Preface – EANM 2023

© Institut Jules Bordet – Magdalena Mileva, MD, Department of Nuclear Medicine, ­Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

© Institut Jules Bordet – Magdalena Mileva, MD, Department of Nuclear Medicine, ­Institut Jules Bordet, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium

Dear Colleagues,

The 36th annual congress of the European Association of Nuclear Medicine (EANM) was held in Vienna, Austria, and virtually from 9th to 13th September. As always, the very much-anticipated event brought more than 7,600 leading experts from across the globe together to learn and discuss the groundbreaking updates and scientific advancements in nuclear medicine, which were covered in nearly 2,000 oral presentations and e-posters in 156 sessions.

The first chapter of this memo ­inOncology report sets the stage for groundbreaking new developments in the diagnosis of neuroendocrine ­tumors (NETs) and spotlights inno­vative approaches utilizing SSTR-anta­gonists such as 68Ga-DATA5m-LMA, [18F]-AlF-NOTA-LM3, [68Ga]Ga-­DATA5m-LM4 or [99mTc]Tc-­TECANT 1 radiotracers.

Subsequently, the latest advancements in NETs are highlighted with emphasis on combining radioligand therapy with standard treatments in patients with progressive advanced non-resectable gastroenteropancreatic NETs. Moreover, the utility of 177Lu-­DOTATATE following peptide receptor radionuclide therapy (PRRT) in patients with bronchopulmonary neuroendocrine neoplasms and a personalized PRRT-regime using tailored 177Lu-­DOTATATE activity in patients with overexpressing SSTR NETs are outlined.

The section on NET theranostics overviews the interim data of the first-in-class alpha-emitting radiopharmaceutical 225Ac-DOTATATE, data gleaned from a human pilot study with 212Pb-VMT-α-NET, as well as the promising prospects of personalized dosimetry-based PRRT, combining mixed doses of [177Lu]Lu- and [90Y]Y-DOTATATE. It further delves deeper into assessing the predictive potential of full-body longitudinal somatostatin receptor imaging features for predicting clinical outcomes in metastatic NET patients receiving PRRT.

Within the realm of prostate cancer, we witness the transformative potential of non-invasive nuclear medicine techniques, offering both diagnostic and targeted therapeutic solutions. Thus, this report accentuates the early prediction of response to 177Lu-PSMA therapy with 68Ga-PSMA or the new class of 18F-rhPSMA-7.3 PET/CT. Additionally, interim data on the utility of 18F-­PSMA-­1007 as a surrogate marker for 177Lu-PSMA imaging and treatment ­effectiveness are summarized.

Furthermore, this special issue encompasses the encouraging advances in PSMA-based therapy in metastatic castration resistant prostate cancer, ­including insights from the phase III ­ProstACT GLOBAL study, findings from the phase II IRST-185.03, an overview of the prospective national Swiss registry assessing 177Lu-PSMA for imaging and therapy, as well as a compilation of ­results from different combinations of 225Ac-TAT/177Lu-PSMA-I&T.

Finally, the section regarding ­further benefits of PET imaging in prostate cancer covers results from the ­VISION and the LuTectomy trial, while further discussing the implementation of PSMA-PET imaging after prostate cancer salvage radiotherapy in recurrent or persistent prostate cancer ­patients after surgery.

Once again, the EANM congress was not only a platform for exchanging groundbreaking scientific insights but also continued to bolster our growth as a specialist community. With the data presented, it is needless to say that the present of nuclear medicine is bright, and that the future holds even greater promise.

I hope you enjoy reading this ­special issue!

More posts

What is new in SCLC?

A novel approach for targeting lung tumors with small-cell histology consists in the inhibition of transactivated transcription, as small-cell lung cancer (SCLC) has been found to be a transcription-addicted malignancy. Rudin et al. defined four molecular SCLC subtypes according to their differential expression of four key transcription regulators.

Interview: Antibody-drug conjugates: the age of almost unlimited possibilities has just begun

Antibody-drug conjugates have opened up an entirely new paradigm. Targeted therapy requires specific mutations, and immunotherapy only works if the tumor expresses neoantigens or is essentially able to respond to these agents. As we know, these two approaches do not work forever, not every patient responds to them, and certainly not every patient has a targetable mutation.

Specific treatment approaches in the EGFR-mutated setting

EGFR exon 20 insertion mutations are found in approximately 5 % to 12 % of EGFR-mutated NSCLC tumors, i.e., in 2 % of all NSCLC cases. They represent the third most common EGFR mutation after L858R and exon 19 deletion. However, EGFR TKIs cannot be used to treat lung cancer with exon 20 insertions as they are insensitive to these drugs due to steric hindrance at the TKI-binding site.

KRAS, HER2 & ALK: targeted options and sequencing issues

The KRAS p.G12C mutation is a key oncogenic driver occurring in approximately 13 % of lung adenocarcinomas and is associated with poor patient outcomes. The first-in-class, highly selective and irreversible KRASG12C inhibitor sotorasib has shown durable clinical benefit in a cohort of 59 heavily pretreated patients with NSCLC included in phase I of the CodeBreaK 100 study.

Pushing the bounds in early-stage lung cancer

Approximately 30 % of patients with non-small-cell lung cancer (NSCLC) present with resectable disease at diagnosis. Surgery with curative intent is the recommended treatment here, followed by adjuvant cisplatin-based chemotherapy in stage II/IIIA and select cases of stage IB disease. However, recurrence rates remain high across disease stages, regardless of postoperative chemotherapy use.