With the presentation of the Nuclear Medicine Development Roadmap, a year-long quartermaster programme was completed. Marieke van Dok, programme director Medical Isotopes at the Ministry of Health, Welfare and Sport looks back and ahead. ‘I see many opportunities for this field, but there is still work to be done to actually get promising developments to patients. For that, this Roadmap is an important first step.’

‘When VWS was given responsibility for building the new PALLAS reactor in Petten, we immediately said that we wanted more than an isolated construction project,’ says Van Dok. ‘We see a strong cluster in the Netherlands around the production and application of isotopes. From our policy objective, we asked the question: how do we ensure that Dutch patients actually benefit from this? Because good research and nice publications do not automatically result in good diagnostics and treatments that benefit patients’.
Against this background, VWS last year appointed Nijmegen professor of nuclear medicine Prof Wim Oyen as quartermaster to identify the possibilities and bottlenecks. This presented the Nuclear Medicine Development Roadmap on Monday 21 October during the EANM 2024 congress in Hamburg. Among other things, it calls for a national coordination platform in which parties within nuclear medicine (practitioners, researchers and industry) inform each other and act together. FAST wants to realise this in the form of a collaboration hub. Van Dok: ‘Collaboration and coordination are essential to achieve results that benefit patients. That may sound a bit like an open door, but it is very important that it actually happens, especially now that fewer research grants are available.’

Oncology
Nuclear medicine is undergoing interesting developments, especially in oncology. For example, treatment with 177 Lutetium-PSMA offers men with metastatic prostate cancer hope for longer survival, and carrier molecules are also being developed for other cancers that deliver radioactive isotopes specifically to the cancer cell. Van Dok expects that some of these therapies can also be used earlier in the treatment pathway, allowing patients to remain socially and economically active for longer.
‘One of the attractions of nuclear medicine in oncology is that there is a direct link between diagnostic and therapeutic applications, because the same molecules can be used with different isotopes,’ says Van Dok. ‘You can see immediately in the diagnostic pathway whether the tumour becomes visible and therefore the therapeutic variant can work in this patient. From a cost-effectiveness point of view, this is very valuable.’ Nuclear diagnostics, she says, also offers opportunities to increase the cost-effectiveness of treatments with expensive drugs more broadly, by showing at an earlier stage whether a drug works or not.

Looking outwards
The Netherlands already occupies a strong position within international nuclear medicine research, but there is still room for improvement, according to Van Dok: ‘Many research groups are focused on their own field of nuclear medicine and on their own project. But even when you ask what the PALLAS reactor can do to strengthen the research field, they often don’t have a clear answer. That is why I welcome this Roadmap and the establishment of the FAST hub, so that more direction can be given collectively.’
Van Dok also sees opportunities for more collaboration between nuclear medicine and other disciplines, especially around diagnostics and drug development. ‘The diagnostic applications of nuclear medicine can also provide opportunities for non-nuclear drug development, for example, by allowing you to visualise receptor binding. Having a better understanding of what is going on in broader drug research helps enormously. Wim Oyens has therefore spent the past year making connections just wider within the broader Life Science and Health sector. But this is also happening, for example, in the FORESIGHT initiative to promote drug development.’ FORESIGHT was intended for the fourth round of the National Growth Fund (NGF), as was the DECISIVE initiative aimed directly at nuclear medicine. Although these consortia missed out on NGF funding because that fourth round was scrapped, the collaborations that grew thanks to the application are still valuable. Van Dok: ‘Especially now that fewer research funds are available, it is extra important to act together, also to acquire European grants, for example.’

Horizontal themes
Van Dok identifies four horizontal themes that apply to almost all development paths within nuclear medicine: intellectual property (IP), funding, data and communication. In her opinion, more can be achieved on these four themes through better coordination and mutual agreements, for example around valorisation: ‘For the technology transfer offices, the TTOs, nuclear medicine is only a fraction of their work, but it does involve very specific pathways. From the point of view of socially responsible licensing, you can achieve more there with coordination. If you get your IP and your data right, you really have something to offer a partner in industry. Then, for instance, in this public-private partnership you could also include indications that are not directly interesting for a pharmaceutical company and thus mean something for patients with a rare condition. In principle, I see all kinds of possibilities there, especially with the expertise FAST has around rare diseases.

Funding is a concern due to the elimination of the Growth Fund and other government cuts. ‘But money can still be found, for example from parties such as KWF Kankerbestrijding and European funds – and by seeking collaboration with private parties.’ Data is crucial to bring products to the clinic and to the market, but then it is important that the data is collected in the right way, for example according to the principles of Good Clinical Practice. And communication is needed, for example, to find the right partners, including outside the nuclear field, to work out new products, services and concepts together. ‘By working together on these four themes, nuclear medicine in the Netherlands can work out its current strong position. When soon the PALLAS reactor will be operational, I hope we can work towards a situation where nuclear medicine plays a bigger role than it does now in diagnostics and treatment.’

‘Where I want us to be in 10 years’ time? That nuclear medicine treatment for some conditions is no longer a last option but can be discussed with the patient much earlier in the pathway. And that we will have advanced at least one drug here to phase three. I hope the new FAST hub can help the nuclear field on its way to making that happen.’