艾昆纬-放射配体治疗是新加坡癌症治疗的未来 Radioligand Therapy as the Future of Cancer Care in Singapore

IQVIA

WhitePaper

RadioligandTherapyas

theFutureofCancerCare

inSingapore

AUGUST2025

LUKEWILLBOURN,Principal,StrategyConsulting,IQVIA

SMITHASREEDHARAN,AssociateDirector,MedicalWriting,IQVIASTEVENSURJA,Consultant,StrategyConsulting,IQVIA

ADIVITIYABIHAGARA,MedicalWriter2,RWEMedicalandScientificWriting,IQVIA

Tableofcontents

Overview1

Executivesummary2

Valueofradioligandtherapy3

CurrentstatusofPSMA+mCRPCinSingapore4

CurrentlandscapeofRLTinSingapore—assessmentofreadinessandidentifiedgaps6

Stakeholderawareness6

ClinicalresearchonRLT6

InfrastructureforRLT8

RegulatoryframeworkforRLT10

FundingschemeforRLT12

Potentialsolutions—casestudiesfromdifferentcountries13

Acalltoaction15

References18

Abouttheauthors22

Aboutthecontributorsandobservers23

Overview

Prostatecancer(PC)representsasignificantandgrowingpublichealth

concerninSingapore,currentlyrankingasthemostcommonlydiagnosed

canceramongmales.Theburdenofdiseaseisexpectedtogrowsubstantiallyinthecomingyears,drivenbydemographicagingandshiftinglifestyle-relatedriskfactors.

Amidthisgrowingburden,nuclearmedicineistransformingcancercarebyenablingprecisediagnosticsandtargetedtherapies.Radioligand

Therapy(RLT),particularlyLutetium-177(Lu-177)-basedprostate-specificmembraneantigen(PSMA)-targetedagents,hasemergedasapromisingandtransformativeapproachinthemanagementofmetastaticCastration-ResistantProstateCancer(mCRPC).

Nationally,PCprevalenceisprojectedtoreach18,000casesby2040.Aconsiderableproportionofthesewillprogresstoadvancedstages,includingmCRPC,for

whichconventionaltreatmentoptionsremainlimitedandpatientoutcomesoftensuboptimal.

Nuclearmedicineistransformingcancercareby

allowingprecisediagnosticsandtargetedtherapies.

RadioligandTherapy(RLT),particularlylutetium-177(Lu-177)–basedprostate-specificmembrane

antigen(PSMA)-targetedagents,hasemergedasa

transformativeapproachinthemanagementofmCRPC.SeveralclinicaltrialssuchasVISIONandPSMAfore

havedemonstratedthatRLTissuperiortoStandardofCare(SoC),whichincludesAndrogenReceptorPathwayInhibitors(ARPIs)andtaxane-basedchemotherapies,inprolongingProgression-FreeSurvival(PFS)and

improvingQualityofLife(QoL).TofullyrealizethetherapeuticpotentialofRLTinSingaporesoncologylandscape,therearevaluableopportunitiestobooststakeholderawareness,strengtheninfrastructure,streamlineregulatoryprocesses,andenhance

financingsupport.

ThiswhitepaperprovidesacomprehensiveassessmentofSingapore’sreadinesstoscaleRLTasastandard-of-

caretreatment.Itidentifiescriticalgapsinstakeholdereducation,diagnosticandtreatmentcapacity,workforceavailability,andregulatoryspecificity.Additionally,it

highlightsfinancialbarriersthatlimitpatientaccessduetothelackofrobustreimbursementmechanismsand

targetedfundingsupport.

Thisdocumentprovidesevidence-basedanalysis

andstakeholder-informedrecommendationsto

assisthealthcareproviders,industrypartners,and

policymakersincreatingacoordinatednational

strategyforRLTimplementation.Byaddressingthesemultidimensionalchallenges,Singaporecanpositionitselfattheforefrontofprecisiononcologyensuringtimely,equitable,andsustainableaccesstoRLTfor

patientswithadvancedPCandothermalignancies.ThestudywasproducedindependentlybyIQVIA.FundingforthisresearchandreportwasprovidedbyNovartis.ThecontributionsofLukeWillbournandtheteamat

IQVIAtothisreportaregratefullyacknowledged.

|1

Executivesummary

PCisthemostcommonlydiagnosedmalignancy

amongmalesinSingapore,withtheprevalence

projectedtoreach18,000casesby2040,including

approximately850patientswithPSMA+mCRPC.WhileARPIsandtaxane-basedchemotherapiesremain

standardtreatments,significantcaregapspersist

duetodelayeddiagnosis,limitedreferrals,poor

chemotherapytolerance,aswellaspatient’sown

preferences(forexample,patientsmightrefusegoingforchemotherapyduetofearofthesideeffects).RLT,especiallyLu-177–basedPSMA-targetedagents,hasshownsuperiorPFSandQoLoutcomes,establishingitasapromisingtherapeuticmodality.

Despiteincreasingclinicalvalidation,RLTadoptioninSingaporefacessystemicreadinesschallenges.

Awarenessamongstakeholdersvaries:medical

oncologistsandNuclearMedicineSpecialists(NMs)

aregenerallywellinformedandthereisanincreaseinawarenessandunderstandingofRLTamongthe

urologistswhichplayakeyroleinthemanagement

ofprostatecancerpatients’journey.However,the

broadermedicalcommunityandpatientsarestill

largelyunawareofthebenefitsofRLTyet.Medical

oncologistsoutsidespecializedcentersexpress

concernsoverhematologictoxicity(blood-relatedsideeffects),limitingcross-disciplinaryreferrals.Onthe

otherhand,regulatorybodies,includingtheMinistryofHealth(MOH),HealthSciencesAuthority(HSA),andNationalEnvironmentAgency(NEA),areinvolvedandthereisgrowingrecognitionoftheopportunityto

furtherdevelopinstitutionalinfrastructuretosupporttheefficientdeliveryofhigh-volumeRLT.

ResearcheffortsarelargelyconcentratedonPC,

withlimitedexplorationofRLTinothermalignancies.Althoughlocaltrials(e.g.,Lu177-PSMA-617,Lu177-

NeoB)areongoing,broaderdiversificationandlong-termdatacollectionareneededtosupportclinical

integration.Thediagnosticinfrastructurealsopresentsabottleneck.PSMA-PositronEmissionTomography

(PET)imagingutilizationisinconsistent,particularlyamongnon-RLTprescribers,delayingeligibility

assessments.MediantimefromdiagnosistoRLT

initiationexceedssixmonths—significantlylongerthaninEuropeancountries—duetofragmented

referralpathwaysandlackofstandardizedprotocols.

Singapore’streatmentcapacityisconstrainedby

workforcelimitations.Of38NMs,onlyabout20areactivelyadministeringRLTacrosssevencenters,

equatingto0.6NMsper100,000population—wellbelowinternationalbenchmarks(UnitedStates[1.1],GermanyandAustralia[1.4each]).Currentcapacitysupports~300patientsannually,insufficienttomeettheprojecteddemandof350–400patientsby2040.

WhileoccupationalradiationexposureremainswithinInternationalCommissiononRadiologicalProtection(ICRP)safetythresholds,expandingRLTpresentsanopportunitytoenhancesafetyprotocolsandoptimizecross-functionalworkloadassessments.

Currently,RLTinSingaporebenefitsfroma

comprehensiveregulatoryfoundationunderthebroadernuclearmedicineframeworkgovernedbymultiplebodies,includingtheMOH,HSA,andNEA.

Thisstructureprovidesflexibility,allowingforboth

registeredtherapies(e.g.,Lutetium-177vipivotide

tetraxetan)andLocallyManufacturedTherapies(LMTs)tobeavailable.AsthefieldofRLTcontinuestoevolve

andgrow,thereisavaluableopportunitytobuildon

thisfoundationbydevelopingadedicatedRLT-specificregulatoryframework.Suchaninitiativewouldsupporttheharmonizationofproductstandardsandenhanceconsistencyinoversight,ultimatelyensuringhigh-

qualityandstandardizeddeliveryofRLTsacrossthehealthcaresystem.

ImprovingfundingsupportforRLTpresentsakey

opportunitytoenhancepatientaccess.TheregisteredRLTproduct(e.g.,Lutetium-177vipivotidetetraxetan)hasundergoneHSA-regulatedclinicalreviewand

randomizedclinicaltrialvalidation—supportingits

efficacyandsafety.Givenitsnovelmechanismand

regulatoryrigor,RLTisexpectedtobemoreresource-intensivethanconventionaltreatments—hence

thecostdifference.WhileRLTisnowincludedinthecancerdruglist—apositivestepforward—currentMediShieldLifeandMediSavemayonlypartially

supportthefullcostoftreatment,includingrelated

2|RadioligandTherapyastheFutureofCancerCareinSingapore

|3

expensessuchasfacilityuse,clinicalstaffing,andpost-treatmentimaging.Patientswithprivateinsurance

typicallyfacelowerOut-Of-Pocket(OOP)costs,

whereasthoserelyingsolelyonpublichealthcare

financingmayencountersignificantaccesslimitations.ThereisalsoroomtostrengthensupportforPSMA-

PETimagingandtoexploretheinclusionofRLT

underbroaderschemessuchastheStandardDrug

ListorMedicationAssistanceFund.Strengthening

thesefundingmechanismswouldpromotemore

equitableandsustainableaccesstoRLTforallpatients,regardlessoffinancialbackground.

TooptimizeRLTdelivery,Singaporemustenhance

stakeholdereducation,expandthediagnostic

andtreatmentinfrastructure,growthespecialist

workforce,establishRLT-specificregulatorypathways,andimplementinnovativefundingmodelstoensureequitableaccessandlong-termsustainability.

Valueofradioligandtherapy

Nuclearmedicinerepresentsatransformative

approachincancercare,integratingdiagnostic

precisionwiththerapeuticspecificity.Traditionalformsofradiotherapy,e.g.,externalbeamradiotherapy

andbrachytherapy,usehigh-energyradiationdoses

toinhibittumorgrowthbutoftenaffectsurroundinghealthytissues,leadingtoadverseeffectssuch

asfatigueandhairloss.1,2Radiopharmaceutical

imaging,throughmodalitiessuchasPET(e.g.,

18F-fluorodeoxyglucose)andsinglephotonemissioncomputedtomography(e.g.,technetium-99m),enablestumordetection,staging,andmonitoringofoncologicandnon-oncologicconditions,includingcardiac

andpulmonarydiseases.3Theranostics—arapidlyevolvingfield—combinestargeteddiagnosticsandtherapeuticsusingthesamemolecularplatform.

RLTrepresentsaprecisiononcologymodalitythat

leveragestargeteddeliveryofcytotoxicradiationto

tumorcellsexpressingspecificbiomarkers,suchas

PSMA.Thetherapycombinesasmall-moleculeligandthatbindsselectivelytotumorcellswitharadioisotope—typicallyLu-177—thatemitsbetaradiationto

inducelocalizedcelldeath.Thistheranosticapproach

enablesbothimagingandtreatment,minimizing

off-targeteffectsandpreservingsurrounding

healthytissues.AgentssuchasLu-177DOTATATEforNeuroendocrineTumors(NETs)andLu-177-PSMAfor

PSMA+mCRPCexemplifythisdual-functionapproach.4Theseagentsbindtospecifictumorbiomarkers,

enablingsimultaneousimagingandselectiveradiationdelivery,minimizingoff-targettoxicity,andimprovingpatientoutcomes.2Thistargetedapproachholds

promiseforexpandedindicationsandpersonalizationofcancertherapy.

TheranosticnuclearmedicineisrapidlygainingtractioninSingapore.Bycouplingradioactiveisotopesto

tumor-targetingligands,theranosticsenablesselectivedeliveryofradiationtocancercells,minimizingoff-

targeteffects.2Positiveclinicaldatafromindustry-

ledtrialssupporttheexpansionoftheseagentsintoearlierlinesofcancertreatment,improvingpatient

outcomesandreshapingtherapeuticsequencing.InSingapore,theHSAhasapprovedLu-177fortreatingNETs(in2020)andPC(in2023),signalingregulatoryrecognitionandpavingthewayforbroaderadoptionacrossadditionaltumortypes.5,6Thiswhitepaper

aimstoassesstheranosticcancercarereadinessin

SingaporeusingthespecificexampleofLu-177forthetreatmentofPSMA+mCRPC.

4|RadioligandTherapyastheFutureofCancerCareinSingapore

CurrentstatusofPSMA+mCRPCinSingapore

PCremainsthemostcommonlydiagnosedmalignancyamongmalesinSingaporeandrankssecondoverall.7Asof2022,the5-yearprevalenceforPCinSingaporewas8,779,withanincidenceof38per100,000

population(around2,000newcasesannually)

(Figure1).8Thisfigureisexpectedtogrowsteadilyduetoagingdemographicsandlifestyle-relatedriskfactors,reaching16,000–18,000by2040.9

In2023,anestimated2,000–2,500patientswere

diagnosedwithmetastaticPC,withapproximately

400–500progressingtomCRPC.Ofthese,300–400wereidentifiedasPSMA+—afigureprojectedtoriseto750–850by2040.Thisanticipatedgrowth,coupled

withapotential15%–20%increaseinpatientvolumefrominternationalmedicaltourists,furtherdrivesthedemandforadvancedoncologyservices,particularlyinnuclearmedicineandtheranostics.Over80%of

patientswithmCRPCexpressPSMA,qualifyingthemforPSMA-targetedRLT.ThetreatmentlandscapeformCRPCinSingaporeiscurrentlydominatedbyARPIssuchasabirateroneandenzalutamide,andtaxane-basedchemotherapeuticagentssuchasdocetaxelandcabazitaxel.10-12

Thetypicaltreatmentjourneyfollowsasequence

fromdiagnosisandstagingtoMultidisciplinaryTeam(MDT)discussionand,then,line-specifictherapeuticinterventions.11,12Diagnosisisfrequentlydelayedduetolackofearlyprostate-specificantigenscreeningandminimalsymptomsinearlystagesofdisease.

First-linetreatment(1L)ofteninvolvesARPIor

Figure1.Prostatecancerstatistics—Singapore

ProstatecancerandmCRPCestimatedpatientsizeinSingapore(sizeofpopulation,2023)

~5.92Million

Singaporepopulation

•

Stable10-yearannualgrowthof~1%

8,500-9,000

Livingwithprostatecancer

•

•

Incidenceof38per100,000population,i.e.,~2,000identifiedcasesannually

Est.annualincidencegrowthof3-4%

2,000-2,500

Metastaticprostate

cancerpatient

•

•

~23%areatmetastaticstage

Est.toreach~28%inthelongterm(detectiontendtobelaterinAsianvs.Westerncountries)

400-500

mCRPCpatient

•

~22%arecastration-resistant(i.e.,hormonaltherapyresistant)

Est.additional15-

20%foreignpatients

mightbeseeking

300-400

PSMA+

mCRPC

•

>80%arehavingpositivelevelofPSMA

treatmentinSG

mCRPC:metastaticcastration-resistantprostatecancer,PSMA+:prostate-specificmembraneantigenpositive,SG,Singapore.

|5

chemotherapy,dependingonthepatient’sclinical

profile.Second-line(2L)therapytypicallyusesan

agent(ARPIorchemotherapy)notappliedinthefirstline.Subsequentlines(2L+)mayincludepoly(ADP-

ribose)polymerase(PARP)inhibitorssuchasolaparib,targetedtherapies,bone-directedtreatments(e.g.,

Ra-223),orPSMA-basedradioligandtherapy(Lu-177)ineligiblepatientswithmCRPC.However,uptakeofsometreatmentoptionsespeciallychemotherapy

(whichisacritical1Land2LinadditiontoARPI)islowduetolimitedreferralfromurologiststooncologists,delayedmultidisciplinaryengagement,andpoor

tolerancetochemotherapyamongAsianpatients.13

PatientswithmCRPCfaceapoorprognosis,with

limitedtreatmentoptionsandasignificantdeclineinQoLassymptoms(suchaspain)worsen.TheneedforgreateradoptionofeffectiveprecisionmedicinesuchasRLT,improvedearly-stagediagnostics,andclearerreferralprotocolsiscriticaltooptimizingpatient

outcomesandbridgingcurrentcaregapsinadvancedPCmanagementinSingapore.

InSingapore,RLThasbeenavailablesince2018for

patientswithPSMA-positivemCRPCasaLMTpreparedinnuclearmedicinecenterswhiletheregistered

product(Lutetium-177vipivotidetetraxetan)receivedHSAapprovalinDecember2023.6,14Administered

infourtosixcyclesatsix-weekintervals(versus

chemotherapygiveneverythreeweeks),RLThasa

well-toleratedsafetyprofileandshowntoenhance

health-relatedQoL.15ClinicaltrialshaveshownthatRLTsignificantlyprolongsmedianPFS(mPFS)to8.7monthsvs.3.4monthswithpriorstandard-of-care(ARPIand

chemotherapy,VISIONstudy),and11.6monthsvs.5.6monthswhencomparedwithARPIalone(PSMAforestudy).16-18Theseoutcomesreflectuptoa60%

reductionintheriskofdeathordiseaseprogressionasobservedintheVISIONstudy.Withstrongefficacyandrobustclinicalevidence,favorablesafety,and

growingregulatorysupport,RLTispoisedtoplayacriticalroleintheadvancedtreatmentlandscapeforPCinSingapore.

ToensureSingaporeisequippedtointegrateRLT

asalong-termtreatmentsolutionforthegrowing

populationofpatientswithmCRPC,acomprehensivereadinessassessmentisessential.Inthiswhitepaper,wehaveoutlinedSingapore’sRLTreadinessbasedonaframeworkcomprisingfourcriticaldomains:

•Awarenessandunderstanding:Thisincludes

evaluatingthelevelofknowledgeamongHealth

CareProfessionals(HCPs)andpatientsaboutRLT’s

safety,efficacy,andtherapeuticvalue,aswellastheirwillingnesstoconsiderorrecommendthetherapy.

•Researchandinnovation:Readinessrequiresa

strongfoundationoflocalclinicalresearchanddatagenerationtosupportRLT’sadoptionacrossdiverseindications.ExpandingtrialsbeyondPCtoother

tumortypesisnecessaryforbroaderapplication.

•Infrastructureandcapacity:Encompasses

diagnosticcapabilities(e.g.,PSMA-PETavailability),referralpathways,healthcarefacilityreadiness,

trainedworkforce(NMs),treatmentcapacity(centersandmanufacturing),andwastemanagement

infrastructure.Metricsincludediagnosis-to-

treatmenttimelines,thenumberofoperational

centers,andtheavailabilityofradiopharmaceuticals.Thisdomainalsoincludesspecificcapacityand

measurementindicators—suchastheproportionofeligiblepatientsundergoingdiagnosisand

treatment,center-levelreadiness,andsafemanagementofradioactivewaste.19

•Regulatoryharmonizationandaccess:InvolvesassessingregulatorypathwaysforRLTproduct

approval(includingbothlocallymanufacturedandimportedtherapies),nuclearsafetystandards,

andalignmentoffundingpoliciestoreducefinancialbarriers.

Holistically,thisstructuredassessmentprovides

aroadmapforSingaporetoscaleRLTeffectively,

ensuringequitableaccess,systemefficiency,andlong-termsustainability.

6|RadioligandTherapyastheFutureofCancerCareinSingapore

CurrentlandscapeofRLTinSingaporeassessmentofreadinessandidentifiedgaps

Stakeholderawareness

Discussionswithstakeholdersandindustryexpertssuggestthatdespitethegrowingbodyofevidenceandpositiveclinicalreception,significantawarenessgapsregardingRLTstillexistamongkeystakeholdergroups.Thesegapscouldpotentiallyhinderoptimalpatientaccessandcare.

•Urologists,whoplayapivotalroleintheinitial

diagnosisandstaging,aregenerallyinformed

regardingRLTindicationsandreferralpathways.However,thebroaderprofessionalcohortswithinthisspecialtymaylacksufficientawarenessofRLT,contributingtosuboptimalreferralpracticesanddelayedtherapeuticintervention.

•Medicaloncologists,whoareinstrumentalin

therapeuticdecision-makingformCRPC,have

reportedfavorableexperienceswithLu-177-basedRLTintermsofbothtrialefficacyandtreatmentoutcomes.Nonetheless,outsideofspecialized

centers,someoncologistsmayhavelimited

exposuretoRLT,particularlyduetoconcerns

regardinghematologictoxicitiessuchasbone

marrowsuppression.Thislimitedknowledgebasemayadverselyaffectcross-disciplinaryreferralstonuclearmedicine.

•NuclearMedicinespecialists(NMs),responsibleforevaluatingpatienteligibilityandadministeringRLT,typicallydemonstratehighproficiencyinmanagingtreatmentprotocols,safetyparameters,and

responseassessment.However,thisexpertiseisnotuniformlydistributed.WhilesomeNMsmighthavemoreexperienceduetoahighervolumeofreferralcases,othersmighthavelittletonone,highlightingtheneedforbroadereducationandstandardized

trainingforNMspecialists.

Fromthepatientperspective,RLTisgenerally

wellreceived,withmanyindividualsperceivingit

asamorefavorabletherapeuticoptioninterms

ofefficacy,symptomscontrolandtolerability,andhence,theQoL.Nevertheless,broaderpatient-

levelawarenessremainslimited,aschemotherapy,ARPIs,andbone-strengtheningtherapycontinuetodominatethetreatmentlandscape.

RegulatoryoversightofRLTinSingaporeisjointly

managedbyGovernmentagencies,includingtheMOH,HSA,andNEA.TheMOHoverseesnuclear

medicinefromaclinicalserviceandprofessional

perspective;theHSAisresponsibleforapproval

oftherapeuticproductswhereproductsafety,

quality,andefficacyareevaluated;andtheNEA

managesradiationsafetyforhealthcareworkers,

patients,andthepublic,aswellasradioactivewastemanagementinnuclearmedicine.Sustainedinter-

agencycoordinationandadaptabilitytoglobal

regulatoryshiftsareessentialforexpandingRLT

access.However,manyhealthcarefacilitieslacktheinfrastructurerequiredtosupportRLTsoperationaldemands.Upgradingthesesystemsiscriticalto

meetingrisingdemandandmaintainingsafe,standardizeddelivery.

ClinicalresearchonRLT

ClinicalresearchonRLTisprogressingglobally;basedonadiscussionwithindustryexperts,therearean

estimated230ongoingRLT-relatedclinicaltrialsas

ofDecember2024exploringitsapplicationacross

variouscancertypes(Figure2).20PCdominatesthe

RLTresearchlandscapewith52trials,followedby

breast(n=36)andgastrointestinal(n=30)cancers.ThisreflectsagrowinginterestinleveragingtargetedradiopharmaceuticalssuchasRLTinothertumor

typesbeyondtheirhistoricaluseinNETsandPC.

However,despitetheincreaseintrialvolume,thereremainsanotableglobalgapinlong-termclinical

andsafetydata,especiallyreal-worldevidence,duetotherelativelyrecentintroductionofmanyRLT

agents.InSingapore,theRLTresearchlandscapeisalignedwithglobaltrends,withastrongfocusonPC.

|7

Figure2.RLT-relatedongoingclinicaltrials(globaldata:2024estimates)

5250

36

30

20

23

17

11

ProstateBreastGIHematologyBrainNeuro-LungOthers

endocrine

Lu177-DOTATATEforsomatostatin-positivemetastaticNeuroendocrineTumors(NETs)wasfirstadoptedin2012.14TheuseofLu177-PSMA-LMTcommencedin

2018.14HospitalshavealsobeguncompoundinglocalRLTpreparationsfollowingpositiveresultsfromlocalstudiesonLMT,21-23improvinglogisticalfeasibilityandaccessibility.Industry-sponsoredstudiesarecurrentlyinvestigatingLu177-PSMA-617incombinationwith

SoC(ARPIandAndrogenDeprivationTherapy/ADTforearlierlinesofPCtreatment).24-26Additionally,anongoingstudyonLu177-NeoBistargetingdoseoptimizationingastrin-releasingpeptidereceptor-positive(GRPR+),estrogenreceptor-positive(ER+),andhumanepidermalgrowthfactorreceptor-2-

negative(HER2-)metastaticbreastcancer,while

anotherexploratorytrialinvolvesstudyingthesafety,tolerability,anddosedeterminationofLu177-LNC1004inpatientswithFibroblastActivationProtein(FAP)-

positivesolidtumors.27,28Althoughtherehasbeen

progress,thescopeofRLTresearchinSingaporeis

stillrelativelylimited,focusingheavilyonPCwhile

minimallyexploringothertumortypes.However,

theRLTresearchlandscapeinSingaporeisexpectedtomovetowardtheglobaltrendofresearchacrossbroadercancerareas.Suchresearcheffortsandlong-termdatacollectiontovalidateRLTefficacyacross

variousmalignancieswillhelpinformfuturepolicy,reimbursement,andclinicalintegration.

8|RadioligandTherapyastheFutureofCancerCareinSingapore

Figure3.PSMA-PETtestingrateamongRLT-prescribingandnon-RLT-prescribingphysiciansbasedonPCtype

PSMA-PETtestingratebyprostatecancertypeandHCP1(%)mCRPCPSMA-PETtestingsharebytreatmentlinesandresult1(%)

Overall60%78%79%

1L

2L

100%

83%

57%

25%

90%

68%

3L

non-mCRPCmHSPCmCRPC

NonRLT-prescribingHCPRLT-prescribingHCP

26%

5%

69%

InfrastructureforRLT

DIAGNOSIS

Marketresearchinputindicatedthatasignificant

diagnosticgappersistsintheutilizationofPSMA-PETimagingacrosshealthcareprovidersinSingapore,

particularlynon-RLT-prescribingphysicians.PSMA-

PETtestingratesaremarkedlyloweramongnon-

prescribersofRLT(withinnon-mCRPCpatients:25%;withinmHSPCpatients:57%)comparedwithRLT

prescribers(83%and100%,respectively),witha

similartrendformCRPCpatients(68%vs.90%)

(Figure3).Furthermore,amongpatientswithmCRPCwhoundergoPSMA-PET,69%aretestedwhileontheirfirstlineoftherapy,whiletheremaining31%areonlytestedatthesecond-orthird-linetreatmentstages

(Figure3).ThisindicatesthatRLTeligibility,andhenceconsiderationforsuchtreatment,canbeidentified

andassessedasearlyasthefirstline.However,

delaysinassessingeligibilityfortheremaining

patientsmayimpacttimelytreatmentdecisionsand

patientoutcomes.Thegapisfurtherexacerbatedbyinfrastructuralconstraints,includingovercapacityinpublichospitalsoffering