# Radiopharmaceutical roadmap: iodine → lutetium → actinium

Source: https://onco.cc/roadmaps/radiopharma-roadmap/  
OnCo record `radiopharma-roadmap` (Roadmap). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

The radiopharmaceutical roadmap runs eighty years from radioactive iodine for thyroid cancer to alpha-emitting drugs for prostate and neuroendocrine cancers, with isotope supply as the limiting factor.

## Summary

The radiopharmaceutical roadmap runs from radioiodine curing differentiated thyroid cancer, the first theranostic, through radium-223 and Lutathera with its matched 68Ga-DOTATATE PET, to PSMA PET and Pluvicto building the first radioligand franchise. The current steps move Pluvicto and Lutathera into earlier lines amid an M&A wave, while the emerging step brings 225Ac and 212Pb alpha emitters and new targets such as FAP, GRPR, CAIX and B7-H3 into trials, with isotope supply as the limiting factor. The speculative end imagines radioligands as a standard modality with pan-cancer FAP theranostics and personalised dosimetry. The route links radioligand therapy, targeted alpha therapy, PSMA PET and FAPI PET, prostate, thyroid and neuroendocrine cancers, and the manufacturing bottleneck.

## Fields

- Kind: Roadmap
- Last checked: 2026-09-04

## Sources

- VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer (New England Journal of Medicine 2021): https://doi.org/10.1056/NEJMoa2107322

## Connected records

- roadmaps: [Hormonal therapy roadmap: removing the ovaries → tamoxifen → oral degraders switched by a blood test](https://onco.cc/roadmaps/hormonal-therapy-roadmap/), [Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch](https://onco.cc/roadmaps/prostate-roadmap/), [Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH](https://onco.cc/roadmaps/radiation-roadmap/)
- fronts: [Radiopharmaceuticals & Theranostics](https://onco.cc/fronts/radiopharma/)
- technologies: [FAPI PET](https://onco.cc/technologies/fapi-pet/), [PET/CT](https://onco.cc/technologies/pet-ct/), [PSMA PET](https://onco.cc/technologies/psma-pet/), [Radio-antibody & radio-ADC](https://onco.cc/technologies/radioimmunotherapy/), [Radioligand therapy (beta emitters)](https://onco.cc/technologies/radioligand-therapy/), [Targeted alpha therapy](https://onco.cc/technologies/targeted-alpha-therapy/)
- cancers: [Neuroendocrine tumours](https://onco.cc/cancers/neuroendocrine/), [Prostate cancer](https://onco.cc/cancers/prostate/), [Thyroid cancer](https://onco.cc/cancers/thyroid/)
- drugs: [Actinium-225 DOTATATE](https://onco.cc/drugs/ryz101/), [Actinium-225 PSMA agents](https://onco.cc/drugs/ac225-psma/), [FAP-2286 (177Lu / 68Ga)](https://onco.cc/drugs/fap-2286/), [Lutetium-177 dotatate](https://onco.cc/drugs/lutathera/), [Lutetium-177 vipivotide tetraxetan](https://onco.cc/drugs/pluvicto/), [Piflufolastat F-18 / Pylarify TruVu](https://onco.cc/drugs/pylarify/)
- targets: [Somatostatin receptor 2](https://onco.cc/targets/sstr2/)
- trials: [PSMAfore](https://onco.cc/trials/psmafore/), [VISION](https://onco.cc/trials/vision/)
- companies: [Fusion Pharmaceuticals (AstraZeneca)](https://onco.cc/companies/fusion-pharma/), [ITM Isotope Technologies Munich](https://onco.cc/companies/itm/), [Orano Med](https://onco.cc/companies/orano-med/), [RayzeBio (BMS)](https://onco.cc/companies/rayzebio/), [TerraPower Isotopes](https://onco.cc/companies/terrapower-isotopes/)
- terms: [Dosimetry](https://onco.cc/terms/dosimetry/)
- pairings: [Beta radioligand → alpha radioligand](https://onco.cc/pairings/beta-then-alpha/)
- bottlenecks: [Manufacturing cost and time for living and radioactive medicines](https://onco.cc/bottlenecks/b-manufacturing-cell-therapy/)
- ideas: [A university cyclotron network with shared regulatory files for new tracers](https://onco.cc/ideas/idea-fund-academic-radiopharma-pipeline/)

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