The RLT Academy project aims to promote education of radioligand therapies in Europe and bridge the educational gap among healthcare professionals.
Radioligand therapy (RLT) is an innovative approach to cancer treatment that delivers radiation directly to tumour cells (with the help of radioisotopes), regardless of where they are inside the body, while minimising the damage to all the healthy tissue that surrounds the tumour cells.
It is a major milestone development in cancer therapy that utilises effective tumour-targeting with therapeutic radioisotopes, with minimised impact to healthy tissues. It currently treats neuroendocrine tumours and prostate cancer, but it has many promising future indications.
One of the greatest strengths of RLT is the concept of theranostics which effectively combines diagnosis and treatment within the same therapy by using the same vector to localize the disease by PET-scan (diagnosis) and then hit the tumour with radiation capable of breaking the DNA of the target tumour cell (treatment). Despite its great promise, this treatment option is a long way from being a mainstream cancer therapy in Europe. One of the main reasons is the lack of knowledge among healthcare professionals on the use and nuances of RLTs. Although RLTs fall under the nuclear medicine subfield, many nuclear medicine specialists in Europe still don’t possess a working knowledge of RLTs, because nuclear medicine has been traditionally focused on diagnostics rather than therapeutics. Making this knowledge gap worse in practice, effective therapy delivery for RLTs requires a strong multidisciplinary approach (i.e. the cooperation between nuclear medicine specialists, oncologists, radiologists, nurses etc.) which is often a challenging task for medical professionals to facilitate. RLTs will become increasingly prevalent and available in the next few years, as such, there is an urgent need to prepare European healthcare professionals for their arrival. Because RLT is a method that can be used for the treatment of different tumour entities, which will certainly increase further in the coming years, an adaptive in-depth training in several areas like molecular imaging, RLT planning, RLT dosimetry and radiation protection is needed. Cancer patients will only be able to access this innovative treatment if the various medical specialists all have a tailored working knowledge on the use of RLTs.
The RLT Academy has started as an Erasmus+ project and will now be continued under ESMIT.
The RLT Academy is divided into two courses: the Basic Course and the Advanced Course.
Both courses can be found online on the ESMIT eLearning platform and can be followed at your own pace.
After the open registration, RLT Academy users have the opportunity to take 3 online courses corresponding to their level of knowledge and apply for 2 of our fellowship programmes.
As part of our online courses, registered RLT Academy users have access to more than 31 hours of lecture video and 40+ downloadable course material documents.
The lecture videos form the backbone of the course curriculum and are available without any restriction for registered users.
After completing a course, you will have the opportunity to take an online exam.
Successful candidates will receive an official, downloadable certificate of completion and the opportunity to take our advanced courses and fellowships.
How to register:
The basic course includes five separate online modules introducing those attending to the field of nuclear medicine and theranostics.
The Basic course of the RLT Academy aims to give an introduction into Radioligand Therapy and will provide insights into topics such as Radioprotection, Radiopharmacy, Radiobiology and Organization. The basic course will provide both on demand course material with multiple-choice questions to test the knowledge gained.
Key Topics are:
Once enrolled in a course, you can stop at any time and return to the course at any time. The system saves where you have been and which lessons you have already completed.
The exam
Certificate
After completing the course, you can take an online exam, which, if successfully completed (minimum 80%), will result in a downloadable ESMIT certificate of successful completion, which will be uniquely identified.
Course Content:
Introduction
Introduction (A1)
Radioprotection
Radionuclides (B2)
Waste management during nuclear medicine therapy (B3)
Patient Radioprotection (B4)
Emerging Issues with new Radionuclides (B6)
Radiopharmacy
EU Legislation (C1)
Lab & equipments (C2)
Targeting in RLTs (C3)
The choice of the radionuclide (C4)
Production and supply (C5)
The choice of the targeted molecule (C6)
Overview on the current radiopharmaceuticals (C7)
Current registered radiopharmaceuticals (C8)
Radiopharmaceuticals in the research setting (C9)
Radiobiology
Introduction to radiobiology and cancer biology for RLT (D1)
Physics: interactions, absorbed dose, absorbed dose rate and LET values (D2)
Targeted effects of Ionizing Radiation (D3)
Conventional Radiobiological models (D4)
Principles of Radioligand therapy (D5)
Radiobiological models for RLT (D6)
Bystander cytotoxic and genotoxic effects (D7)
Bystander immunity (D8)
Short term and long term effects (D9)
Dosimetry and microdosimetry (D10)
Combination regimens: rationale (D11)
Radiobiological Properties affecting the Choice of Radionuclide (D12)
Cases (D13)
Organization
Role of Physicists (E1)
Role of Chemist/Radiopharmacists (E2)
Role of Nurses (E3)
Role of Technologists (E4)
The role of hybrid imaging in patient assessment(E5)
Patient Flow in RLTs (E6)
Basic Course Exam
The advanced course aims to deepen the knowledge and expertise of radioligand therapy, gained in the basic course. It features topics such as Dosimetry, Thyroid, NET, Bone, Prostate & Urinary Cancer and Special Topics which include lectures such as Setting up an IMPD, Phase I clinical trial using radiopharmaceuticals, Informed Consent (standard of care and clinical trial) as well as a short MIBG overview.
In some topics, cases are presented to further deepen the content.
The content will be valuable for nuclear medicine physicians who has not yet experiences Radioligand Therapy, as well as for a referring clinician to better understand indications, the treatment schedule, potential side-effects and proper management of concomitant treatments.
Key Topics are:
Once enrolled in a course, you can stop at any time and return to the course at any time. The system saves where you have been and which lessons you have already completed.
The exam
Certificate
After completing the course, you can take an online exam, which, if successfully completed (minimum 80%), will result in a downloadable ESMIT certificate of successful completion, which will be uniquely identified.
Course Content
Dosimetry
What is dosimetry & why should we do it? ( F1)
MIRD (F2)
3 S Values (F3)
TIA (F4)
Non-imaging (gamma counters, probes, HPGe, dose rate meter) (F5)
Gamma camera (quantitative SPECT – calibration) (F6)
Gamma camera (quantitative SPECT – segmentation) (F7)
Thyroid dosimetry (F8)
MIBG Dosimetry (F9)
Lu-177 SPECT dosimetry (potentially hybrid) (F10)
Thyroid
Overview of the disease (G1)
Pathology (G2)
Patient Selection (G7)
Treatment management (G8)
Patient Monitoring (G9)
RLT assessment (G10)
Combination Treatment (G12)
Overall: Summary of clinical results, Guideline and research perspective (G13)
Impact of molecular thyroid scintigraphy in the clinical management of thyroid nodules with indeterminate cytology (G17)
NET
Overview of the disease (H1)
Pathology (H2)
Diagnosis and Staging and Prognostication (H3)
RLT when, why, how (H5)
Schedule and Regimens and Dose Adjustment (H6)
Patient Selection (H7)
Patient Monitoring (H9)
RLT assessment (H10)
Special Dosimetric Issues & Special Population (H11)
Overall: Summary of clinical results, Guideline and research perspective (H13)
Overview of the disease (I1)
Bone
Overview of the current treatment (I3)
Targets for Bone Pain palliation (I4)
RLT when, why, how (I5)
Schedule and Regimens and Dose Adjustment (I6)
Patient Selection (I7)
Treatment management (I8)
Patient Monitoring (I9)
RLT assessment (I10)
Combination Treatment (I11)
Overall: Summary of clinical results, Guideline and research perspective (I12)
Overview of the disease (J1)
Prostate & Urinary Cancers
Pathology (J2)
Diagnosis and Staging Prognostication (J3)
Overview of the current treatment (J4)
RLT when, why, how (J5)
Hormone-sensitive prostate cancer (J7)
CRPC (J8)
Patient Selection (J9)
Treatment management (J10)
RLT assessment (J12)
Special Dosimetric Issues & Special Population (J13)
Combination Treatment (J14)
Overall: Summary of clinical results, Guideline and research perspective (J15)
Kidney Cancer (J16)
Setting up an IMPD (L3)
Special Topics
Phase I clinical trial using radiopharmaceuticals (L4)
MIBG Overview (L8)
Advanced Course Exam
A systematic survey has been performed to assess the existing gaps in Europe in multidisciplinary education for integration of radioligand therapy (RLT) into cancer care and to obtain detailed information on the current limitations and key contents relevant. A high-quality questionnaire, with emphasis on survey scales, formulation, and validity of the different items, was designed. An expert validation process was undertaken. The survey was circulated among medical specialties involved in cancer treatment, universities, and nursing organizations. For more information, have a look at the publication on Radioligand therapies in cancer: mapping the educational landscape in Europe.
Map the knowledge gap in RLTs
The project elevates the understanding of the current RLT education landscape and delivers a state-of-the-art research on this topic.
Bridge the knowledge gap that currently exists among healthcare professionals
We have created a structured, transnational, and multidisciplinary education programme on the use of RLTs for interested healthcare professionals. Our training programme is delivered in an online format. The training programme fills the current knowledge gap on RLTs and strengthens the multidisciplinary cooperation between oncologists, nuclear medicine specialists and other relevant professionals.
Promote the integration of RLTs into mainstream cancer care
Through its innovative approach, RLT has the potential to create a true paradigm shift and become the new pillar of cancer care. Adaption of this treatment will transform patient outcomes and contribute to a more successful EU-level effort at combatting cancer, but only if it is properly adapted into mainstream cancer care. This cannot be done without first laying the foundations through proper education and training a new generation of healthcare professionals who can integrate RLTs in their ongoing practices.
Through these efforts, the project contributes to the European Commission’s initiatives to improve European cancer care. This goal is clearly outlined in the Commission’s Beating Cancer Plan, as well as its SAMIRA Action Plan that specifically identified the programme as a tool to promote capacity building and training in nuclear medicine and strengthen the fight against cancer in Europe. The project advises policymakers on addressing the complex barriers RLTs face in Europe through a set of policy recommendations. Ultimately, the consortium of the RLT Academy hopes to improve European cancer care so that patients may access this promising treatment option regardless their place of living.
Downloadable documents:
RLT Academy Policy Recommendations onepager (PDF)
RLT_Academy_Policy recommendations (PDF)
RLT_Academy_Policy_Recommendations (PPT)
RLT Policy Recommendations – Irish College, KU Leuven, Leuven, Belgium – 16 July 2024
……………………………………………………………………………………………
Prioritising scientific innovation and development
RECOMMENDATION 1
To drive innovation in Radioligand Therapies (RLTs), it is essential to secure private and public funding for academic and pre-clinical research to bridge the current gap between research and clinical practice, facilitating the translation of new therapies into cancer care.
At the same time, initiatives such as the Innovative Health Initiative (IHI) can support building public-private partnerships on RLTs, potentially through targeted topic funding.
RECOMMENDATION 2
To accelerate development in targeted cancer treatments, researchers must be provided with the necessary resources. Sustained financial support is essential to expand esearch into new medical isotopes.
This should involve targeted and ongoing funding from the EU’s Cancer Mission and the EU Research and Innovation Framework Programmes (i.e. Horizon).
RECOMMENDATION 3
To ensure scientific advancement in integrating RLTs into cancer care it is urgent to financially reinforce and incentivise the reliable supply of radioactive isotopes and ligands.
A robust and dynamic EU infrastructure which guarantees the availability of research materials can enable faster development of new therapeutic applications of RLTs.
RECOMMENDATION 4
By supporting the creation of personalised and innovative patient pathways, RLTs can be better integrated into enhancing accessibility and treatment options for cancer patients from an early stage to follow-up care. In this sense, increasing the number of accredited RLTs centres is necessary to ensure that patients receive the most effective and safe available treatment.
Prioritising scientific innovation and development
RECOMMENDATION 5
Recognising the clinical interest and potential benefits of RLTs is critical. To do so, educating and training healthcare professionals on RLTs to further expand this novel therapy across the European Union (EU) should be a main policy priority as it ensures that the European workforce is at the forefront of cancer care innovation.
RLT workforce should be considered and included in any future comprehensive approach to the healthcare workforce developed by the European Commission.
RECOMMENDATION 6
Cancer is a disease with multiple variations, stages, and prognoses.
Shaping educational programs to include comprehensive RLT training for healthcare providers can boost the integration of RLTs into the national healthcare systems, improving patient outcomes and quality of life.
RECOMMENDATION 7
Strengthen implementation science in the field of RLTs. Real-world evidence can provide valuable feedback loops to various elements of healthcare systems as it can support the refinement of practices and guidelines based on the latest scientific data. This process serves in assessing the opportunities and needs of each cancer patient, including their treatment with RLTs.
At the same time, real-world monitoring systems should be considered to better understand the European workforce landscape active on RLTs and to assist with training and planning.
RECOMMENDATION 8
The development and dissemination of both written and online guidelines to ensure the highest level of quality in the implementation of RLTs for healthcare professionals is critical.
Certified accreditation system should be placed to standardise and measure the level of expertise of healthcare providers specialised in RLTs.
Integrating RLTs across policies
RECOMMENDATION 9
The current European legal frameworks that govern RLTs are fragmented across different texts and levels. This impacts all sectors – as the frameworks do not adequately reflect the realities in the healthcare setting.
Misalignment and unclarity in the EU legislation ultimately delay patients’ access to RLTs. As such, ensuring that national and European regulations are harmonised, and standardisation is promoted across regions is critical.
Additionally, to bring promising therapies, such as RLTs, regulatory bodies should faster assess medicines and expedite approvals.
As RLTs demand will grow exponentially in the upcoming decade, RLTs must be integrated into National Cancer Plans to offer patients the best therapy available.
RLTs should be recognised as a key component in each of the Member States’ cancer plans, emphasising the importance of comprehensive cancer care strategies.
The running implementation of Europe’s Beating Cancer Plan should also reflect on the availability and use of RLTs across Europe. Increased RLTs availability should be addressed through the EU Critical Medicines List and the Joint Clinical Assessments from the Health Assessment Regulation, in which RLTs should benefit from specific workstreams for Radiopharmaceuticals.
RECOMMENDATION 10
To ensure the financial feasibility of RLTs for patients and healthcare providers and with the aim of their full integration into national healthcare systems, reimbursement-independent bodies specifically responsible for radiopharmaceuticals must be created.
RECOMMENDATION 11
To advance and ensure the integration of innovative therapies such as RLTs within the healthcare community, it is
indispensable to disseminate innovative cancer research findings and treatment methodologies for new therapies.
To do so, targeted educational initiatives, interdisciplinary collaborations, and the utilisation of digital platforms, such as the European Health Data Space (EHDS), are key to ensuring widespread awareness and adoption of RLTs across healthcare policies.
Policy and Health Economics:
Prostate:
177Lu-PSMA Radioligand Therapy for Prostate Cancer
NET:
Other Tumour Types:
General:
Radiotheranostics – Precision Medicine in Nuclear Medicine and Molecular Imaging
Radiopharmaceutical therapy in cancer: clinical advances and challenges
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