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Phillip J. Koo: Hi. I'm Phillip Koo, and welcome to UroToday. We have a really special discussion that we're recording today focusing on radiopharmaceuticals in oncology, and specifically prostate cancer. With the introduction and growth of RLT in prostate cancer, there are two major specialties that are obviously authorized to provide these services, and that includes nuclear medicine and radiation oncology. And if we really put the patient at the center of what we do when it comes to clinical care, it becomes very clear that all of the stakeholders need to work collaboratively together.

And to talk about the path forward with regards to this collaboration, we have two amazing leaders who are going to present both sides, both specialties, to walk us through what that might look like. And we have Dr. Neha Vapiwala, who is Professor of Radiation Oncology and Vice chair at the University of Pennsylvania, and also Dean of Admissions at the School of Medicine. She's also the president-elect of ASTRO.

And we also have Dr. Heather Jacene, who is associate professor of Radiology at the Harvard Medical School and the Clinical Director of Nuclear Medicine and PET at the Dana-Farber Cancer Institute. And she is the vice president-elect of the SNMMI. So first off, thank you both for joining us today at UroToday.

Heather Jacene: Thank you, Phil, for initiating this. It's really exciting to be here today.

Neha Vapiwala: Yeah. Thanks so much for this opportunity.

Phillip J. Koo: Great. So let's first start off in talking about your societies and what you're doing with regards to therapeutic radiopharmaceuticals. So Neha, let's start with you and ASTRO.

Neha Vapiwala: Yeah, sure. So again, thanks to everyone for this opportunity to gather with you today and talk about radiopharmaceutical therapies, which ASTRO, I'll just give you quickly an overview. We have a workshop in radiopharmaceuticals that's been part of our annual meeting agenda for many years now, and this will, I'm happy to say, continue this year at our annual meeting in San Francisco, in addition to having a whole radiopharmaceutical therapy track for attendees.

We also have an RPT specialty meeting being planned for February 2026. Mark your calendars. It's going to be in California. I'm really intending for this to be a multidisciplinary gathering, and we're actively putting together the educational session and the topics for this symposium for next year.

We did hold a roundtable meeting in April. This is a meeting that we've been having twice yearly now, bringing together all the stakeholders from industry, from radiation oncology and ASTRO members involved in the RPT space, as well as our collaborators in nuclear medicine. And actually, Dr. Jacene attended the meeting in person this year, really demonstrating our continued commitment to improving collaborative efforts between our specialties.

ASTRO has also published a curriculum paper and a safety white paper on RPT in the rad-onc environment, really, again, focused on improving education and quality and safety efforts in this space. We did produce a nine-part webinar series called Beyond the Beam, and this highlights, again, this idea of going beyond external beam in our specialty, and highlighting RPT, educating our members on the workflows and requirements if one was to establish or if they already have an established program, how to maintain an active RPT program.

Phillip J. Koo: Wonderful. So Heather, tell us more about the SNMMI and their efforts with regards to RPT.

Heather Jacene: Certainly. And I think, as many of you may know, radiopharmaceuticals, both diagnostic and therapeutic, are really the foundation of nuclear medicine. It's what the field has been built on. And since, I think, 1954, SNMMI has been a driving force and leader in this space. But we've really expanded efforts to match this rapid growth that's happening in the field. We are continuing to develop procedure standards and clinical guidelines. These often are in collaboration with colleagues in radiation oncology with international specialty societies.

We established a Radiopharmaceutical Therapy Center of Excellence Program. In addition, we partnered with the Intersocietal Accreditation Commission to launch a formal Radiopharmaceutical Therapy accreditation program. Educational efforts are very widespread. They go from live workshops, which our big annual meeting is coming up next week. So hopefully, many people will be there. And then all the way to weekly offerings like Therapy Thursdays, which the technology section puts together, which gives pearls on practical implementation and what's happening new in the field.

We have an annual, well-attended therapeutics conference, which, Phil, you spearheaded and really were the impetus behind. There's research support that comes through the SNMMI Clinical Trials Network, and now a therapy clinical trial network really geared to help sites participate and get trials up and running. There is also task forces that are focused on dosimetry and AI. And the [Inaudible] now funds novel and innovative research to really help push the field forward.

And then, of course, there's the advocacy domain. We're very involved in, again, trying to help work with government agencies to advance policies for safe, effective, reimbursable RPT, provide education to the public and our professional. So all in a nutshell, I feel like everything that SNMMI is doing contributes to this advancing of theranostics.

Phillip J. Koo: Wonderful. So if we think about diversity, diversity also includes different perspectives and experiences and whatnot. So tell us a little bit about what nuclear medicine can learn from radiation oncology with regards to the practice when it relates to radiopharmaceuticals?

Heather Jacene: So I actually think that the fields of-- even though we've been doing this in nuclear medicine for 50-- a very long time, the field is really expanding into diseases that we haven't treated previously. I think that we're really at a nascent stage where we're really learning about the tumor biology, how the tumors are responding to radiation therapy, and there's a lot of gaps in knowledge that we don't know. And one prime example to me is, how do we pair radiopharmaceutical therapy and external beam radiation therapy to get-- to combine them? Is it safe? When should we do it? When should we not do it?

So I think there are-- while there's overlap in our specialties, there's lots of unique strengths and perspectives. And we can really work together to find what those gaps are and define them, and then work together to bring that knowledge to better patient care. And then I also think beyond these technical things, simply learning how to collaborate, aligning the priorities, sharing insights, and building that foundation to achieve common goals is something that I've learned through attending these different sessions, and that's been really useful too.

Phillip J. Koo: Great. So, Neha, from your perspective as a radiation oncologist, what are some things that you could learn from nuclear medicine?

Neha Vapiwala: Yeah. I mean, as you just heard, I think there's always, for us as radiation oncologists, this foundation that we have in understanding the effects of radiation on tumors and normal tissues. And so we have that deep bench of knowledge there. But at the same time, we look at our nuclear medicine colleagues and are learning so much about-- in the space of workflows, about safety and administration, what nuclear medicine technologists and other members of the care team contribute and how that can be part of the workflow.

So I think there's opportunities there to really think about the processes that have been in place that SNMMI has established and that have been effective, and that if not already happening in radiation oncology clinics, could be a model and serve as a path for moving forward.

So I think, again, this interrelationship in terms of the oncologic care and the broader disease sites that rad-oncs are used to seeing and the different modalities that we're used to treating with is an opportunity for us to contribute, but at the same time, really focus on what SNMMI has done so far and how we might work together to establish new models moving forward And I always say, the fun thing about being in medicine and being a physician is you never stop learning. And I'd love to think that learning from other colleagues in other specialties is a key part of that.

Phillip J. Koo: I agree wholeheartedly. I think we continue to push the envelope further and further, and it just pushes all of us to keep pushing forward for the benefit of all patients. As we bring this to a close, what are some concrete steps or the roadmap to the future from your perspective?

Neha Vapiwala: Yeah. I mean, I think-- look, cancer care, absolutely, by its very nature, requires collaboration across and between specialties, right? And I think this is just a prime example of why that's true. So we think about in most cancer treatments these days are multimodality, and it's often been combination of input from surgeons, radiation and medical oncologists, and of course, our nuclear medicine colleagues are part of that conversation increasingly.

And so I think for patients to receive the most appropriate care, for sequencing of care, for understanding the overlapping adverse effects of our treatments and how we need to be cognizant of the decisions and the recommendations we make with that biology always at the center of our conversations, as much as the technology drives us, I think we always have to come rooted back to the biology.

I think this is where having the combined expertise of delivering radiopharmaceuticals, and also thinking about patients in terms of recurrence, in terms of post-treatment care, survivorship issues, all of this, I think, is just absolutely critical. And this path moving forward, I think, absolutely requires our specialties and our societies to really be thinking in novel ways how we make sure to do that, not just at the level of our societies and at the level of national guidelines and workflows, but at the individual patient level. And how is this manifest in our day to day practices? Making sure that we're talking to each other and working alongside each other.

Phillip J. Koo: Great. Heather.

Heather Jacene: Yeah, I agree with everything you said. And I already think-- we already started taking some of those concrete steps forward. The ASTRO roundtable, I was present. We had Neha at the SNMMI theranostic summit where we were able to get input from all the stakeholders who are treating patients with RPT. And then, this is another example.

At our annual meeting coming up, we have a joint session with ASTRO. At the ASTRO meeting, SNMMI, there's a joint SNMMI/ASTRO session. So I think continuing to keep that dialogue open and really these open, honest exchanges I think will really help come up with those concrete ways to keep moving that field forward. It helps surface the challenges, align the perspectives, build trust. And I think when we do that, we'll be able to really expand RPT and improve care for the patients.

Phillip J. Koo: This is wonderful. I think we could all agree, the end goal is to make sure all patients across America and across the globe have access to high-quality therapeutic radiopharmaceuticals. And it really takes strong leadership to make this a reality. And really, really and grateful that we have both of you leading these great societies to really make this a reality. So appreciate the time, and we look forward to diving into some of these topics at a deeper level as they become more materialized. So thank you both.

Heather Jacene: Thank you, Phil.

Neha Vapiwala: Thanks so much. Happy to be here.