Two Meetings, One Message: SNMMI + ASCO

What SNMMI and ASCO 2026 Told Us About Community Theranostics

Last week I said to watch five areas at SNMMI: access, workforce, operations, dosimetry, and the pipeline. The meeting delivered on all five, and ASCO, running concurrently in the same city, added a clinical data layer that made the combined week more useful than either meeting would have been alone.

The combined message is worth stating plainly: theranostics is no longer primarily a question of "should we be doing this?" It is becoming a question of how to staff it, supply it, image and treat safely, manage toxicity, and build durable referral pathways across nuclear medicine, medical oncology, urology, radiation oncology, pharmacy, nursing, and radiation safety. The access problem is increasingly an operational and workforce problem, and that is the territory ARC was built to address.

The Scale of the Meeting Signals Something

SNMMI reported nearly 8,000 in-person attendees, more than 130 CE and scientific sessions, close to 1,000 posters, and approximately 1,500 submitted abstracts. Theranostics, AI, quantitative imaging, and radiopharmaceutical scalability were the dominant themes.

The scale matters less than what it reflects. A meeting with this volume of theranostics content is a meeting that has decided the field is ready to grow beyond academic centers. That decision is relevant for community programs because it means the training infrastructure, the regulatory guidance, the quality frameworks, and the peer-reviewed evidence are all moving in the same direction at the same time.

Workforce: The Certificate Program Is the Most Concrete Thing That Happened

The SNMMI-TS Technologists Theranostics Certificate Program was not a lecture series. It required a hands-on module on Saturday, May 30, covering two sessions (8:30 AM to 12:30 PM and 1:30 to 5:00 PM), plus attendance at at least 7 of 8 didactic sessions running through the rest of the meeting.

This is a meaningful shift in how SNMMI is approaching technologist readiness for RPT. Competency-based requirements, not just attendance, for Pluvicto, Lutathera, I-131, Y-90, Xofigo, post-therapy imaging, contamination control, and patient-release workflows. For community programs that need to demonstrate staff readiness to hospital credentialing bodies, this certification pathway is going to matter.

Operations: The Regulatory Boot Camp Was More Useful Than It Might Sound

The session title does not do it justice. The Boot Camp included presentations from Bayer on alpha-emitter platform regulatory strategy, PharmaLogic/CMO Therapeutics on CMO regulatory compliance, Telix on vertical integration and complete response letter strategy, and Oak Ridge National Laboratory on isotope production and distribution regulation.

For a community hospital, that list translates directly into daily operational concerns: isotope availability and reliability, radiopharmacy relationships, alpha-emitter readiness, shipment timing, waste handling, and how to participate in trials without an academic cyclotron or in-house radiochemistry group.

The RPT Centers of Excellence framework from SNMMI is worth knowing. SNMMI describes COE sites as centers that have affirmed the training, personnel, equipment, and experience needed to manage RPT patients. The listed resources include reimbursement guidance, procedure standards, appropriate use criteria, the RaPTR registry, dosimetry guidance, and theranostics advocacy. For a community program, that is the checklist: not just treatment rooms, but policies, personnel, training, QA, reimbursement, patient education, outcomes tracking, and dosimetry capability where feasible. MITRP holds this designation, and it informs how we structure what we share with ARC sites.

The ASCO–SNMMI Bridge: Why Oncology Integration Is the Whole Game

One of the most useful SNMMI sessions was "ASCO in Real Time: Breaking Advances for Nuclear Medicine," moderated by Michael Hofman and Heather Jacene, with speakers from Dana-Farber, Mayo Clinic, and MD Anderson. The session was built specifically to bring major ASCO RPT and molecular imaging updates directly into the nuclear medicine conversation.

The reason that session exists is the reason ARC's referral pathway work matters. RPT growth will not happen because nuclear medicine programs start offering it. It will happen because oncologists, urologists, and radiation oncologists start requesting it. For that to happen, the nuclear medicine community needs to understand and speak the language of those referrals. Two programs can have identical physical infrastructure and reach entirely different patient volumes depending on how well they're embedded in their oncology teams.

PSMAddition: The Referral Line Is Moving Earlier

The community implication is specific. Current real-world RPT programs are built around late-line mCRPC: post-taxane or taxane-naïve castration-resistant disease. PSMAddition, if it leads to a label expansion, would require nuclear medicine programs to evaluate and treat patients at an earlier disease stage, with different systemic therapy combinations, different follow-up cadences, and different monitoring expectations. A regulatory submission was anticipated before the end of 2025.

Neither the dry mouth nor the cytopenia numbers are alarming, but both require proactive patient counseling and lab surveillance that community programs need to build into their standard workflow before they're needed, not after.

Real-World Pluvicto Data: What 6,464 Patients Actually Show

The Epic Cosmos database analysis presented at ASCO is the most practically useful piece of real-world evidence to emerge from the meeting for community program design.

For community practice, those survival associations are a direct argument for baseline risk stratification before therapy. The patients in this dataset represent a national cross-section, not a carefully selected trial population. That means the comorbidity profile, the supportive care access, and the lab monitoring capability of the treating site all matter. RPT programs need more than drug access and a treatment room. They need protocols for baseline assessment, lab surveillance, and outcomes tracking. The Epic Cosmos data make that hard to argue against.

Alpha Therapy: Prepare Now

Two alpha therapy presentations at ASCO together define what community programs need to be thinking about before the first approvals arrive.

The combined lesson is not that alpha therapy is ready for community implementation. It is that the phase 3 trials are running and the regulatory timelines are moving. Community programs building infrastructure today should be designing for alpha from the start: treatment room waste planning that accounts for different isotope decay characteristics, staff training that includes alpha-emitter safety principles, and patient counseling protocols that address xerostomia monitoring even when current agents produce it at lower rates.

Beyond PSMA and SSTR: What the Pipeline Looks Like

Two SNMMI highlights point toward where the field is heading in the next five years.

A RET-targeted theranostic approach (Ga-68 DOTA-RET-L7 for PET and Lu-177 DOTA-RET-L7 for therapy in preclinical models) addresses a problem PSMA-based strategies cannot: neuroendocrine prostate cancer is frequently PSMA-low or PSMA-negative. As more patients receive extended ARPI therapy, neuroendocrine differentiation is increasingly common. Programs that can only offer PSMA-targeted RPT will have no theranostic option for a growing subset of their prostate cancer patients.

Ga-68 RCC78, a CAIX-targeted cyclic peptide PET tracer for clear cell renal cell carcinoma, showed higher uptake than FDG in CAIX-positive disease in a first-in-human study of 13 patients, with the same molecule being explored for therapeutic isotope labeling. This connects directly to what we're covering at the Roanoke workshop.

The practical implication for community programs is the same in both cases. Building around PSMA and SSTR is correct for today. But the infrastructure, the referring physician relationships, and the staff training should accommodate additional targets as they come.

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