The Rhenium-SCT®: A Breakthrough in Non-Melanoma Skin Cancer Treatment

Summary The Rhenium-SCT® is an innovative medical device using the ß-emitter rhenium-188 to treat non-melanoma skin cancer (NMSC). This advanced therapy employs a custom applicator to deliver the radioactive compound directly to the lesion, sparing healthy underlying tissues due to its limited penetration depth of 3 mm. Approved for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) in 2017, it offers a painless and non-invasive alternative to surgery, particularly for patients with large, complex, or surgically ineligible lesions. The ongoing EPIC-Skin Phase IV clinical trial further investigates its efficacy.

Keywords: Rhenium-188; Rhenium-SCT®; Non-Melanoma Skin Cancer (NMSC); Basal Cell Carcinoma (BCC); Squamous Cell Carcinoma (SCC); Beta Radiation Therapy.

Introduction: Addressing the Challenge of Non-Melanoma Skin Cancer

Non-melanoma skin cancer (NMSC) is among the most common cancers globally, with basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) representing the majority of cases. While surgical excision remains the standard treatment, many patients present unique challenges, such as large lesion sizes, difficult-to-treat anatomical locations, or contraindications for surgery. The Rhenium-SCT® emerges as a revolutionary, non-invasive treatment that provides effective alternatives for these patients.

What is the Rhenium-SCT®?

The Rhenium-SCT® is a brachytherapy device designed specifically for the external treatment of NMSC. The core of the technology lies in its use of rhenium-188, a ß-emitter with limited radiation penetration. This ensures that only the targeted cancerous cells up to 3 mm in depth are destroyed, leaving healthy tissues unharmed.

The Treatment Process

• Custom Applicator and Protective Foil: The lesion is first covered with a protective foil, which conforms to its unique dimensions. A custom applicator is then used to apply the rhenium-188 compound.
• Controlled Radiation Exposure: The radiation dose is precisely controlled by adjusting the treatment duration, ensuring optimal effectiveness while minimising risks.
• Instantaneous Deactivation: Once the foil is removed, the radioactive compound can be fully removed, ceasing any further radiation exposure to the patient.

How Rhenium-188 Works

Rhenium-188 emits beta electrons (β–), a type of radiation characterised by its short-range penetration. This is critical for treating superficial lesions such as BCC and SCC, as it targets cancer cells while preserving underlying tissues.

The Fluid Matrix

The rhenium-188 is suspended in a fluid matrix and filled into carpules for application. Upon contact with the protective foil over the lesion, the suspension polymerises, ensuring an even and effective distribution of radiation.

Applications and Advantages of the Rhenium-SCT®

The Rhenium-SCT® is approved for treating BCC and SCC. It has been commercialised since 2017, gaining popularity due to its numerous advantages:

• Painless and Non-Invasive: Patients experience no surgical incisions, making it ideal for those who cannot undergo traditional surgery.
• Precise Treatment: The therapy conforms to the lesion’s size and shape, ensuring that only the affected area is targeted.
• Quick Recovery: The ability to instantaneously deactivate the radioactive compound allows for faster recovery.
• Minimal Side Effects: The limited penetration depth significantly reduces the risk of damaging healthy tissues.
• Accessibility for Complex Lesions: The Rhenium-SCT® is especially beneficial for lesions in challenging locations, such as the nose, ears, cheeks, and areas near the eyes and lips.

The EPIC-Skin Study: A Deeper Dive into Effectiveness

Launched in 2021, the EPIC-Skin Phase IV clinical trial aims to provide comprehensive data on the long-term efficacy and safety of the Rhenium-SCT®. This study will assess:

• Patient outcomes across diverse demographics.
• Effectiveness in treating complex and large lesions.
• Patient satisfaction and quality of life improvements post-treatment.

The Mechanism of Action: A Targeted Approach

The Rhenium-SCT® operates as a brachytherapy device, delivering direct external radiation to the lesion. This targeted approach ensures the destruction of cancerous cells while preserving the surrounding healthy tissue. Its ability to be instantly deactivated upon removal of the protective foil adds another layer of safety, distinguishing it from traditional radiation therapies.

Who Benefits Most?

The Rhenium-SCT® is ideal for:

• Patients Ineligible for Surgery: Those with contraindications for surgery or those at higher risk of complications.
• Patients with Large or Complex Lesions: Especially in sensitive areas such as the face or hands.
• Surgery-Resistant Cases: Patients who have experienced recurrence after previous treatments.

Comparing Rhenium-SCT® to Traditional Treatments

Commercialisation and Global Reach

Since its approval in 2017, the Rhenium-SCT® has been commercialised globally, offering a novel solution to patients worldwide. Its ease of application and broad suitability make it an attractive option for healthcare providers addressing the growing burden of NMSC.

The Future of Rhenium-SCT®

Ongoing research and clinical trials, such as the EPIC-Skin study, aim to expand the understanding and applications of Rhenium-SCT®. Future innovations could include:

• Enhanced delivery systems for improved precision.
• Expanded approvals for other types of superficial cancers.
• Integration into multi-modal treatment strategies.

Conclusion

The Rhenium-SCT® represents a significant advancement in the treatment of non-melanoma skin cancer, offering a painless, precise, and effective alternative to traditional methods. By harnessing the unique properties of rhenium-188, it provides targeted therapy with minimal side effects, particularly benefiting patients with complex or surgically ineligible cases. As research continues to validate and expand its applications, the Rhenium-SCT® stands poised to become a cornerstone in skin cancer treatment.

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