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DOI: 10.1055/s-0045-1812102
Multidisciplinary Perspectives of Clinical Trials in Theranostics
Autoren
Abstract
Theranostics and clinical trials are driving the future of nuclear medicine and require a multidisciplinary approach to achieve the best possible care for the patient. Theranostics refers to using chemical compounds with similar diagnostic and radiotherapeutic applications. Therefore, the biodistribution remains the same for the imaging and therapy portions, a low radiation dose being delivered during imaging, and a higher radiation dose being delivered to the target disease areas during the treatment phase. The new era of theranostics has revolutionized nuclear medicine through the prospective phase 3 clinical trials, which have resulted in its adoption into the treatment paradigms of patients, particularly those with neuroendocrine tumors and prostate cancer. Molecular imaging can be used to assess the role and utility of new tracers and molecular endpoints to help improve the understanding of tumor biology and evaluation of treatment response, leading to intelligent clinical trial design and more rapid drug development. Clinical trials networks such as EANM Research Ltd. (EARL), SNMMI Clinical Trials Network (CTN), and Australasian Radiopharmaceutical Trials Network (ARTnet), encourage a standardized approach and promote a collaborative approach to clinical trials in molecular imaging. Clinical Trials in Theranostics require the skills and expertise of a multidisciplinary team including the principal investigator, nuclear medicine specialists, study coordinators, medical physicists, radiopharmaceutical scientists, nuclear medicine technologists, research nurses, and research assistants. All personnel involved in theranostics clinical trials should be certified in Good Clinical Practice (GCP). Accurate documentation and record keeping in clinical trials provides validation that clinical trials is conducted at the highest ethical and clinical standards, meets the expectation of the study protocol, and adheres to GCP. Radiation safety is a critical factor for staff, patients, and the public in theranostics and clinical trials and must follow country-specific guidelines and international guidelines to ensure basic safety standards are met. As theranostics and clinical trials continue to stamp their mark in molecular imaging and radionuclide therapy, it is imperative that nuclear medicine professionals remain upskilled and adequately trained in these two aspects of the profession to ensure optimal care is delivered to the patient.
Keywords
clinical trials - clinical trials networks - Good Clinical Practice - radiation safety - theranosticsPublikationsverlauf
Artikel online veröffentlicht:
07. Oktober 2025
© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)
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References
- 1 Pini C, Gelardi F, Sollini M. Present and future of target therapies and theranostics: refining traditions and exploring new frontiers-highlights from annals of Nuclear Medicine 2021. Eur J Nucl Med Mol Imaging 2022; 49 (11) 3613-3621
- 2 Bauckneht M, Ciccarese C, Laudicella R. et al. Theranostics revolution in prostate cancer: basics, clinical applications, open issues and future perspectives. Cancer Treat Rev 2024; 124: 102698
- 3 Kandi V, Vadakedath S. Clinical trials and clinical research: a comprehensive review. Cureus 2023; 15 (02) e35077
- 4 Bodei L, Herrmann K, Schöder H, Scott AM, Lewis JS. Radiotheranostics in oncology: current challenges and emerging opportunities. Nat Rev Clin Oncol 2022; 19 (08) 534-550
- 5 Abdel-Wahab M, Giammarile F, Carrara M. et al. Radiotherapy and theranostics: a Lancet Oncology Commission. Lancet Oncol 2024; 25 (11) e545-e580
- 6 Accessed September 21, 2025 at: https://www.tga.gov.au/resources/publication/publications/ich-guideline-good-clinical-practice
- 7 International council for harmonisation of technical requirements for pharmaceuticals for human use. ICH harmonised guideline for good clinical practice. E6(R3). Final version adopted on January 6, 2025 . Accessed September 21, 2025 at: https://database.ich.org/sites/default/files/ICH_E6%28R3%29_Step4_FinalGuideline_2025_0106.pdf
- 8 Accessed September 21, 2025 at: https://earl.eanm.org/
- 9 Kaalep A, Sera T, Oyen W. et al. EANM/EARL FDG-PET/CT accreditation - summary results from the first 200 accredited imaging systems. Eur J Nucl Med Mol Imaging 2018; 45 (03) 412-422
- 10 Accessed September 21, 2025 at: https://www.snmmi.org/Research/ClinicalTrialsNetwork.aspx?ItemNumber=6831
- 11 Mallak N, Sunderland J. . The Clinical Trials Network Newsletter; June 2023 Launch of the Therapy Clinical Trials Network (TCTN). Accessed September 21, 2025 at: https://snmmi.org/common/Uploaded%20files/Web/Research-Publications/Pathways/Pathways-2023-06.pdf
- 12 Accessed September 21, 2025 at: https://artnet.org.au/
- 13 Accessed September 21, 2025 at: https://artnet.org.au/our-research-services/
- 14 Accessed September 21, 2025 at: https://www.safetyandquality.gov.au/sites/default/files/2020-02/fact_sheet_8_national_clinical_trials_governance_framework_-_roles_and_functions_-_site_principal_investigator.pdf
- 15 Trembath L, Frye SA, Scott PJH, Hoffman JM. SNMMI Clinical Trial Network research series for technologists: application of Good Clinical Practice to clinical research in medical imaging. J Nucl Med Technol 2023; 51 (01) 2-8
- 16 Lee ST, Emmett LM, Pattison DA. et al. The importance of training, accreditation, and guidelines for the practice of theranostics: the Australian perspective. J Nucl Med 2022; 63 (06) 819-822
- 17 Emmett L, Willowson K, Violet J, Shin J, Blanksby A, Lee J. Lutetium 177 PSMA radionuclide therapy for men with prostate cancer: a review of the current literature and discussion of practical aspects of therapy. J Med Radiat Sci 2017; 64 (01) 52-60
- 18 Accessed September 21, 2025 at: https://www.arpansa.gov.au/regulation-and-licensing/regulatory-publications/radiation-protection-series/codes-and-standards/rps14
- 19 Accessed September 21, 2025 at: https://www.nrc.gov/reading-rm/doc-collections/cfr/part020/full-text.html#part020-1301
- 20 International Atomic Energy Agency. . Release of Patients After Radionuclide Therapy, Safety Reports Series No. 63, IAEA, Vienna; 2009
- 21 Lapi SE, Scott PJH, Scott AM. et al. Recent advances and impending challenges for the radiopharmaceutical sciences in oncology. Lancet Oncol 2024; 25 (06) e236-e249
- 22 Scott AM, Zeglis BM, Lapi SE. et al. Trends in nuclear medicine and the radiopharmaceutical sciences in oncology: workforce challenges and training in the age of theranostics. Lancet Oncol 2024; 25 (06) e250-e259 Erratum in: Lancet Oncol. 2024 Aug;25(8):e336.
- 23 Giammarile F, Paez D, Zimmermann R. et al. Production and regulatory issues for theranostics. Lancet Oncol 2024; 25 (06) e260-e269
- 24 Pascual TNB, Paez D, Iagaru A. et al. Guiding principles on the education and practice of theranostics. Eur J Nucl Med Mol Imaging 2024; 51 (08) 2320-2331 Erratum in: Eur J Nucl Med Mol Imaging. 2025 May 30.

