Introducing Abby Kim, PharmD, BCOP

Abby Kim, a Board-Certified Oncology Pharmacist (BCOP), is a key member of Prime Therapeutics' Specialty Clinical Strategy and Innovation team. With a robust background in clinical practice and leadership at academic medical centers, Abby has worked extensively with both pediatric and adult oncology patients. Her dedication to oncology thought leadership and her drive for innovation and excellence are evident in her work. 

In this edition of Oncology Insights, Abby explores radiopharmaceuticals. 

The use of internal radiation therapy via administration of radiopharmaceuticals is beginning to disrupt the oncology armamentarium as discovery and use is gaining momentum.¹˒²˒³ 

Radiopharmaceuticals are drugs containing a radioactive isotope, which is an element that emits radiation during its decay. They are categorized as diagnostic, therapeutic or both.³˒⁴ Diagnostic radiopharmaceuticals have historically been more prevalent and widely used for cancer detection, staging and monitoring. However, the use of therapeutic radiopharmaceuticals is growing due to interest in their targeted mechanism of delivery, advances in technology resulting in more effective and safer agents and clinical success.³ Some radiopharmaceuticals are designed similar to antibody drug conjugates such as fam-trastuzumab deruxtecan (Enhertu) and sacituzumab govitecan (Trodelvy), in that they also contain a linker and targeting molecule to help take the radioactive isotope directly to the cancer cells.⁵

In 1951, the approval of sodium iodide I-131 marked the beginning of the successful use of therapeutic radiopharmaceuticals for diagnosis and treatment of thyroid cancer. It took another 50 years to see additional approvals that have been met with variable success due to efficacy as well as competition from other drugs entering the market at the same time.²  Lutetium Lu 177 dotatate (Lutathera) was approved in 2018 for gastroenteropancreatic neuroendocrine tumors (GEP-NETs) demonstrating improved progression free survival when combined with octreotide vs. octreotide alone (22.8 months vs. 8.5 months), marking a significant advancement in the treatment of this uncommon and difficult to treat tumor.⁶ Pluvicto + best standard of care (BSOC), approved in 2022 for PSMA-positive metastatic castration-resistant prostate cancer, also demonstrated statistically significant improvements in median overall survival (15.3 months vs. 11.3 months) and radiographic progression free survival (8.7 months vs. 3.4 months) when compared to BSOC.⁷ 

The success of these agents has garnered interest in continued research and development. It is believed that any tumor with a targetable molecule on the surface of its cells and a blood supply sufficient to deliver drugs could potentially be treated with a radiopharmaceutical.¹˒⁵ With a number of agents in clinical use, many in late-phase clinical trials and research in a range of cancers such as melanoma, lung cancer, colorectal cancer and leukemia some key opinion leaders believe that we may have a full cabinet of radiopharmaceutical options in the coming years.²˒⁸