Real breakthrough: radionuclides against deadly cancer

“Own stem cells will hunt for cancer”

– Undoubtedly, science does not stand still, including in the choice of means to combat malignant neoplasms, – said Andrey Dmitrievich. It is no coincidence that the last few Nobel Prizes have been awarded for work in the field of genetic research, which has given the world such tools as, for example, genetic “scissors” – a way to remove a damaged gene. Undoubtedly, this has a very great prospect of being used in the fight against the main enemy of our time – cancer.

Almost on the eve of World Cancer Day, coincidentally, at the Medical Radiological Research Center. A.F. Tsyba (a branch of the Federal State Budgetary Institution National Medical Research Center of Radiology in Obninsk), a unique for Russia research and production complex of cell technologies that meets international GMP standards has opened. Without exaggeration, this is a real technological breakthrough and new opportunities for the diagnosis and treatment of malignant neoplasms.

— What is the uniqueness of the new method of treatment? Explain for the uninitiated…

– New tissue and cellular methods of treatment are based on the principle of growing an “antidote” for malignant tumors from the cells of the patient himself, to put it simply. In fact, it is like a vaccine that uses the antigenic material of the disease and human immunity. With the help of this method, we will be able, for example, to abandon a very difficult for the patient, but effective and now common method of treating hemoblastoses (tumors of the hematopoietic and lymphatic tissue) – bone marrow transplantation. Now oncologists in their medical practice will be able to move in such promising areas as regenerative medicine, tissue engineering and many others.

In the future, it is planned to apply here, among other things, CAR T-technologies. In fact, it is a type of cancer immunotherapy. This is a completely new direction in the treatment of cancer patients. It will allow the patient’s own immune cells to be reprogrammed outside of the patient’s body to create new cells capable of hunting for tumors and effectively destroying them.

In addition to surgical, radio-beam methods of treatment and chemotherapy, cellular technologies are being added today, which allow closing the full cycle.

“Thank you to sanctions”: forced Russia to return to creating its own drugs

– Andrey Dmitrievich, growing an “antidote” for malignant tumors is still a matter of the future. And what else can save patients, especially those with metastases?

“Nuclear medicine remains a very relevant area today. Back in the 80s of the last century, we were close to creating our own base for the production of radiopharmaceuticals based on various isotopes. But we were persuaded that it would be better not to produce them ourselves, but to supply raw materials abroad and receive ready-made radiopharmaceutical drugs from there. As a result, these drugs cost several times more. Today, the situation has forced us to return to our own production, “thank you” to the sanctions.

For the first time, state funds have been allocated for the development of a whole range of radionuclides, which will make it possible to bring three unique medical preparations based on rhenium, lutetium and actinium to the market. They are effective in the treatment of metastatic prostate cancer, neuroendocrine tumors, liver tumors and some brain tumors. As you understand, medicines made on the basis of these radionuclides will be much cheaper than imported ones.

By the way, American colleagues have calculated that only the introduction of lutetium-177 to the world market can increase the capitalization of the industry to $26 billion by 2030. There is a serious battle for this market. And we have a colossal advantage, because the lion’s share of raw materials is exported from Russia.

And as for the domestic radionuclide based on rhenium-188, it is also used to treat bone metastases, diseases of the kidneys, liver, breast and prostate gland, and other organs, our expert believes. For its synthesis, scientists of the Physico-Energy Institute. A.I. Leipunsky created a unique compact and mobile tungsten generator – a small cone that can be transported to any corner of the country and produce the necessary radiopharmaceutical based on rhenium-188 within six months. Of course, with the necessary permits. And with it, too, it is necessary to enter the world market.

— Impressive. Andrey Dmitrievich, as you know, in 2022, a group of scientists and doctors of the National Medical Research Center for Radiology received an award from the Government of the Russian Federation in the field of science and technology for the development and use of the method of radioembolization of the liver (minimally invasive treatment) on stream. These operations went on stream? And is it possible to replicate this technique in Russia?

— Yes, today the Department of Radiosurgery performs such operations every day. Work has also been completed on the registration of a “nuclear pharmacy” in Russia, which allows national research centers to engage in the synthesis of new radionuclide preparations.

“Domestic medical equipment is still very, very lacking”

“Everyone understands how important modern equipment is for making a correct diagnosis. Especially in oncology. And we must admit that in recent years the situation has changed for the better. But is everything good in this “kingdom”?

So far, modern PET / CT, which combines positron emission and computed tomography, is in some deficit. It is necessary to clarify diagnoses in complex cases and to control the quality of the prescribed treatment. But in Russia, unfortunately, not a single such device has been produced yet. True, they can be purchased in China. Colleagues from the Middle Kingdom have already succeeded in this – they have produced all the lines of medical equipment of this class: PET / CT, CT, MRI, ultrasound machines.

So far, there are problems with the production of electron accelerators for radiation therapy, which today, along with surgery and chemotherapy, is one of the main methods of fighting cancer. Last year, Rosatom registered the first electron accelerator for radiation therapy – a completely domestic development. The efforts of many Russian scientists and specialists have been invested in its creation. But so far this is only one example. And according to experts, there should be almost 500 such devices throughout our country.

“So there is a beginning. And what needs to be done to keep the process going?

If we already have more or less clear prospects for radiopharmaceuticals, then as far as domestic medical equipment is concerned, it is still very, very lacking.

Of course, this does not mean that everything is so bad. The oncological service of Russia continues to develop. The covid-19 pandemic unwittingly gave a huge impetus to the emergence of not only samples of new domestic drugs and equipment, but also telemedicine technologies. Certain restrictions in the movement of patients prompted us to actively use telemedicine with regional colleagues. Moreover, modern digital equipment allows you to “see” at a distance glass preparations (samples of biomaterial from a tumor) through special scanning programs. In the course of a collective analysis of the situation, doctors of various specialties remotely refine or correct the established diagnoses and treatment regimens.

— And what about the reference centers and outpatient cancer care centers that are life-saving for regional patients? And during the covid pandemic, and even now, not every cancer patient can get not only to doctors in the capital, but even to the regional center.

— Reference centers are open in many national medical research centers. They are especially important in complex cases of diagnostics in the field of pathomorphology, radiation research methods, molecular genetic diagnostics. And new outpatient cancer care centers (CAOPs) have appeared in the regions.

— There is one more piece of news that will please cancer patients: a department of bone marrow transplantation has recently been opened at the National Medical Research Center for Radiology. What will it give to the sick?

“This will help create the Federal Bone Marrow Donor Registry, which will increase the number of potential donors and simplify their search for specific patients.

… By the way, the incidence of cancer and mortality from it in the world are continuously growing: in 2020, 19.3 million new cases and 10 million deaths were registered. Among men, the highest incidence was noted in France (361 per 100 thousand population), and among women – in Brazil (283.4 per 100 thousand population). Many researchers attribute this to the aging of the population. Indeed, most tumors develop in those over 50, and every second cancer patient is over 60 years old. The most lethal for men are lung cancer and prostate cancer. Women are more likely to die from breast, lung, and rectal cancers. According to sociologists, “from 80 to 90% of malignant tumors are formed not for genetic reasons, but due to the influence of external factors.”

In our country, according to statistics, “malignant neoplasms are the second most popular cause of death.” The first is cardiovascular disease.