Current Status of Clinical 177 Lu-PSMA Radiopharmaceutical Therapies: Insights from a Survey of High-End Nuclear Medicine Theranostic Centers

Radiopharmaceutical therapy (RPT) is becoming a cornerstone of cancer treatments with the approval of 177Lu-PSMA (Pluvicto; Novartis), 177Lu-DOTATATE (Lutathera; Novartis), and 223Ra-dichloride (Xofigo; Bayer). An even larger number of treatments with different isotopes and biologic targets are being studied and promise a revolution in oncology care. However, the Food and Drug Administration’s approval of 177Lu-PSMA RPT in the prechemotherapy space has raised concerns regarding access, logistics, supply, quality of care, and workforce challenges. Methods: To understand the current and future landscapes and to advocate for best patient care practices in the setting of prostate-specific membrane antigen–targeted RPT (PSMA RPT), the Society of Nuclear Medicine and Molecular Imaging Theranostics Leadership and Operations Group surveyed its members to explore the demand for PSMA RPT and the capacity and preparedness of the centers providing this therapy. Results: Survey results indicated that the glass is half-full, with nuclear medicine therapy centers meeting current challenges in various aspects of PSMA RPT including logistics, capacity, infrastructure, access, reimbursement, imaging, and clinical care. Eighty-six percent stated that they have a comprehensive consult with their patients, 83% reported that they ordered and managed their patient’s initial and follow-up blood work, and 83% reported that reimbursement was satisfactory. Although 86% had no concerns managing their current volume, this dropped to 52% when queried about concerns regarding their capacity to handle PSMA RPT volume in the future, noting various challenges including staffing (physicians, technicians, and nurses), a limited number of treatment rooms, and limited access to SPECT/CT for posttherapy imaging. Conclusion: Survey results indicate the glass is half-full, with nuclear medicine therapy centers meeting current challenges in various aspects of PSMA RPT, including logistics, capacity, infrastructure, access, reimbursement, imaging, and clinical care. Future needs of nuclear medicine theranostics can be met with proper planning, vision, and effort.