Researchers call to remove barriers to cutting-edge cancer care

Theranostic nuclear medicine has the potential to transform cancer care, but patient access to it is being stalled because health systems struggle to accurately assess its cost-effectiveness, a University of Queensland study has found.

A study funded by the ARC Research Hub for Advanced Manufacture of Targeted Radiopharmaceuticals (AMTAR) and led by health economists Dr Yufan Wang and Professor Haitham Tuffaha set out to review the value for money of theranostic nuclear medicine, which combines diagnostic imaging and targeted radiopharmaceutical therapy in a precise, personalised approach to cancer care.

What’s a theranostic?

An approach often used with radiopharmaceuticals, theranostics have the potential to lead the way with personalised cancer care by combining diagnosis and treatment into a single, targeted approach. A typical approach might see patients first receive a diagnostic imaging agent to determine whether the targeted drug successfully reaches their tumour. Only those who show a positive imaging result go on to receive the therapeutic agent, as the treatment is designed to follow the same biological pathway.

This ensures therapy is directed to the patients most likely to benefit, making cancer treatment more precise, personalised and potentially with less harsh side effects.

AIBN Director Professor Kristofer Thurecht, who serves as the Director of AMTAR, recognises the potential for theranostics to change the landscape of cancer treatment.

“Theranostics have already been shown to be a game changer for cancer treatment, giving unique insight into how, why and when therapeutics might work by combining imaging and therapy into a single, personalised medicine approach,” Professor Thurecht said.

What are the barriers to patient access?

As promising as these new treatments are, patients are unable to easily access them. Lead author Dr Yufan Wang from UQ’s School of Economics says that the cost of manufacturing radiopharmaceuticals creates a significant barrier to accessing this treatment.

“It is expensive considering radionuclide supply, production costs, manufacturing capability, regulatory approvals and workforce capacity,” Dr Wang said.

“Health systems around the world are weighing up whether to fund these treatments, so the critical question is: are they actually worth the cost?”

Professor Haitham Tuffaha who was the lead senior author on the paper said the team analysed 25 economic evaluations of theranostic radiopharmaceuticals in use globally.

“We found conventional healthcare funding models were clearly not well suited to these advanced treatments,” Professor Tuffaha said.

“Almost no economic evaluations assessed the diagnostic and therapeutic components together as a genuine theranostic pair — even though that integration is the whole point of this technology.”

“There were also many inconsistencies in the calculations of cost per year of healthy life gained from theranostics, ranging from USD $21,000 to $400,000.”

“Variations in health outcome measures, costing perspectives and model structures made comparisons almost impossible.”

Enabling patient access with a dedicated reimbursement pathway

Dr Wang said there were real life consequences to a lack of an appropriate funding framework.

“Patient access is affected which can delay or limit access to this treatment,” she said.

“A dedicated reimbursement pathway that recognises the unique value of theranostic nuclear medicine for cancer patients is an urgent clinical necessity.”

“There is a sector-wide effort calling for action.”

“The next stage of our research is to develop a value framework to guide reimbursement decisions.”

AIBN’s biotherapeutics pipeline enables end-to-end translation

AIBN’s capabilities in the discovery and manufacture of radiopharmaceuticals and theranostics are second to none.

Alongside housing AMTAR, AIBN supports UQ’s established pipeline for the translation of biotherapeutics, providing researchers and industry partners with broad capability to advance their concepts into new medicines, therapies or diagnostics.

Professor Thurecht believes the combination of AIBN’s expertise and unique co-located facilities positions the institute to lead the way with next-generation theranostic development.

“We have leading target discovery and production facilities, radiobiology and radiochemistry labs, a cyclotron on site and a suite of imaging equipment to evaluate a potential theranostic, alongside a proven track record of partnering with industry to translate therapeutics.”

“Working in concert with AIBN’s other strengths in personalised medicine, we can enable an entire pipeline of theranostic translation producing real solutions for society.”

“Once we've designed and produced the radiopharmaceutical and theranostic, AIBN’s broader capabilities then enable assessment of function using cell and organoid models, before moving into pre-clinical studies. At UQ, we've got a comprehensive offering of the required tools and expertise that is co-located, and that’s very unique in Australia.”

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Read the systematic review in the Journal of Nuclear Medicine.

The review is a collaboration by researchers from UQ’s Centre for the Business and Economics of Health and Australian Institute for Bioengineering and Nanotechnology.