-led efforts are underway to improve the supply of pluvicto for patient treatments.
Radioactive iodine (iodine-131) is an important treatment for some patients with follicular and papillary thyroid cancer. These cancers start in the cells of the thyroid that absorb iodine. Doctors typically use radioactive iodine as adjuvant therapy after surgery.
“With a high level of expertise in endocrinology and nuclear medicine, Fred Hutch has seen a growing volume of patients with routine and complex thyroid cancers,” says Dr. Chen. “But our use of radioiodine therapy overall has decreased somewhat since research shows it’s not useful for low-risk thyroid cancer. Sometimes, the best cancer care means sparing patients from treatments they don’t need.”
Single-photon emission computed tomography (SPECT) uses radiotracers to diagnose a wide range of conditions, including brain and heart disorders.
At Fred Hutch, most SPECT imaging is therapy-related. After treatment with lutathera, pluvicto or radioactive iodine, the nuclear medicine team often uses SPECT to:
Since arriving at Fred Hutch in 2019, Dr. Chen has continued her research efforts to expand the field of nuclear medicine and find new diagnostic imaging and therapy agents. She currently leads a clinical trial investigating how well 68Ga-PSMA-11 PET/CT can predict response in patients with prostate cancer to standard therapies, such as chemotherapy and targeted hormonal therapy.
Dr. Chen also partners with researchers across Fred Hutch. She collaborated in a recently-closed prostate cancer trial led by Fred Hutch medical oncologist Michael Schweizer, MD. The trial showed a benefit with pluvicto treatment in patients previously treated with androgen receptor-directed therapy but not chemotherapy.
Along with fellow nuclear medicine physician, Amir Iravani, MD, Dr. Chen also brings national trials to Fred Hutch through her participation in prestigious cooperative groups. “There are many exciting trials on the horizon,” says Dr. Chen. “As new trials become available, we evaluate each patient to determine their eligibility.”
The nuclear medicine team at Fred Hutch is available to consult with community providers to discuss treatment options and available clinical trials. To consult with a Fred Hutch physician, contact (800) 4UW-DOCS.