Dr. Ebrahim S. Delpassand: Stimulating Discoveries in Nuclear Medicine, Saving Lives

This is the story of Dr. Ebrahim (Abe) S. Delpassand, a dynamic CEO of RadioMedix, a Board certified nuclear medicine physician, and a visionary leader who is working to develop new radiopharmaceuticals for both diagnostic and therapeutic purposes, envisioning the trajectory of addressing unmet needs in the treatment of neuroendocrine, prostate, brain, pancreatic, and ovarian cancers. With over three decades of expertise in health care and drug development, Abe emerged as a trailblazer, helped commercializing radiopharmaceuticals for PET imaging and targeted alpha and beta-emitter therapies against cancer. In academics, he received his M.D. degree from the prestigious University of Tehran in Iran and completed his residency training in anatomical and clinical pathology and nuclear medicine at Baylor College of Medicine in Houston.

To delve deeper into this journey and his venture, we had a candid conversation with Dr. Delpassand. In this exclusive dialogue, he unveiled various facets of his endeavor, providing insightful information that deepens our understanding of the industry insights and the revolutionary potentials of radiopharmaceutical technologies in healthcare.

The Inspiring and Innovative Journey—From the Outset

Abe kickstarted his career by joining Baylor as junior faculty for 2 years. He then moved to the MD Anderson Cancer Center in Houston , where after three years was appointed as Chief of clinical nuclear medicine and director of therapeutic nuclear medicine. After 12 years at MD Anderson, he left the institution to start Excel Diagnostics and Nuclear Oncology Center (EDNOC), one of the premier outpatient diagnostic imaging and therapeutic nuclear medicine centers in Houston.

The goal was to build an infrastructure to not only provide standard of care in diagnostic medical imaging and therapeutic nuclear medicine but also to be able to conduct clinical research in the field of nuclear medicine. In accordance with this vision, he filed his first IND with FDA using high-activity 111In-Octreotide in the treatment of SSTR-expressing neuroendocrine tumors (NET) in 2005. He began the 177Lu-DOTATATE clinical trial for the first time in the United States in 2010 under a physician-sponsored IND. For more than four years, this study served as the only source of PRRT to treat neuroendocrine cancers in the nation. It also paved the way for the subsequent Netter-1 trial, sponsored by Advanced Accelerator Applications (AAA), now a Novartis Company, which resulted in the approval of the medication, LutaThera™ . Together with their UCLA colleagues, they sponsored the first phase II 177Lu-PSMA-617 IND in the United States in 2017 for treatment of castration resistant prostate cancer.

In 2006, Dr. Delpassand laid the foundation of RadioMedix by hiring four scientists in a small radiochemistry laboratory with the objective of creating novel targeted alpha-emitter radiopharmaceuticals for oncology and diagnostic PET. RadioMedix also served as the manufacturing site for a number of investigational medications supporting the IND efforts. The FDA approved 64Cu-Dotatate (Detectnet™), a diagnostic radiopharmaceutical for neuroendocrine cancer in 2020; Curium Pharma has a license to manufacture, produce, and distribute the product, commercially. Further, he started a physician-sponsored phase II IND on 225Ac-PSMA I&T. Fusion Pharma recently received a license to continue developing its phase II IND. In late 2022, RadioMedix was able to raise $40.0 MM to advance its drug pipeline and manufacturing site. RadioMedix then sponsored 212Pb- DOTAMTATE medication to treat SSTR-expressing NET, in collaboration with OranoMed, it’s business partner, a French company. In May 2023, the phase II multicenter trial’s enrollment was finished. The team has been able to speed up the development of new diagnostic and therapeutic radiopharmaceuticals by combining the expertise of the EDNOC clinic with that of RadioMedix in the research and development of revolutionary radiopharmaceuticals and comprehending the regulatory landscape.

The Role and Impact of Theranostics

In personalized medicine and oncology, therapeutic targeted radiopharmaceuticals are the way of the future, and that time is already here. The industry has unquestionably and impressively had an impact on the treatment of neuroendocrine and prostate malignancies. Prostate cancer patient care has significantly changed because of PSMA PET imaging ligands. In the next five to seven years, Abe believes there will be a major expansion in the Radio-Theranostics menu.

Unique and innovative radiopharmaceuticals have their foundation in developments in the comprehension of the biology and pathophysiology of cancer, the finding of new targets within cancer cells or their surroundings, and other metabolic pathways. “The area of nuclear medicine is experiencing a golden age, and it is our duty as specialists to take advantage of the immense possibilities for the benefit of our patients. The industry has already realized this and is investing billions of dollars in our space.” Said Dr. Delpassand.

The Newest Theranostic: A Glance

The development of new targeted alpha therapies (TAT) has immense potential for the field of therapeutic nuclear medicine. Many ligands tagged with beta emitters (i.e., 177Lu), such as somatostatin or PSMA analogues, are currently transitioning to alpha emitters, like 225Ac, 212Pb, 211At, 141 tb, etc.

Regarding ligands, FAPI appears to be a very promising diagnostic tool, not only for cancers but also for other disorders involving activated fibroblasts, including rheumatology, cardiology, etc.

Although Abe is skeptical about the efficacy of FAPI therapeutic agents in treating various malignancies, he is keenly interested in discovering and creating dual-targeting compounds that combines FAPI with certain cancer markers to target both cancer cells and the tissues that support them. LDL receptors for pancreatic cancer and GBM, and CXCR4 for hematological malignancies, are further intriguing targets.

Creating New Frontiers to Tackle the Unmet Needs

The inspirational man believes in investing his time and resources to create new frontiers and attack unmet clinical needs in oncology to expand the field. They chose to create 64Cu-DOTATATE because, in comparison to competing PET agents, they could actually see the practical benefits in terms of centralized manufacturing and end-user simplicity of use. They started working on 212Pb-DOTAMTATE in order to provide NET patients with PRRT that would be safer and more effective. Dr. Delpassand and his colleagues are currently investing substantial funds in the development of therapeutic and diagnostic medicines to treat pancreatic and brain cancer, as well as expanding the manufacturing capacity of alpha emitters.

The Primary Hurdles of the Supply Chain

One of the major roadblocks to the development and commercialization of novel therapeutic radiopharmaceuticals is the availability of alpha emitters. For companies to establish a strong supply chain for the production of isotopes in general and alpha emitters in particular, cooperation between scientists, industry, and government is necessary. Abe mentioned that to solve the availability of radioisotopes, all three parties have to devote a considerable amount of resources—including infrastructure, money, technology, and labor. The visionary leader stated, “I expect that the supply chain issue related to the most popular isotopes will be resolved in the next five years.”

Dr. Delpassand’s Take on the Significance of updated curriculum of the Residency Programs and Training

The education of the next generation of nuclear medicine doctors will determine the specialty’s future. Ebrahim is sure that there is a significant window of opportunity to address this unmet need. Future nuclear medicine doctors should have special trainings in functional molecular imaging (FMI) and targeted radioligand therapy (TRLT), as well as clinical aspects of managing cancer patients undergoing these treatments.

If there are not enough doctors with this kind of training, our field will miss out on huge opportunities, and patients will suffer. “If we take no action, other disciplines that will profit are those like radiation oncology. If other specialties receive sufficient training, have a thorough understanding of the field, and can advance it through innovation and research, I have no problem with them working in our field. However, when we look at the current curricula of radiation oncology, radiology, or oncology residency trainings, I see no substantial and pertinent education in subjects related to FMI and TRLT”. Said Dr. Delpassand. He believes that simply having “competency” will not allow physicians from other specialties to practice nuclear medicine unless they receive comprehensive training in the field. By strengthening and expanding the curriculum for nuclear medicine training, we raise the bar for achieving our degree and create an “independent but integrated specialty.”

Nuclear medicine residency training programs need to adapt to the needs of our field. Together with the current fundamentals, residency curricula should place a strong emphasis on four key areas: targeted radioligand therapy, molecular diagnostic imaging, translational research, and regulatory expertise for drug development,. Future nuclear medicine doctors must be well-versed in the uses of TRLT, competent to identify any side effects associated with the treatment, and comfortable with managing these consequences.

New residency curriculums must include managing side effects of targeted therapies, such as those currently managed by oncologists and residents interested in radiopharmaceutical research and development, hoping to work in the pharmaceutical or drug development industries, should be offered training in these areas. To transform research into discoveries and clinical trials into innovative treatments, future nuclear medicine subspecialists will also require an unparalleled breadth and depth of knowledge in the field, all while emphasizing safety, compassion, and a steadfast dedication to the care of cancer patients. “I believe we have all the knowledge and resources to take advantage of this turning point in the field of nuclear medicine,” Dr. Delpassand stated.