Exploring Novel Treatment Developments in Radiation Oncology

Although 2 theranostics medicines are FDA-approved for prostate and neuroendocrine tumors, the growing utility of these therapies may expand as more patients are eligible for these treatments, according to Brandon Mancini, MD, MBA, FACRO.

CancerNetwork® spoke with Mancini, medical director at Bold Advanced Medical Future (BAMF) Health and clinical associate professor of medicine at the Michigan State University College of Human Medicine, about developments in radiation oncology treatment or research he believed had the potential to transform clinical practice, contextualized by his recent attendance of the 2025 American College of Radiation Oncology (ACRO) Summit.

Mancini began by highlighting the ability of radiation oncology practice to continually hone the specificity of therapy and exhibit safe use. He then identified 2 techniques that expressed this trend: MRI-guided radiation therapy as unique due to its favorable adverse effect profile and adaptive radiation therapies, which include continually changing therapy based on transient factors of an individual undergoing treatment.

Furthermore, he expressed excitement for the field of theranostics, which he believes has the potential to expand into further indications beyond the 2 current FDA approvals in prostate and neuroendocrine tumors, respectively.1,2 He then remarked that continual interest in radiopharmaceuticals in radiation oncology was exciting.

Mancini concluded by touching upon ACRO’s incorporation of benign disease states into the meeting, particularly regarding the presentation of available existing data and then how to implement strategies for treating them into clinical practice.

Transcript:

From a transformation perspective of clinical practice, the ability to continue to hone our practice from the specificity of therapy and safety is incredible. There are a number of techniques that are at different stages of development, but MRI-guided radiation therapy is something unique and has been shown to have an improved [adverse] effect profile so far in prostate cancer and other disease sites. Another exciting development is adaptive radiation therapy, which was also a part of ACRO as well, which is changing the plan or [treatment delivery method], potentially on a daily basis for an individual, based on changing tumor size, anatomy, and different factors. With that same precedent, that same ability, where you are trying to target what is there and minimize what is normal tissue, etc, to improve that therapeutic ratio is critical.

[Another aspect that is] exciting is the field of theranostics––theranostics being targeted radiation medicines that are injected peripherally as a systemic therapy. There are 2 FDA-approved products in prostate cancer and neuroendocrine tumors, but the utility of those therapies is going to continue to expand with a large number of patients going to be eligible for those treatments in the near future. Because radiopharmaceutical treatments are something that our field has historically participated extensively in, energizing individuals to continue to have an interest in that field and play a part is exciting.

[There are] unique approaches to other problems to enable the high usefulness of our technology software planning to create meaningful contributions to oncologic patient care, where maybe that was not considered in the past, is something that was exciting. Another buzzword or phrase within radiation oncology is the treatment of benign diseases like osteoarthritis. There has been a lot of excitement in the field on that specifically. ACRO did a great job of incorporating that into this meeting, having a dedicated session on the data that exists, and then how to implement that in clinical practice immediately.

References

1. FDA approves first PSMA-targeted PET imaging drug for men with prostate cancer. News release. FDA. December 1, 2020. Accessed March 25, 2025. https://tinyurl.com/37tadvwj
2. FDA approves Pluvicto for metastatic castration-resistant prostate cancer. News release. FDA. March 23, 2022. Accessed March 25, 2025. https://tinyurl.com/ypshufms