# Fund alpha emitters beyond actinium-225: lead-212, terbium-149 and astatine-211

Source: https://onco.cc/ideas/idea-reg-alpha-emitter-portfolio/  
OnCo record `idea-reg-alpha-emitter-portfolio` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Almost every alpha cancer therapy in development relies on one scarce isotope. Developing several alternatives at once would stop the whole field waiting on a single supply chain.

## Summary

Actinium-225 dominates targeted alpha therapy pipelines, but lead-212 (from thorium-228/radium-224 generators, used by Orano Med and Perspective Therapeutics), astatine-211 (cyclotron-produced, short half-life, suited to regional supply) and terbium-149 have complementary properties and independent supply routes. The proposal is a public-private programme that funds isotope-agnostic chelator and linker chemistry, comparative dosimetry and small head-to-head clinical studies so that a given targeting ligand can be paired with whichever alpha emitter is available, and that de-risks generator and cyclotron capacity for each.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Within five years at least two alpha emitters other than actinium-225 reach late-stage trials with GMP supply exceeding clinical demand, and the proportion of alpha therapy trials delayed by isotope supply falls below 10%.
- Rationale: Diversifying supply has repeatedly been cheaper than expanding a single constrained route; lead-212 generators are already in clinical use and astatine-211 chemistry has matured at several centres.
- Proposed test: Award funding to three ligand programmes to produce matched actinium-225, lead-212 and astatine-211 versions and compare biodistribution, dosimetry and manufacturability in first-in-human studies.
- Maturity: preclinical-evidence
- Actor: philanthropy

## Sources

- Bottleneck evidence (Manufacturing cost and time for living and radioactive medicines): Hernandez, Prasad & Gellad, Total costs of chimeric antigen receptor T-cell immunotherapy (JAMA Oncology 2018): https://doi.org/10.1001/jamaoncol.2018.0977

## Connected records

- technologies: [Targeted alpha therapy](https://onco.cc/technologies/targeted-alpha-therapy/)
- companies: [Orano Med](https://onco.cc/companies/orano-med/), [Perspective Therapeutics](https://onco.cc/companies/perspective-therapeutics/)
- terms: [Alpha vs beta emitters](https://onco.cc/terms/alpha-vs-beta/)
- bottlenecks: [Manufacturing cost and time for living and radioactive medicines](https://onco.cc/bottlenecks/b-manufacturing-cell-therapy/)
- key papers: [Total Costs of Chimeric Antigen Receptor T-Cell Immunotherapy](https://onco.cc/key-papers/paper-hernandez-jama-oncol/)

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