The Power of Astatine-211: From the COST- NOAR Success Story to Clinical Reality

Objectives:
Astatine-211 is emerging as a transformative and promising option in cancer therapy due to its unique properties. The COST Action Network on Optimized Astatine-Labeled Radiopharmaceuticals (NOAR) aimed to establish Astatine-211 as the gold standard for the treatment of certain types of cancer in Europe.
This initiative brings together leading European and international laboratories, manufacturing centers, hospitals, industries, and patient associations from over 20 countries, creating a comprehensive and innovative value chain that spans production, chemistry, radiochemistry, biology, preclinical and clinical research, and the delivery of radiopharmaceuticals to patients.
The goal of this project was to demonstrate that Astatine-211used in targeted alpha therapy (TAT), can be established as the European standard for cancer treatment. Its alpha-emitting properties minimize damage to healthy tissue while maximizing therapeutic effects, offering a safer, more comfortable alternative for patients due to its short half-life of 7.2 hours, potential for outpatient treatment, and improved waste management.
Methods:
The project involved the creation of a European network of dedicated Astatine-211 Treatment Nodes (ATNodes), integrating manufacturing, chemical processing, radiopharmaceutical synthesis, and clinical facilities with uniform quality standards.
During its implementation, the project identified dual pathologies and vectors for which Astatine-211 TAT is relevant, integrated findings to refine therapeutic strategies, and developed internationally harmonized protocols for preclinical and clinical radiation dosimetry.
Methods also included proposing new regulations and practices to standardize care across Europe, promoting Good Manufacturing Practices (GMP), and creating a reference web portal and user community (researchers, clinicians, patients) to increase exposure to Astatine-211 technology for European citizens and industry. Key objectives included enhancing collaboration and knowledge sharing between European and international stakeholders.
Results:
The continued implementation of ATNodes will foster collaboration between researchers from COST member states, neighboring countries, and international partners, establishing a global network dedicated to Astatine-211.
Early results from the five working groups indicate progress in areas such as targeting, manufacturing, extraction, radiopharmaceutical development, dosimetry optimization, and clinical application. The project has generated significant interest in Astatine-211 production, bolstered European expertise, and established partnerships that provide critical mass for continued collaboration.
A key initiative was the training of Early Career Investigators (ECIs) and PhD students through Short-Term Scientific Missions (STSM), promoting interdisciplinary collaboration and mobility.
Conclusions:
The COST NOAR action has facilitated efficient interdisciplinary, cross-sectoral, and international knowledge exchange, promoting collaboration between European and international stakeholders to advance the medical applications of Astatine-211.
The initiative has led to increased interest in production capacity, optimized transport conditions, advances in radiolabeling chemistry, and progress in the development of new radiopharmaceuticals.
Astatine-211 nodes strategically located across Europe will serve as innovation hubs, integrating cyclotrons, radiopharmacy, imaging centers, and patient injection facilities.
By standardizing treatment protocols and ensuring equitable access to state-of-the-art cancer therapies, NOAR aims to improve cancer treatment across Europe.
The project also provided valuable insights into national research systems, encouraging organizational improvements in line with best practices. The continued success of NOAR will depend on further collaborations and the expansion of Astatine-211 TAT technology, contributing to the global fight against cancer.