For the Latest Nuclear Medicine Therapies, Look to Fred Hutch

By Fred Hutch Staff · February 16, 2023

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.

Delphine Chen, MD and Director of Molecular Imaging and Therapy smiles for a portrait in a courtyard at Fred Hutch.

“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.”

Experience and Collaboration Are Key for Optimal Care

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® (Lutetium Lu 177 dotatate) for NETs

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:

Lung carcinoid tumors
Paragangliomas
Pheochromocytomas

Pluvicto™ (Lutetium Lu 177 vipivotide tetraxetan) for Prostate Cancer

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 for Thyroid Cancer

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.”

SPECT Imaging for Monitoring Nuclear Medicine Therapy

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:

Assess how much of the drug is getting to the tumor
Determine how the tumor is responding to treatment
Locate all disease sites based on drug distribution

Clinical Trials

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.”

Nuclear Medicine Consultations

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.

Antigen A foreign substance, such as bacteria, that causes the body’s immune system to respond by making antibodies. Antibodies defend the body against antigens. Chemotherapy Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. It may be given alone or with other treatments. Treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing. Chemotherapy may be given by mouth, injection, infusion or on the skin, depending on the type and stage of the cancer being treated. It may be given alone or with other treatments, such as surgery, radiation therapy or biologic therapy. Computed tomography A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are used to create three-dimensional (3-D) views of tissues and organs. A procedure that uses a computer linked to an X-ray machine to make a series of detailed pictures of areas inside the body. The pictures are taken from different angles and are used to create three-dimensional (3-D) views of tissues and organs. A dye may be injected into a vein or swallowed to help the tissues and organs show up more clearly. This scan may be used to help diagnose disease, plan treatment or find out how well treatment is working. Grade In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. In cancer, a grade is a description of a tumor based on how abnormal the cancer cells and tissue look under a microscope and how quickly the cancer cells are likely to grow and spread. Low-grade cancer cells look more like normal cells and tend to grow and spread more slowly than high-grade cancer cells. Grading systems are different for each type of cancer. They are used to help plan treatment and determine prognosis. Also called histologic grade and tumor grade. Hormone therapy Hormones can cause some cancers to grow. To slow or stop growth, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove a hormone-producing gland. Treatment that adds, blocks or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. Hormones can also cause certain cancers (such as prostate and breast cancer) to grow. To slow or stop the growth of cancer, synthetic hormones or other drugs can be used to block the body’s natural hormones, or surgery is used to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy and hormone treatment. Imaging In medicine, a process that makes pictures of areas inside the body. Imaging uses methods such as X-rays (high-energy radiation), ultrasound (high-energy sound waves) and radio waves. Medical oncologist A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A physician who has special training in diagnosing and treating cancer in adults using chemotherapy, hormonal therapy, biological therapy and targeted therapy. A medical oncologist is often the main health care provider for someone who has cancer. A medical oncologist also gives supportive care and may coordinate treatment given by other specialists. Metastatic A metastatic cancer is a cancer that has spread to other areas of the body by way of the lymph system or bloodstream. Oncologist A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment, such as treating cancer with radiation. A physician who has special training in diagnosing and treating cancer. Some oncologists specialize in a particular type of cancer treatment. For example, a radiation oncologist specializes in treating cancer with radiation. PET (positron emission tomography) scan A procedure in which a small amount of radioactive glucose is injected into a vein, and a scanner is used to make detailed pictures of areas inside the body in order to find cancer cells. A procedure in which a small amount of radioactive glucose (sugar) is injected into a vein, and a scanner is used to make detailed, computerized pictures of areas inside the body where the glucose is taken up. Because cancer cells often take up more glucose than normal cells, the pictures can be used to find cancer cells in the body. Side effects A problem that occurs when treatment affects healthy tissues or organs. Some side effects of cancer treatment are nausea, vomiting, fatigue, pain, decreased blood cell counts, hair loss and mouth sores. Standard care A treatment or other intervention currently being used and considered to be of proven effectiveness based on past studies.

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Tags ·

clinical trials

molecular imaging and therapy

neuroendocrine tumors (NETs)

Nuclear medicine therapy

prostate cancer

thyroid cancer

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