Year: 2026
Type: article
Abstract: Targeted radionuclide therapy (TRT) is a rapidly growing therapeutic modality designed to deliver highly localised cytotoxic radiation to tumour cells, while minimising exposure to surrounding healthy tissues. This approach has been demonstrated to be beneficial in prolonging progression-free survival and/or overall survival in thyroid carcinoma, neuroendocrine tumours and prostate carcinoma. However, treatment efficacy is heterogeneous with substantial variability in both magnitude and duration of clinical benefit. The development of predictive biomarkers could optimise patient selection and enable early identification of treatment failure, thereby improving the effectiveness of TRT. Predictive biomarkers may guide individualised radiation dosing or identify patients unlikely to achieve a sufficient therapeutic response. As TRT combines aspects of targeted pharmacotherapy with radiotherapy, evaluation of pharmacogenomic and radiation genomic factors may provide a basis for optimising patient selection and prediction of treatment response. In the context of TRT, genomic mutations can potentially influence clinical outcomes by altering tissue expression of the molecular target or key cellular processes in response to radiation, such as DNA repair, apoptosis, cell-cycle control, signal transduction, and modulation of the tumour microenvironment. This article provides an overview of current TRT applications and recent clinical studies evaluating the effect of pharmacogenomic and radiation genomic factors on treatment outcome. High-quality evidence from large prospective randomised trials are currently lacking, and results from available smaller and mostly retrospective clinical studies have been variable. Given the complex network of cellular biochemical pathways involved in target expression and DNA repair, parallel evaluation of multiple genes, gene transcripts and splice variants to yield multigene transcript signatures and integrative models may identify relevant alterations. There is a clear need for appropriately designed and adequately powered clinical trials evaluating genomic factors in TRT to inform individualised treatment decision making.
Source: EANM Innovation
Language: English
Subfield: Radiology, Nuclear Medicine and Imaging
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
OpenAlex ID: W7201991406