In precision oncology, the success of nuclear medicine research, at the confluence of molecular biology, technology and computer science, preclinical and clinical science, relies on the development of specific radiopharmaceuticals, of instrumentation and advanced image analysis for the characterisation and risk assessment of tumours, the choice of the most appropriate treatment and response evaluation including also targeted radiation therapy.
Advanced image analysis techniques including deep learning are expected to greatly influence the interpretation of diagnostic imaging studies in the near future as they allow evaluating data beyond visual interpretation. The fascination for these techniques must not let us forget that the results need standardised evaluation, extensive testing, including for reproducibility and reliability, before being implemented in clinical practice. Besides methodological aspects, their impact in characterisation of disease, risk stratification, response assessment and outcome prediction are the essential questions to be addressed in clinical studies. The combination with other non-imaging biomarkers and genomics will likely enhance our capacity to guide patient management.
The introduction of immunotherapy has extraordinarily changed the fate of many patients with cancer and has a major impact on the entire field of oncology. However, only a fraction of treated patients appear to benefit from immunotherapy and reliable markers to identify responding patients are lacking. Furthermore, immune responses may confound response assessment by morphologic imaging and FDG PET/CT. New radiopharmaceuticals and imaging techniques, including advanced imaging analysis, as well as combination of nuclear medicine methods with other imaging and/or laboratory biomarkers need to be developed, and tested; the assessment of optimal timing of controls and the impact of the results on patient management are essential questions to be studied.
Radiation dosimetry is a central aspect of new developments in theragnostics. Knowing the absorbed radiation dose to target and non-target organs is essential for the design of new and improved radionuclide therapies as well as for radioprotection issues in diagnostic nuclear medicine applications.
Furthermore, it is important to focus on tissue and subcellular interactions of radiation to determine the micro-distribution of radiopharmaceuticals, which influences the choice of the therapeutic radionuclide. Radiation induced biological effects and bystander effects between tumour and neighbouring cells and the development of biomarkers of the radiation damage of tumour and normal cells, including genetics, epigenetics and proteomics, are other interesting areas of research.
In 2018, malignant tumours of the breast and female reproductive organs represented about 20% of the worldwide total cancer incidence and represent therefore a major global health concern. Even if survival has improved in the last 20 years, the absolute number of women who die from these cancers remains high and asks for improvement of early diagnosis, tumour characterisation and risk assessment as well as treatment response monitoring based on diagnostic imaging and other biomarkers. This includes the development and (pre-clinical and clinical) testing of new radiopharmaceuticals, imaging devices and data analysis.
Accumulating evidence exists on the role of inflammation not only in autoimmune diseases but also various others such as neurodegeneration, atherosclerosis, and cancer. Several radiopharmaceuticals are available for imaging and measuring inflammatory processes and their use in clinical studies is likely to provide new insights in the pathophysiology of a variety of diseases. However, further development of new radiopharmaceuticals is needed to study the pathways linking inflammation to disease in animal models and patients. This knowledge might ultimately be used for improved disease characterisation and the design of new of therapeutic interventions in patients.
Molecular imaging, in reference to molecular biology, intends gaining new insights in the biology of brain tumours while clinical studies address topics such as tumour characterisation, risk assessment, radiation treatment planning, surgical guidance and radionuclide therapy, as well as assessment of response to therapy and detection of recurrence. Research aiming at better understanding and management of brain tumours with hybrid imaging (PET/MRI) will also be presented here.
Theragnostics in neuroendocrine tumours has been one of the dominant research topics in nuclear medicine for several decades. The broad availability of gallium labelled somatostatin receptor targeting peptides and the regulatory approval of diagnostic/therapeutic pairs for imaging and therapy of neuroendocrine tumors has given a new momentum and fostered research in other theragnostic radiopeptides, additional targets, and treatment schemes based on advanced radiation dosimetry as well as combination of targeted radionuclide therapy with other therapeutic approaches. The present series offers room for a comprehensive collection of results addressing the various aspects of basic, pre-clinical and clinical research.
Neurodegenerative disorders including but not limited to Alzheimer’s disease, movement disorders or motor neuron diseases represent major health care issues. Despite progress in the understanding of these diseases, only palliative treatments exist so far. This series intends presenting new developments of basic research and imaging (pre-clinical and clinical) with radioactive and other molecular probes, to advance the understanding and management of these diseases.
This series addresses all aspects of molecular imaging research in psychiatric disorders including depressive and bipolar disorders, schizophrenia and other psychotic disorders, substance-related and addictive disorders, autism spectrum, and post-traumatic stress disorder.
The development and evaluation of novel radiolabelled compounds for imaging tumours is a central issue in nuclear oncology. Rather than basic radiochemical or radiopharmacy aspects, this series addresses target discovery, the assessment of the interaction of probes with the corresponding cellular receptors, in vivo stability, biokinetics and uptake in experimental tumours as well as early human studies in volunteers and patients. Experimental molecular radiotherapies in animals as well as early clinical trials are also included.
A large body of evidence already exists on the very promising role of radiopharmaceuticals targeting PSMA (prostate specific membrane antigen) in the diagnostic and therapeutic management of prostate cancer but many aspects need further systematic clinical exploration. This includes both diagnosis of prostate cancer, restaging of patients with biochemical recurrence, treatment monitoring as well as therapeutic application of various PSMA ligands in different disease states of metastatic prostate cancer. In addition, PSMA expression by the vasculature of various tumours may expand the diagnostic and therapeutic use of PSMA ligands to other malignancies.
Non-invasive imaging using PET and SPECT but also MRI and optical imaging of various components of the tumour microenvironment such as stromal and immune cells, blood vessels, extracellular matrix and biologically active molecules, are expected to advance knowledge about important aspects of tumour biology e.g. tumour progression, aggressiveness and metastatic spread. The feasibility of such an approach has been demonstrated by ligands for various integrins and more recently by ligands for fibroblast activation protein. The investigation and validation of methods assessing the tumour microenvironment might lead to the development of imaging biomarkers and therefore offer great potential for improved assessment, treatment and surveillance of tumours.