Theranostics in Developing Countries: Addressing Challenges and Potentials from Training to Practice.

Abstract

In recent times, nuclear medicine (NM) has witnessed noteworthy expansion, presenting several technologies and procedures that aid in the identification and management of various illnesses and disorders. The current era of globalization has posed difficulties for health care systems in managing the escalating incidence of noncommunicable diseases (NCDs) in developing countries.1 The use of radionuclide pairs for both diagnosis and treatment, known as theranostics, has become increasingly popular in developing countries.2 This is due to the availability of more resources, expertise, and personnel. Although the idea of combining therapyand diagnosis has been studied and utilized formany years, recent advancements in cancer genomics and hallmarks have led to significant progress in the field of theranostics over the past two decades. Nowadays, NM theranostics are improving the prognosis of cancer patients through the use of lutetium-based radionuclide therapies, whichhavebeenvalidated in phase III clinical trialswith high confidence.3,4 To date, many Southeast Asian, Middle Eastern, and Latin American countries have continuously offered advanced NM services.5–7 Some of these countries serve as exemplary models in the developing world, as they leverage their limited resources to generate numerous radionuclides, conduct practical research projects, and significantly contribute to the progress of theranostics. Additionally, they have augmented the size of their NM workforce by offering specialized NM training programs as well as fellowship programs. Although theranostics has made substantial strides and improvements, a discernible discrepancy persists among developing countries. This disparity is particularly noticeable in theMiddle East, where numerous countries are embroiled inwars and conflicts.8 These developing countries are currently encountering difficulties keeping up with the latest advancements in theranostics. Presently, there are over 2,000 NM centers in the region.9 Several countries in the region have made investments in establishing production facilities. This investment has contributed to a noticeable increase in the local supply of essential radiopharmaceuticals. It is noteworthy that several centers of excellence in NM are currently involved in providing early experience with innovative theranostic agents, despite several limitations. This has been made possible due to flexible national and institutional regulations that have facilitated the early adoption ofmany novel theranostic pairs. A notable example of this was the recent publication of the first-inhuman single photon emission computed tomography /computed tomography of terbium-prostate-specific membrane antigen (PSMA) in metastatic castration-resistant prostate cancer by the King Hussein Cancer Center team.10,11 In many developing countries, NM specialists are often perceived by other specialties as diagnostic physicians. This perception remains prominent in regions where the infrastructure for training, education, and fellowship programs in theranostic practice is insufficient. Consequently, it is imperative to impart extensive guidance on the significance of theranostic practice through education, training, and accreditation.12 To be eligible for theranostic applications, physicians who have been board-certified must undergo specialized training and accumulate significant practical experience while conforming to the specific curricula of their respective countries to attain authorization as theranosticians. Several advanced countries are currently implementing licensing programs to facilitate the transition of NM practitioners into theranostic practice. Developing countries such as the Philippines and Jordan are also adopting this same approach by creating fellowship and accreditation programs. The International Atomic Energy Agency (IAEA) held a consultation meeting to establish a consistent curriculum for theranostics programs that can be implemented in both developed and developing countries. The sharing of research and knowledge in multicentric settings may be a