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Nuclear medicine has made enormous progress in the past decades. However, there are still significant inequalities in patient access among different countries, which could be mitigated by a suitable pharmaceutical regulatory framework and associated guidelines. This paper summarizes major considerations for a suitable pharmaceutical regulatory framework to facilitate patient access to radiopharmaceuticals. These include the distinct characteristics of radiopharmaceuticals advocating dedicated regulations, the impact of variable complexity of radiopharmaceutical preparation, personnel requirements, manufacturing practices and quality assurance, regulatory authorities interfaces, communication and training, as well as marketing authorization procedures to ensure availability of radiopharmaceuticals. Finally domestic and regional supply to ensure patient access via alternative regulatory pathways, including in-house production of radiopharmaceuticals, is described and an outlook on regulatory challenges faced by new developments, such as the use of alpha emitters, is provided. All these considerations are an outcome of a dedicated Technical Meeting organized by the IAEA in 2023.

Background: The Editorial Board of EJNMMI Radiopharmacy and Chemistry releases a biannual highlight commentary to update the readership on trends in the field of radiopharmaceutical development. Main Body: This selection of highlights provides commentary on 24 different topics selected by each coauthoring Editorial Board member addressing a variety of aspects ranging from novel radiochemistry to first-in-human application of novel radiopharmaceuticals. Conclusion: Trends in radiochemistry and radiopharmacy are highlighted. Hot topics cover the entire scope of EJNMMI Radiopharmacy and Chemistry, demonstrating the progress in the research field in many aspects.

Mission: Impossible - Understanding Regulations For Radiopharmaceuticals

Outcome from an ITF EMA meeting of PRISMAP (quality requirements for new radionuclides in clinical trials)

The revision of the pharmaceutical legislation – it is time to act for nuclear medicine in Europe

Background: The Editorial Board of EJNMMI Radiopharmacy and Chemistry releases a biannual highlight commentary to update the readership on trends in the field of radiopharmaceutical development. Main Body: This selection of highlights provides commentary on 21 different topics selected by each coauthoring Editorial Board member addressing a variety of aspects ranging from novel radiochemistry to first-in-human application of novel radiopharmaceuticals. Conclusion: Trends in radiochemistry and radiopharmacy are highlighted. Hot topics cover the entire scope of EJNMMI Radiopharmacy and Chemistry, demonstrating the progress in the research field, and include new PET-labelling methods for 11C and 18F, the importance of choosing the proper chelator for a given radioactive metal ion, implications of total body PET on use of radiopharmaceuticals, legislation issues and radionuclide therapy including the emerging role of 161Tb.

[18F]Fluoromisonidazole ([18F]FMISO, 1H-1-(3-[18F]fluoro-2-hydroxypropyl)-2-nitroimidazole) is a commonly used radiotracer for imaging hypoxic conditions in cells. Since hypoxia is prevalent in solid tumors, [18F]FMISO is in clinical application for decades to explore oxygen demand in cancer cells and the resulting impact on radiotherapy and chemotherapy. Since the introduction of [18F]FMISO as positron emission tomography (PET) imaging agent in 1986, a variety of radiosynthesis procedures for the production of this hypoxia tracer has been developed. This paper gives a brief overview on [18F]FMISO radiosyntheses published so far from its introduction until now. From a radiopharmaceutical chemist’s perspective, different precursors, radiolabeling approaches and purification methods are discussed as well as used automated radiosynthesizers, including cassette-based and microfluidic systems. In a GMP compliant radiosynthesis using original cassettes for FASTlab we produced [18F]FMISO in 49% radiochemical yield within 48 min with radiochemical purities >99% and molar activities >500 GBq/µmol . In addition, we report an easy and efficient radiosynthesis of [18F]FMISO, based on in-house prepared FASTlab cassettes, providing the radiotracer for research and preclinical purposes in good radiochemical yields (39%), high radiochemical purities (>99%) and high molar activity (>500 GBq/µmol) in a well-priced option.

PSMA: Aktuelle und zukünftige Entwicklungen

New Horizons in Imaging and Therapy

Technical Meeting

Young DGN Fortbildung

Zyklotrone bilden als Ressource medizinischer Radionuklide eine zentrale Infrastruktur für die Entwicklung neuer und die Produktion klinisch etablierter Radiotracer zur molekularen Hybridbildgebung. Da die letzte umfassende Veröffentlichung zu Zyklotronen ca. 15 Jahre alt ist, wurde eine Statuserhebung zu den für die Nuklearmedizin und Radiopharmazie in Deutschland, Österreich und der Schweiz (D-A-CH-Länder) betriebenen Zyklotronen angestrebt.

The daily clinical practice in Nuclear Medicine makes use of radiopharmaceuticals that either are obtained from external commercial suppliers or prepared in-house for immediate use. The latter are usually non-commercial preparations that represent the major source of radiopharmaceuticals for essential routine Nuclear Medicine practices for both diagnostic and therapeutic applications. According to European legislation, namely directive 2001/83/EC, radiopharmaceuticals that are commercially distributed must have a marketing authorization (MA) to be placed on the market. The availability of this type of finished radiopharmaceutical products with MA ready to use is limited due to different reasons: one is the very short half-life or shelf life, which limits the shipment of these radiopharmaceuticals from external sources. In addition, the market potential for radiopharmaceuticals that are used in rare clinical indications is limited to be financially attractive for pharmaceutical industry, and therefore the number of MA applications for radiopharmaceuticals is concise. However, the development of innovative radiopharmaceuticals usually takes place in radiopharmacies, research centres or nuclear medicine laboratories. Practically all recent major clinical breakthroughs in Nuclear Medicine over the last decade, exemplified by the success of theranostics with Somatostatin analogs and prostate cancer applications, were based on the use of in-house preparations of these innovative products. In case a new radiopharmaceutical has both the technical (half-life) and clinical potential to be produced and distributed commercially, these new radiopharmaceuticals more frequently make their way to pharmaceutical companies that take over from academia and provide funding for further clinical trials besides phase 0 / phase I. European legislation treats radiopharmaceuticals used in the preparation process of a radiopharmaceutical different than other, i.e., non-radioactive pharmaceuti

Background: Cyclotrons form a central infrastructure and are a resource of medical radionu- clides for the development of new radiotracers as well as the production and supply of clini- cally established radiopharmaceuticals for patient care in nuclear medicine. Aim: To provide an updated overview of the number and characteristics of cyclotrons that are currently in use within radiopharmaceutical sciences and for the development of radiopharma- ceuticals to be used for patient care in Nuclear Medicine in Germany (D), Austria (A) and Switzerland (CH). Methods: Publicly available information on the cyclotron infrastructure was (i) consolidated and updated, (ii) supplemented by selective desktop research and, last but not least, (iii) vali- dated by members of the committee of the academic “Working Group Radiochemistry and Radiopharmacy” (AGRR), consisting of radiochemists and radiopharmacists of the D-A-CH countries and belonging to the German Society of Nuclear Medicine (DGN), as well as the Radiopharmaceuticals Committee of the DGN. Results: In total, 39 cyclotrons were identified that are currently being operated for medical radionuclide production for imaging and therapy in Nuclear Medicine clinics, 29 of them in Germany, 4 in Austria and 6 in Switzerland. The majority of the cyclotrons reported (69%) are operated by universities, university hospitals or research institutions close to a university (clinic), less by/in cooperation with industrial partners (26%) or a (non-university) clinic/PET-center (5%). Most of the cyclotrons (82%) are running with up to 18 MeV proton beams, which is sufficient for the production of the currently most common cyclotron-based radionuclides for PET imaging. Discussion: The data presented provide an academically-updated overview of the medical cy- clotrons operated for the production of radiopharmaceuticals and their use in Nuclear Medi- cine in the D-A-CH countries. In this context, we discuss current developments and trends with a

This document is intended as a supplement to the EANM “Guidelines on current Good Radiopharmacy Practice (cGRPP)” issued by the Radiopharmacy Committee of the EANM [1]. The aim of the EANM Radiopharmacy Committee is to provide a document that describes how to manage risks associated with small-scale “in-house” preparation of radiopharmaceuticals, not intended for commercial purposes or distribution.

Zyklotrone bilden als Ressource medizinischer Radionuklide eine zentrale Infrastruktur für die Entwicklung neuer und die Produktion klinisch etablierter Radiotracer zur molekularen Hybridbildgebung. Da die letzte umfassende Veröffentlichung zu Zyklotronen ca. 15 Jahre alt ist, wurde eine Statuserhebung zu den für die Nuklearmedizin und Radiopharmazie in Deutschland, Österreich und der Schweiz (D-A-CH-Länder) betriebenen Zyklotronen angestrebt.

6th Life Sciences Forum Sachsen

Regulatory Requirements for the Translation of Radiopharmaceuticals