War in Ukraine snaps supply of rare cancer treatment molecule

For more than a year, there has been no import of Actinium-225, which used to come from Russia via Germany, said Dr C.S. Bal, head of the department of nuclear medicine at New Delhi’s All India Institute of Medical Sciences (AIIMS). Although Actinium-225 is found in nature, nuclear facilities and technology are required to separate it from other isotopes and obtain a sizable purified amount.

“Actinium is not available for the last one year, since the war between Russia and Ukraine started. Russia is the hub of world’s radionuclides. Unfortunately, Russia has got the raw material but does not make the final product. It is procured by Germany and from there, it is shipped to all other countries including India," Dr Bal said. Radionuclides, also called radioactive materials, emit radiation as their atomic nuclei house excess neutrons or protons.

At Bal’s department, Actinium-225 is used in theranostics, a method of using one radioactive drug to diagnose and another to deliver therapy to treat tumours. The term is a combination of therapeutics and diagnostics.

Since Actinium is not available in India, AIIMS Delhi is using other, less effective molecules. The institution has a heavy load of patients requiring theranostics, and the department selects the most priority patients.

The vanishing of Actinium-225 assumes importance given that India’s cancer burden is the world’s third-largest after China and the US, and the non-availability of the molecule might impact treatment strategies. Earlier this year, the Indian Council of Medical Research said the number of cancer cases in the country may rise from 1.46 million in 2022 to 1.57 million in 2025. In India, the common cancer burdens are lung, breast, cervical, colon and prostrate.

Several private hospitals in India also offer theranostics for cancer treatment. One of them is New Delhi’s Indraprastha Apollo.

“Actinium-225 is an alpha particle emitter. At present, we are using Lutetium-177 which is a beta emitter. An alpha emitter has both mass and charge and can dissipate a lot of energy in a small area. They have good potential but are expensive," said Dr Dipanjan Panda, senior consultant and medical oncologist, at Indraprastha Apollo.

Questions emailed to a health ministry spokesperson on 18 December remained unanswered.

AIIMS has to treat patients “with what is available", said Dr Bal. “We cannot send back patients. There is huge demand for theranostics. It was introduced in India much before it started in the US. We have even received requests from US residents for getting treatment at AIIMS since it hasn’t been approved by the US FDA yet. The alternative currently available one is from Bhaba Atomic Research Centre (BARC), which is of low quality, which is only 20% effective of what we were getting from Germany which was 100% effective," added Dr Bal.

“The therapy dose includes Lutetium and Actinium which are radionuclides that target the specific area of tumour cell and gets attached and delivers its purpose. There is no further impact on the body. What we are importing from other countries is very small in amount, not matching the requirement in India. The therapy has to be given in four doses in an interval of every eight weeks and the cost of whole course comes close to around ₹23 lakh. At AIIMS, the poor patients are given the treatment available for free from the money received as a part of research grant from ICMR," Dr. Bal said.