Australian round-table event raises awareness of radioligand therapy

Australia has a good foundation for providing radioligand therapy, but expansion is needed to prepare for the future. Australia has an expert nuclear specialist workforce, new and emerging biotech companies, and sovereign manufacturing capabilities,¹ but access to radioligand therapy has predominantly been limited to a small patient group – people with neuroendocrine neoplasms. There is a recognised need to upscale systems to future-proof the current environment for new therapies and increased demand.^{2 3}

In 2021, NeuroEndocrine Cancer Australia and the National Theranostics Roundtable Committee hosted a round table on the future of precision oncology in nuclear medicine.³ The goal was to bring together stakeholders from sometimes disconnected fields, such as academia, clinical research, health technology assessment bodies, industry and patients, to enable them to work collaboratively in the future.²

The participants were able to work together towards common goals, aiming to ensure that innovative radioligand therapy development is supported, that the treatment is safe and effective and that people with cancer can access it.² During the round table, the experts outlined the current landscape of nuclear medicine, including clinical trials, radiopharmaceutical production, guidelines and care pathways, infrastructure and the regulatory environment.³ The key discussion points focused on the following:

• Ensuring sovereign capability to produce the radiopharmaceuticals used in radioligand therapy as new therapies are approved. This is particularly important in light of the COVID-19 pandemic, which saw the capability pushed to its limits. Current capabilities are under evaluation, and the Australian Nuclear Science and Technology Organisation is future-proofing manufacturing and supply through investment in new and upgraded facilities.³
• Including radioligand therapy in the newly created optimal care pathways. These pathways will form the basis of the Australian Cancer Plan.³
• Providing education on radioligand therapy across all specialties to ensure that the workforce is upscaled. The Australasian Association of Nuclear Medicine Specialists is broadening existing training to enable radiation oncologists to also gain qualifications in nuclear medicine.³

By including health technology assessment chairs from the Medical Services Advisory Committee (MSAC) and the Therapeutic Goods Administration (TGA) in the round table, NeuroEndocrine Cancer Australia has raised the profile of radioligand therapy within regulatory bodies.³ This is important because there is a need to change regulatory frameworks to ensure readiness for the radiopharmaceuticals used in radioligand therapy in the future.²

The round table also helped raise awareness of radioligand therapy within government, with Mark Butler MP – then Shadow Minister for Health and Ageing and now Minister for Health and Aged Care – speaking at the event.^{2 3} Government support is needed to implement change for radioligand therapy and make sure that the health system is prepared once more therapies are approved.²

Recommendations for next steps following the round table included contributing to the upcoming health technology assessment review, perhaps suggesting that joint imaging and therapy submissions be considered.^{2 3}

Another recommendation was to hold a theranostics horizon scanning workshop, bringing together not only health technology bodies, industry, patients, academia and clinical researchers but also the Federal Health Minister, the health department and other government representatives.^{2 3} The aim would be for this event to include patient groups from cancer types where radioligand therapies are currently under investigation, including ovarian, breast and brain cancers. This would allow them to learn from the experiences of neuroendocrine cancer groups regarding how to advocate for the future of radioligand therapy.²

Recently, the Prime Minister’s Critical Technologies Policy Coordination Office listed nuclear medicine as a critical technology.³ In addition, the government and industry committed to an investment of AUD $71 million in the Australian Precision Medicine Enterprise to meet the gap in the supply of radiopharmaceuticals.^{3 4} As a result of these changes, it is now a good time to be holding discussions on radioligand therapy.^{2 3}