U svijetu gdje se rak još uvijek smatra jednim od najstrašnijih dijagnoza, nova nada dolazi iz neočekivane kombinacije dviju medicinskih disciplina. Radioligandna terapija, koja spaja nuklearnu medicinu s onkologijom, već mijenja živote pacijenata u susjednim zemljama, a stručnjaci vjeruju da će uskoro revolucionirati način na koji pristupamo liječenju raka.
Dok se pacijenti s rakom prostate u Hrvatskoj još uvijek oslanjaju na tradicionalne metode liječenja, pacijenti u Sloveniji, Austriji i Italiji već imaju pristup lijeku koji je promijenio pravila igre - novom radioligandnom pristupu koji je odobren u Europi.
Radioligandna terapija - što čini ovu terapiju posebnom?
Za razliku od kemoterapije koja, kako to liječnici opisuju, "bombardira" cijelo tijelo u nadi da će pogoditi tumorske stanice, radioligandna terapija djeluje poput preciznog snajperista. Ovaj pristup koristi radioaktivne molekule koje se vezuju za specifične receptore na površini tumorskih stanica.
"Zamislite da možete poslati lijek koji će pronaći točno one stanice koje želite uništiti, a pritom ostaviti zdravo tkivo netaknutim", objašnjava dr. Katja Zaletel, predstojnica Klinike za nuklearnu medicinu UKC Ljubljana. "To je upravo ono što radioligandna terapija čini - ona cilja samo na problematične stanice"[1].
Novi radioligandni lijek
Revolucionarni radioligandni lijek, poznat pod nazivom lutecij Lu 177 vipivotid tetraksetan, odobren je od strane Europske komisije u prosincu 2022. godine[2]. Ovaj lijek namijenjen je pacijentima s metastatskim rakom prostate otpornim na kastraciju koji već nisu reagirali na standardne terapije.
Brojevi govore sami za sebe - u kliničkim studijama, pacijenti koji su primali ovaj radioligandni pristup pokazali su 38% smanjenje rizika od smrti u odnosu na one koji su primali standardnu terapiju (HR 0.62; 95% CI 0.52-0.74; p<0.001)[3][4][5]. Još impresivnije, rizik od napredovanja bolesti smanjen je za čak 60% (HR 0.40; 95% CI 0.29-0.57; p<0.001)[6][7].
Medijan ukupnog preživljenja bio je 15.3 mjeseca u skupini koja je primala radioligandnu terapiju naspram 11.3 mjeseca u kontrolnoj skupini[3][4][5]. "Kada govorimo o produžetku života od 15,3 naspram 11,3 mjeseci, to možda ne zvuči dramatično, ali za pacijente i njihove obitelji, svaki dodatni mjesec je neprocjenjiv", kaže jedan od liječnika uključenih u europske studije[2].
Kako radioligandna terapija funkcionira u praksi?
Proces počinje dijagnostikom - pacijent prolazi kroz PET/CT pretragu koja koristi tracer Ga68 PSMA[8][9][10]. Ovaj postupak omogućava liječnicima da vide točno gdje se nalaze tumorske stanice koje eksprimiraju PSMA protein. Ako je pretragom potvrđeno da su tumorske stanice "pozitivne" na PSMA, pacijent je kandidat za radioligandnu terapiju.
Sam lijek se daje intravenski, obično u ciklusima od šest tjedana[4][11]. Tijekom tog vremena, radioaktivni lutecij-177 putuje kroz krvotok, pronalazi tumorske stanice koje eksprimiraju PSMA i tamo ispušta lokalizirano zračenje koje uništava maligno tkivo.
Istraživanja pokazuju da je uspješnost terapije izravno povezana s razinom ekspresije PSMA na tumorskim stanicama - što je viša ekspresija, bolja je učinkovitost liječenja[12][13][14].
Slovenija prednjači u regiji
Naša sjeverozapadna susjeda već je napravila značajne korake u implementaciji ove tehnologije. Onkološki institut Ljubljana uveo je PET/CT pretragu s Ga68 PSMA koja je dostupna bez lista čekanja - nešto što je rijetko u europskim zdravstvenim sustavima.
"Potrebe za PSMA-usmjerenim radionuklidnim liječenjem rastu iz dana u dan", objašnjava dr. Zaletel. "Vidimo kako se ta potreba povećava, a mi se pripremamo da možemo odgovoriti na te zahtjeve"[1].
Slovenija je također pokrenula vlastitu proizvodnju CAR-T stanica za liječenje određenih vrsta limfoma i leukemije, što pokazuje ozbiljnost njihova pristupa personaliziranoj medicini[15].
Austrija i Italija nisu daleko
Austrija, s dobro razvijenom infrastrukturom nuklearne medicine, već nudi širok spektar srodnih usluga. Diagnostikum u Grazu, kao jedini privatni institut na jugu Austrije, pionir je u kombiniranju različitih vrsta medicinskog snimanja za preciznije dijagnoze.
Italija se pak pozicionirala kao jedna od vodećih europskih zemalja u implementaciji radioligandnih terapija. Zemlja je uključena u glavne europske RLT mreže i ima establirane centre koji pružaju ove usluge, što je čini dostupnom destinacijom za pacijente iz drugih zemalja[16].
Zašto Europa još uvijek čeka?
Usprkos obećavajućim rezultatima, Europa se suočava s nizom izazova koji usporavaju širu primjenu radioligandnih terapija. Trenutno samo 29 centara diljem Europe nudi napredne radioligandne terapije, što je daleko od potreba[17].
Glavni problemi uključuju nedostatak obučenog osoblja, neadekvatnu zaštitnu opremu, probleme s odlaganjem radioaktivnog otpada i različite regulatorne okvire među zemljama članicama[18][19]. Mnoge ustanove nemaju zaštićene prostorije potrebne za sigurno rukovanje radioaktivnim materijalima[17][20][21].
"Inovacija u RLT-u napreduje brže nego što se zdravstveni sustavi prilagođavaju", objašnjava jedan od stručnjaka uključenih u europske inicijative. "Bez potrebne infrastrukture i resursa, potencijalne koristi neće biti u potpunosti iskorištene"[18].
Prema analizi IQVIA instituta, kapacitet za radioligandne terapije značajno varira među europskim zemljama - dok Španjolska i Njemačka imaju relativno viši kapacitet s više od 55 identificiranih mjesta za liječenje na 100.000 ljudi, Francuska i Italija imaju mnogo niži kapacitet[17].
RLT Akademija - europska obrazovna inicijativa
Prepoznavši ovaj problem, pokrenuta je RLT Akademija - transnacionalni obrazovni program za zdravstvene radnike koji nastoji riješiti obrazovne praznine u Europi[22][23][24]. Ova inicijativa, podržana Erasmus+ grantom, rezultat je dvogodišnje suradnje između ključnih dionika u području.
Program je usmjeren na obuku liječnika, medicinskih tehničara i drugog zdravstvenog osoblja za sigurno i učinkovito korištenje radioligandnih terapija. Platforma je službeno pokrenuta u travnju 2024. godine na događaju u Europskom parlamentu u Bruxellesu[23][24].
Radioligandna terapija nije ograničena samo na rak prostate
Radioligandna terapija nije ograničena samo na rak prostate. Istraživanja su u tijeku za dodatne indikacije, uključujući HER2 pozitivni rak dojke, glioblastom, karcinom mokraćnog mjehura i različite vrste limfoma[25][26][27].
Posebno se istražuju kombinacije radioligandnih terapija s imunoterapijom, što bi moglo dodatno povećati učinkovitost liječenja[28]. Neki stručnjaci vjeruju da će ova kombinacija predstavljati sljedeći veliki korak u personaliziranoj medicini.
Za HER2-pozitivni glioblastom, istraživanja pokazuju da HER2-usmjerene terapije mogu uspješno ciljati na tumorske stanice uključujući i one otporne na konvencionalne tretmane[25][26].
Za pacijente s rakom prostate koji su iscrpili standardne opcije liječenja, radioligandna terapija predstavlja novu nadu. Iako još uvijek nije dostupna svugdje, trend je jasan - ova tehnologija će uskoro postati standardni dio onkološke prakse.
Najnovija istraživanja pokazuju da se radioligandna terapija može primijeniti i u ranijim stadijima bolesti. PSMAfore studija pokazala je da radioligandna terapija kao drugolinijski tretman daje bolje rezultate preživljenja bez napredovanja bolesti u odnosu na inhibitore androgenskih receptora[28].
"Svaki pacijent zaslužuje pristup najboljim dostupnim terapijama", kaže jedan od vodećih europskih onkologa. "Radioligandna terapija pokazuje da možemo biti precizniji, efikasniji i humaniji u pristupu liječenju raka"[2].
Dok čekamo da se ova tehnologija proširi i na našu regiju, jasno je da se medicina kreće prema budućnosti gdje će liječenje raka biti sve više personalizirano i ciljano. Ovaj radioligandni pristup je samo početak - prvi korak u novom dobu precizne onkologije koja obećava bolje rezultate uz manje nuspojava.
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