Medical Isotopes for the 21st Century

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Medical Isotopes for the 21st Century

• Presented by
• G. L. Troyer
• Chair Citizens for Medical Isotopes
• www.medicalisotopes.org

RainbowPush Coalition Annual Conference
2008 SESSION I - CLOSING THE HEALTH GAP THE
CIVIL RIGHT TO HEALTHCARE
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Background

• Medical Isotopes are
• Small quantities of radioactive materials
• Essential to modern medical diagnostic methods
  for organ function and cancer
• Originated from
• X-ray imaging
• 1977 Nobel laureate Dr. Rosalyn Yalow
• Spin off of nuclear science research

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Todays Medical Isotope Therapy Strategies

• Only a few protocols are accepted as first
  choices, examples
• Non-Hodgkins lymphoma (95 effective)
• Prostate cancer radioactive seeds
• Otherwise, used in salvage situations
• All other slash, burn, and poison methods have
  failed
• A relapse has occurred.

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Senator Ted Kennedy

• Brain tumor (malignant glioma)
• Considered low cure cancer type
• Treatment (Duke University)
• Tumor reduction (surgery) followed by
• Chemotherapy
• External beam radiation
• Duke University research
• Medical isotope Astatine-211 targeted for gliomas
• Five times or more cell-killing efficiency than
  external beam radiation or beta-particle injection

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Astatine-211

• Rare
• Available in only three (3) US locations
• Short lived
• 7 hours, must be generated close to patient
• Radiation type
• Alpha, affects only target and neighbor cells
• In clinical research
• Unavailable except in salvage protocols
• 18 glioma patients treated to date

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Cancer Cost
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Supply Side

• Over 90 imported from outside US
• Dec. 2007 sudden lack of Technetium-99m
• Canadian plant had unexpected prolonged closure
• Replacement reactors doubtful
• Shutdown of existing expected 2011
• Demand for medical radioisotopes growing
• 8-20 per year
• US production resources not adequate to meet
  anticipated needs

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NAS Finding Loss of Federal Commitment for
Nuclear Medicine Research.
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Primary Sources

• Majority from Canada
• Chalk River - Expected shutdown 2011
• Maple Reactor - Replacement cancelled 2008
• US Federal
• Aging reactors, require pre-payment
• Higher priority schedules
• US Commercial
• Protocols in development chain
• Sources await approval, results in delays

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Managing Cancer Care CostsPET Scans
Impact of Positron Emission Tomography (PET)
Initial Results from the National Oncologic PET
Registry. Bruce Hillner, Barry A. Siegel, Dawei
Liu, Anthony F. Shields, Ilana F. Gareen, Lucy
Hanna, Sharon Hartson Stine, and R. Edward
Coleman (2008)
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New Applications

• RIT continuing development
• Molecular science determining targets
• Desired isotopes in low supply
• Short lived alpha emitters
• Branching to diseases other than cancer
• HIV/AIDS (Albert Einstein College of Medicine)
• Malaria (IAEA tracer/sterile insect)
• New resources
• Small footprint accelerators
• Modular or retooled reactors

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Compact Systems for Isotope Production

• Linear accelerators proton, alpha particle
• Electron-beam high-energy gamma source
• Plasma purifier for rare stable isotopes
• Neutron generator

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Compact Systems for Isotope Production

• Linear accelerators proton, alpha particle
• Electron-beam high-energy gamma source
• Plasma purifier for rare stable isotopes
• Neutron generator

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Recommendations

• Medical isotopes are a powerful augmentation in
  fighting dread diseases
• US needs to recognize advantages and return to
  supporting development
• Enable continuing development of compact
  accelerators
• Remove blocking language in research funding
• Enable education across nuclear and medical
  science fields
• Improve approval pathways and reimbursement rules