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Radiopharmaceuticals & Theranostics

A molecule that homes to the tumour carries a radioactive atom. The same molecule with a different atom lets you see the tumour first.

Theranostic pairs (68Ga/18F for PET imaging; 177Lu for beta therapy; 225Ac/212Pb for alpha therapy) against PSMA, SSTR, FAP and more. Pluvicto and Lutathera are approved; alpha emitters and new targets are in late-stage trials. Isotope supply is the bottleneck.

Radiopharmaceuticals & Theranostics: how this front works · animated schematic, not to scale

Technologies

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Preclinical
Alpha-emitter nanogenerators and daughter trapping

Actinium-225 releases four alpha particles as it decays, but the daughters escape and irradiate the kidneys and salivary glands. Nanocarriers try to hold them in place.

Preclinical
Auger-electron therapy

Radioactive atoms that spray very short-range electrons, lethal only if the atom sits on or inside the cell's DNA.

Standard of care
Medical cyclotrons, hot cells, and synthesis modules

The particle accelerators and shielded robotic chemistry boxes that make PET tracers in hospital basements and commercial pharmacies.

Established
MIBG imaging and 131I-MIBG therapy

A noradrenaline look-alike that neuroblastoma cells swallow: labelled with a small amount of radioactivity it shows the tumour on a scan; with a large amount it treats it.

Approved
Peptide receptor radionuclide therapy (PRRT)

A radioactive version of the hormone mimic used for the scan; it homes to neuroendocrine tumour cells and irradiates them from inside.

Standard of care
PET tracer manufacturing and distribution

Making PSMA, FDG, and new tracers under drug-manufacturing rules and delivering them daily.

Standard of care
PSMA PET

A prostate-cancer-specific PET scan that finds spread far earlier than CT or bone scan, and tells you whether a matched radioactive drug will work.

Phase 2
Radio-antibody & radio-ADC

Attaching a radioactive atom to an antibody, so an ADC's targeting is used to deliver radiation instead of chemotherapy.

Established
Radioembolisation (TARE / SIRT, yttrium-90)

Millions of tiny radioactive glass or resin beads are injected into the liver artery, lodging in the tumour and irradiating it from within.

Standard of care
Radioiodine therapy and whole-body iodine scanning

Using the thyroid's natural appetite for iodine to image and treat thyroid cancer with a radioactive form of it. The oldest theranostic, and now used more selectively than it was.

Phase 1
Radioligand plus DNA-repair inhibitor combinations

Adding a PARP or ATR inhibitor to a radioactive drug so the tumour cannot repair the damage the radiation causes.

Approved
Radioligand therapy (beta emitters)

A drug that finds tumour cells and carries a radioactive atom that irradiates them from inside the body.

Standard of care
Radionuclide generators and cold kits

Bench-top devices that 'milk' a short-lived isotope from a long-lived parent, plus vials of ready-to-label ligand. How most hospitals make PSMA and somatostatin PET tracers without a cyclotron.

Standard of care
Radiopharmacy and cyclotron networks

The factories and courier routes that make and deliver short-lived radioactive tracers to hospitals within hours.

Standard of care
Somatostatin receptor PET (68Ga/64Cu-DOTATATE)

A PET scan using a radioactive hormone mimic that lights up neuroendocrine tumours and shows whether the matching radioactive treatment will work.

Phase 3
Targeted alpha therapy

Like radioligand therapy but with alpha particles: far more destructive over a much shorter range, so single cells can be killed with less collateral damage.

Established
Therapeutic isotope supply chain (Mo-99, Lu-177, Ac-225)

Where the radioactive atoms for imaging and therapy actually come from: ageing reactors, new accelerators, and a scramble for actinium.

Connected

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technologies

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companies

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institutions

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roadmaps

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