What Does the Future Hold for Nuclear Medicine?

When asked what excites him about the future of nuclear medicine, Phillip Kuo, MD, emphasized the burgeoning paradigm of theranostics and a long list of exciting targets and radiopharmaceuticals that are currently being studied.

“Obviously, they all cannot make it across the finish line. … It takes a massive amount of investment to get them across the finish line and, finally, nuclear medicine is getting that kind of attention and investment to really unlock our potential,” noted Dr. Kuo, who is affiliated with Kuo Radiology, LLC.

While noting his focus in oncology, Michael Hofman, MBBS, FRACP, estimated that there are approximately 100 medium-sized startup companies focusing on the use of positron emission tomography (PET) to image and treat a variety of cancer types as well as facets of neurological, cardiovascular and inflammatory conditions.

“The wonderful thing about this specialty is it really crosses all the domains of medicine and the technology — the innovation in radiopharmaceutical sciences and on the equipment side — is progressing at a rate that is faster than I've ever seen in my … 25 years in the career,” added Dr. Hofman, director of the Prostate Cancer Theranostics and Imaging Centre of Excellence and head of PET/CT at the Peter MacCallum Cancer Centre in Melbourne, Australia.

Jeremie Calais, MD, PhD, concurred about the rapid growth of nuclear medicine technologies, citing continued research on non-PSMA targets for prostate cancer, ranging from acid phosphatase 3 (ACP3) and fibroblast activation protein (FAP) to carbonic anhydrase IX (CAIX-9).

“Seeing all these new developments all the time going so fast, for me, it's really a pleasure to have the opportunity as a professional to evolve in (this) field,” noted Dr. Calais, the director of clinical research and theranostics programs at the University of California-Los Angeles (UCLA).

Heather Jacene, MD, the new president of the Society of Nuclear Medicine and Molecular Imaging (SNMMI), maintained that there is a growing knowledge and respect for nuclear medicine among medical colleagues as well as patients. Dr. Jacene envisions nuclear medicine physicians taking on a more prominent role in patient consults.

“I think we're at … a tipping point of our colleagues and patients understanding (that) what we do is very safe and effective, and it can really impact the outcomes for patients,” emphasized Dr. Jacene, the clinical director of nuclear medicine/PET-CT and senior physician at Dana-Farber Cancer Institute in Boston.

(Editor’s note: For additional coverage of the recent SNMMI conference, click here.)

Surekha Yadav, MBBS, MD, suggested that the treatment aspect of theranostics may take center stage in future research efforts.

“I think the next decade of nuclear medicine research is going to be less about detection and more about figuring out how to act on what we are detecting, especially as theranostics like lutetium(-177) PSMA give us treatment options tied directly to the imaging modality findings,” posited Dr. Yadav, a nuclear medicine resident at the University of California-San Francisco (UCSF).

Noting a background in biochemistry prior to becoming a nuclear medicine technician, Alicia Corlett, NMT, said there is limitless potential with theranostics.

“There's literally thousands of different biomarkers out there that are just waiting to be discovered, and then we'll be able to use them to see (patient) disease and then treat their disease,” added Corlett, the lead nuclear medicine technologist at Peter MacCallum Cancer Centre in Melbourne, Australia.