AANMS Position Statement on Practice of Theranostics in Australia

Executive Summary

Therapeutic options in malignant disease are expanding rapidly with the aim of improving patient outcomes. With the increasing cost of health care, there is a need to ensure the most cost-effective modalities are both available and appropriately implemented as part of the armamentarium of therapies available for patients. Molecular imaging and radionuclide therapy are relatively new options that offers many benefits, including cost and safety, in comparison to those currently available.

Theranostics is a term that has been coined to cover the use of a radiopharmaceutical for both diagnosis and, after demonstrating appropriate levels of concentration of the radiopharmaceutical in tumours, subsequent therapy. This often, though not universally, involves a different isotope bound to the same targeting ligand.

This position statement establishes a consensus on recommendations regarding the care of patients receiving theranostic therapy and to support the provision of safe, high quality, targeted care by qualified professionals in this area. These recommendations include, but not limited to: identifying the optimal workplace and facility requirements; specialist training requirements; patient workflow and MDT requirements.

While a range of theranostic therapies are currently available, there is sufficient commonality among these therapies to allow uniform guidelines to be developed whilst accepting that some specific flexibility will be necessary. Important aspects of theranostics considered in the development of these guidelines include:

  • The rapidly evolving scientific and technological advances in the practice of theranostics often see a delay between availability and sufficient clinical evidence to indicate widespread use
  • The design of disease, and patient specific, treatment options and delivery methodologies
  • The complexity of managing patients with cancer when there is a wide range of differing treatment options each with their own inherent strengths and weaknesses. This has required a multidisciplinary approach for many therapies, particularly the newer ones, requiring input from medical experts in different sub-specialties to encompass all aspects of the patient’s current medical status in order to select the optimal treatment pathway.
  • The need to understand and respect patients’ values, goals, needs and financial situation, and engage them in an informative process of treatment options and shared decision-making
  • Requirements related to each patient’s disease, as well as the specific risks vs the benefits of the treatment, needs to be assessed by a multidisciplinary team. This assessment will be influenced by local capabilities that may change with time.

The AANMS is of the position that the development of skills and expertise in theranostics is necessary for its safe and effective use in a clinical setting and that these should also be AANMS Theranostics Position Statement (Version 1.0, February 2021) 5 maintained through life-long learning. A multidisciplinary approach to patient selection, management and administration of the therapy is a key component of theranostic treatments.