{"format":{"id":"radioligand","name":"Radioligands","blurb":"A ligand that binds the target, a chelator that holds the metal, and an isotope whose emission does the work; beta emitters travel millimetres, alpha emitters micrometres.","route":"/modalities/radioligand/","engine":"/pipeline/engine/radioligand/"},"counts":{"drugs":17,"approved":7,"phase3":8,"trials":10,"companies":15,"papers":3,"ideas":22,"eras":13},"how":{"paragraphs":["A drug that finds tumour cells and carries a radioactive atom that irradiates them from inside the body.","177Lu emits beta particles with ~2 mm range and gamma photons for SPECT imaging; the ligand determines biodistribution."],"from":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}],"technologies":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/","status":"approved","tldr":"A drug that finds tumour cells and carries a radioactive atom that irradiates them from inside the body."},{"id":"lu177-radioligand-therapy","kind":"technology","name":"Lutetium-177 radioligand therapy","route":"/technologies/lu177-radioligand-therapy/","status":"approved","tldr":"Cancer-seeking molecules carrying the radioactive metal lutetium-177, which delivers short-range radiation to tumours it binds; approved for neuroendocrine tumours and prostate cancer."},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/","status":"phase-3","tldr":"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."},{"id":"prrt","kind":"technology","name":"Peptide receptor radionuclide therapy (PRRT)","route":"/technologies/prrt/","status":"approved","tldr":"A radioactive version of the hormone mimic used for the scan; it homes to neuroendocrine tumour cells and irradiates them from inside."},{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/","status":"phase-2","tldr":"Attaching a radioactive atom to an antibody, so an ADC's targeting is used to deliver radiation instead of chemotherapy."},{"id":"radioiodine-therapy","kind":"technology","name":"Radioiodine therapy and whole-body iodine scanning","route":"/technologies/radioiodine-therapy/","status":"standard-of-care","tldr":"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."},{"id":"mibg-theranostics","kind":"technology","name":"MIBG imaging and 131I-MIBG therapy","route":"/technologies/mibg-theranostics/","status":"established","tldr":"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."},{"id":"astatine-211-alpha-therapy","kind":"technology","name":"Astatine-211 alpha therapy","route":"/technologies/astatine-211-alpha-therapy/","status":"phase-1","tldr":"A rare alpha-emitting halogen that can be attached to antibodies and small molecules like iodine, tested in leukaemia conditioning and brain and ovarian cancer."},{"id":"radioligand-dosimetry","kind":"technology","name":"Radioligand dosimetry","route":"/technologies/radioligand-dosimetry/","status":"established","tldr":"Measuring, from scans taken after each dose, how much radiation a radioligand actually delivers to the tumour and to kidneys and marrow, so treatment can be personalised."},{"id":"radionuclide-parp-combination","kind":"technology","name":"Radioligand plus DNA-repair inhibitor combinations","route":"/technologies/radionuclide-parp-combination/","status":"phase-1","tldr":"Adding a PARP or ATR inhibitor to a radioactive drug so the tumour cannot repair the damage the radiation causes."},{"id":"alpha-nanogenerators","kind":"technology","name":"Alpha-emitter nanogenerators and daughter trapping","route":"/technologies/alpha-nanogenerators/","status":"preclinical","tldr":"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."},{"id":"therapy-isotope-supply-chain","kind":"technology","name":"Therapeutic isotope supply chain (Mo-99, Lu-177, Ac-225)","route":"/technologies/therapy-isotope-supply-chain/","status":"established","tldr":"Where the radioactive atoms for imaging and therapy actually come from: ageing reactors, new accelerators, and a scramble for actinium."},{"id":"actinium-225-supply","kind":"technology","name":"Actinium-225 supply: thorium stocks, accelerators and radium targets","route":"/technologies/actinium-225-supply/","status":"phase-3","tldr":"Actinium-225 is the alpha-emitting atom behind the most promising next wave of radioligand therapies, and there is not enough of it. Almost all of it used to come from one decaying stock of thorium in a US national laboratory. New routes use accelerators and old radium."},{"id":"research-reactor-isotope-production","kind":"technology","name":"Research reactors for medical isotopes (Mo-99, Lu-177, I-131)","route":"/technologies/research-reactor-isotope-production/","status":"standard-of-care","tldr":"Most of the world's therapeutic and scanning isotopes are made by putting targets into about half a dozen ageing research reactors and flying the product out within days. When two reactors were down at once in 2009 and 2010, hospitals worldwide ran short of the most used scan isotope."},{"id":"cyclotron-isotope-production","kind":"technology","name":"Cyclotron isotope production (F-18, Ga-68, Cu-64, Zr-89, At-211)","route":"/technologies/cyclotron-isotope-production/","status":"standard-of-care","tldr":"Proton-rich isotopes for PET scans and some therapies are made by hitting a target with a beam from a cyclotron. Fluorine-18 is made every morning within driving distance of the scanner; gallium-68 comes from either a generator or a cyclotron; copper-64 and zirconium-89 last long enough to ship across a country."},{"id":"radiopharmaceutical-gmp-release","kind":"technology","name":"Radiopharmaceutical GMP and releasing a drug that decays","route":"/technologies/radiopharmaceutical-gmp-release/","status":"standard-of-care","tldr":"A radioactive medicine loses activity every hour, so it is made to order, tested in hours and often injected before the sterility test has finished. The rules for that are different from ordinary drugs, and the handful of plants that make lutetium therapies have had their own shortages."},{"id":"radiopharmacy-network","kind":"technology","name":"Radiopharmacy and cyclotron networks","route":"/technologies/radiopharmacy-network/","status":"standard-of-care","tldr":"The factories and courier routes that make and deliver short-lived radioactive tracers to hospitals within hours."}]},"terms":[{"id":"theranostics","kind":"term","name":"Theranostics","route":"/terms/theranostics/","tldr":"Using the same targeting molecule for a diagnostic scan and a therapy, so you treat exactly what you can see.","category":"Treatment jargon"},{"id":"rai-refractory","kind":"term","name":"Radioiodine-refractory (RAI-R) thyroid cancer","route":"/terms/rai-refractory/","tldr":"Thyroid cancer that no longer takes up radioactive iodine, or keeps growing despite it. This is when kinase inhibitor pills come in.","category":"Clinical"},{"id":"alpha-vs-beta","kind":"term","name":"Alpha vs beta emitters","route":"/terms/alpha-vs-beta/","tldr":"Beta particles (lutetium-177) travel millimetres and are good for bulky disease; alpha particles (actinium-225) travel a few cells' width and kill with far higher energy.","category":"Treatment jargon"},{"id":"dosimetry","kind":"term","name":"Dosimetry","route":"/terms/dosimetry/","tldr":"Measuring how much radiation dose each organ and tumour actually received from a radioactive drug.","category":"Treatment jargon"}],"engine":{"route":"/pipeline/engine/radioligand/","axes":["Target","Isotope"],"rows":7,"cols":7,"counts":{"approved":7,"development":5,"stopped":0,"unclear":0,"untried":37},"placed":16,"total":17,"pct":94},"approved":[{"drug":{"id":"radioactive-iodine","kind":"drug","name":"Radioactive iodine (I-131)","route":"/drugs/radioactive-iodine/"},"brand":"Sodium iodide I-131","status":"approved","modality":"Radiopharmaceutical (beta/gamma emitter, natural uptake)","cancers":[{"id":"thyroid","kind":"cancer","name":"Thyroid cancer","route":"/cancers/thyroid/"}],"indications":["Hyperthyroidism and thyroid carcinoma (first radiopharmaceutical approval)"],"years":[1951],"firstYear":1951,"regions":["US"],"target":{"key":"target","id":"nis","name":"Sodium-iodide symporter (NIS)"},"companies":[]},{"drug":{"id":"samarium-153-lexidronam","kind":"drug","name":"Samarium-153 lexidronam","route":"/drugs/samarium-153-lexidronam/"},"brand":"Quadramet","status":"approved","modality":"Bone-seeking therapeutic radiopharmaceutical (beta emitter)","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"nsclc","kind":"cancer","name":"Non-small-cell lung cancer","route":"/cancers/nsclc/"}],"indications":["Relief of pain in patients with confirmed osteoblastic metastatic bone lesions that enhance on radionuclide bone scan","Relief of bone pain from multiple painful osteoblastic skeletal metastases (Quadramet)"],"years":[1997,1998],"firstYear":1997,"regions":["US","EU"],"target":{"key":"target","id":"psma","name":"PSMA","href":"/targets/psma/"},"companies":[{"id":"curium","kind":"company","name":"Curium","route":"/companies/curium/"},{"id":"lantheus","kind":"company","name":"Lantheus","route":"/companies/lantheus/"}]},{"drug":{"id":"ibritumomab-tiuxetan","kind":"drug","name":"Ibritumomab tiuxetan","route":"/drugs/ibritumomab-tiuxetan/"},"brand":"Zevalin","status":"approved","modality":"Radioimmunotherapy (yttrium-90 labelled anti-CD20 antibody)","cancers":[{"id":"follicular-lymphoma","kind":"cancer","name":"Follicular lymphoma","route":"/cancers/follicular-lymphoma/"}],"indications":["Relapsed or refractory low-grade, follicular or transformed B-cell NHL including rituximab-refractory follicular lymphoma","Consolidation after first-line chemotherapy in previously untreated follicular NHL","Rituximab-relapsed or refractory CD20-positive follicular lymphoma; first-line consolidation added 2008"],"years":[2002,2004,2009],"firstYear":2002,"regions":["US","EU"],"target":{"key":"target","id":"cd20","name":"CD20","href":"/targets/cd20/"},"companies":[{"id":"acrotech-biopharma","kind":"company","name":"Acrotech Biopharma","route":"/companies/acrotech-biopharma/"}]},{"drug":{"id":"radium-223","kind":"drug","name":"Radium-223 dichloride","route":"/drugs/radium-223/"},"brand":"Xofigo","status":"approved","modality":"Targeted alpha therapy (bone-seeking)","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"}],"indications":["Symptomatic bone-metastatic CRPC without visceral disease"],"years":[2013],"firstYear":2013,"regions":["US"],"target":{"key":"target","id":"psma","name":"PSMA","href":"/targets/psma/"},"companies":[{"id":"bayer","kind":"company","name":"Bayer","route":"/companies/bayer/"}]},{"drug":{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},"brand":"Lutathera","status":"approved","modality":"Radioligand therapy (beta)","cancers":[{"id":"neuroendocrine","kind":"cancer","name":"Neuroendocrine tumours","route":"/cancers/neuroendocrine/"},{"id":"small-intestinal-net","kind":"cancer","name":"Small intestinal neuroendocrine tumours","route":"/cancers/small-intestinal-net/"},{"id":"pancreatic-net","kind":"cancer","name":"Pancreatic neuroendocrine tumours","route":"/cancers/pancreatic-net/"},{"id":"grade-3-net","kind":"cancer","name":"Grade 3 well-differentiated neuroendocrine tumour","route":"/cancers/grade-3-net/"},{"id":"metastatic-ppgl","kind":"cancer","name":"Metastatic pheochromocytoma and paraganglioma","route":"/cancers/metastatic-ppgl/"},{"id":"esthesioneuroblastoma","kind":"cancer","name":"Esthesioneuroblastoma (olfactory neuroblastoma)","route":"/cancers/esthesioneuroblastoma/"}],"indications":["SSTR+ GEP-NETs","Paediatric ≥12 years; first-line (NETTER-2 label)","First approval globally (Sep 2017)"],"years":[2017,2018,2024],"firstYear":2017,"regions":["US","EU"],"target":{"key":"target","id":"sstr2","name":"Somatostatin receptor 2","href":"/targets/sstr2/"},"companies":[{"id":"novartis","kind":"company","name":"Novartis","route":"/companies/novartis/"}]},{"drug":{"id":"i131-mibg","kind":"drug","name":"131I-MIBG (iobenguane I-131) therapy","route":"/drugs/i131-mibg/"},"brand":"Azedra","status":"established","modality":"Radioligand therapy (beta, norepinephrine transporter)","cancers":[{"id":"neuroblastoma","kind":"cancer","name":"Neuroblastoma (paediatric)","route":"/cancers/neuroblastoma/"},{"id":"neuroblastoma-high-risk","kind":"cancer","name":"High-risk neuroblastoma","route":"/cancers/neuroblastoma-high-risk/"},{"id":"metastatic-ppgl","kind":"cancer","name":"Metastatic pheochromocytoma and paraganglioma","route":"/cancers/metastatic-ppgl/"},{"id":"neuroendocrine","kind":"cancer","name":"Neuroendocrine tumours","route":"/cancers/neuroendocrine/"}],"indications":["Iobenguane scan-positive unresectable, locally advanced or metastatic phaeochromocytoma or paraganglioma in patients 12 and older (Azedra, high-specific-activity form; discontinued 2024)"],"years":[2018],"firstYear":2018,"regions":["US"],"target":{"key":"target","id":"net","name":"Norepinephrine transporter"},"companies":[{"id":"lantheus","kind":"company","name":"Lantheus","route":"/companies/lantheus/"}]},{"drug":{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},"brand":"Pluvicto","status":"approved","modality":"Radioligand therapy (beta)","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"},{"id":"prostate-mhspc","kind":"cancer","name":"Metastatic hormone-sensitive prostate cancer","route":"/cancers/prostate-mhspc/"}],"indications":["PSMA+ mCRPC after ARPI and taxane","PSMA+ mCRPC after ARPI, before chemotherapy","Label expansion (July 2026)","mCRPC post-ARPI and taxane; pre-chemo 2025"],"years":[2022,2025,2026],"firstYear":2022,"regions":["US","EU"],"target":{"key":"target","id":"psma","name":"PSMA","href":"/targets/psma/"},"companies":[{"id":"advanced-accelerator-applications","kind":"company","name":"Advanced Accelerator Applications (Novartis)","route":"/companies/advanced-accelerator-applications/"},{"id":"novartis","kind":"company","name":"Novartis","route":"/companies/novartis/"}]}],"phase3":[{"drug":{"id":"itm-11","kind":"drug","name":"177Lu-edotreotide","route":"/drugs/itm-11/"},"status":"phase-3","modality":"Radioligand therapy (beta)","cancers":[{"id":"neuroendocrine","kind":"cancer","name":"Neuroendocrine tumours","route":"/cancers/neuroendocrine/"},{"id":"grade-3-net","kind":"cancer","name":"Grade 3 well-differentiated neuroendocrine tumour","route":"/cancers/grade-3-net/"}],"target":{"key":"target","id":"sstr2","name":"Somatostatin receptor 2","href":"/targets/sstr2/"},"trials":[{"id":"nct04919226","kind":"trial","name":"Lutetium 177Lu-Edotreotide Versus Best Standard of Care in Well-differentiated Aggressive Grade-2 and Grade-3 GastroEnteroPancreatic NeuroEndocrine Tumors (GEP-NETs) - COMPOSE","route":"/trials/nct04919226/"}],"companies":[{"id":"itm","kind":"company","name":"ITM Isotope Technologies Munich","route":"/companies/itm/"}],"recruiting":9},{"drug":{"id":"lu177-psma-it","kind":"drug","name":"177Lu-PSMA-I&T","route":"/drugs/lu177-psma-it/"},"status":"phase-3","modality":"Radioligand therapy (beta)","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"}],"target":{"key":"target","id":"psma","name":"PSMA","href":"/targets/psma/"},"trials":[],"companies":[{"id":"curium","kind":"company","name":"Curium","route":"/companies/curium/"},{"id":"lantheus","kind":"company","name":"Lantheus","route":"/companies/lantheus/"}],"recruiting":4},{"drug":{"id":"aaa817","kind":"drug","name":"AAA817","route":"/drugs/aaa817/"},"status":"phase-3","modality":"radioligand","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"target":{"key":"target","id":"psma","name":"PSMA","href":"/targets/psma/"},"trials":[{"id":"nct06855277","kind":"trial","name":"Study Comparing AAA817+ARPI Versus Standard of Care in Adult Participants With PSMA-positive mCRPC","route":"/trials/nct06855277/"},{"id":"nct06780670","kind":"trial","name":"Open-label Study Comparing AAA817 Versus Standard of Care in the Treatment of Previously Treated PSMA-positive mCRPC Adults Who Have Disease Progressed on or After [177Lu]Lu-PSMA Targeted Therapy","route":"/trials/nct06780670/"}],"companies":[{"id":"novartis","kind":"company","name":"Novartis","route":"/companies/novartis/"}],"recruiting":2},{"drug":{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},"status":"phase-3","modality":"Targeted alpha therapy","cancers":[{"id":"neuroendocrine","kind":"cancer","name":"Neuroendocrine tumours","route":"/cancers/neuroendocrine/"},{"id":"sclc","kind":"cancer","name":"Small-cell lung cancer","route":"/cancers/sclc/"}],"target":{"key":"target","id":"sstr2","name":"Somatostatin receptor 2","href":"/targets/sstr2/"},"trials":[{"id":"action-1","kind":"trial","name":"ACTION-1","route":"/trials/action-1/"}],"companies":[{"id":"bms","kind":"company","name":"Bristol Myers Squibb","route":"/companies/bms/"},{"id":"rayzebio","kind":"company","name":"RayzeBio (BMS)","route":"/companies/rayzebio/"}],"recruiting":1},{"drug":{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},"status":"phase-3","modality":"Targeted alpha therapy","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"}],"target":{"key":"target","id":"psma","name":"PSMA","href":"/targets/psma/"},"trials":[],"companies":[{"id":"astrazeneca","kind":"company","name":"AstraZeneca","route":"/companies/astrazeneca/"},{"id":"bayer","kind":"company","name":"Bayer","route":"/companies/bayer/"},{"id":"fusion-pharma","kind":"company","name":"Fusion Pharmaceuticals (AstraZeneca)","route":"/companies/fusion-pharma/"},{"id":"novartis","kind":"company","name":"Novartis","route":"/companies/novartis/"}],"recruiting":0},{"drug":{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},"status":"phase-2","modality":"Theranostic pair (peptide radioligand)","cancers":[{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"},{"id":"sarcoma","kind":"cancer","name":"Sarcomas (soft tissue, bone, GIST)","route":"/cancers/sarcoma/"},{"id":"tnbc","kind":"cancer","name":"Triple-negative breast cancer (TNBC)","route":"/cancers/tnbc/"}],"target":{"key":"target","id":"fap","name":"FAP","href":"/targets/fap/"},"trials":[{"id":"nct05939414","kind":"trial","name":"An Open-label Study Comparing Lutetium (177Lu) Vipivotide Tetraxetan Versus Observation in PSMA Positive OMPC.","route":"/trials/nct05939414/"},{"id":"nct06520345","kind":"trial","name":"The Study of 177Lu-TLX591 Plus SOC Versus SOC Alone in Patients With mCRPC (ProstACT Global)","route":"/trials/nct06520345/"},{"id":"nct07219238","kind":"trial","name":"Study to Evaluate the Diagnostic Performance of GEH300079 (68Ga) Injection PET/CT for Detection of PC in Patients With Colorectal, Gastric, Ovarian, o","route":"/trials/nct07219238/"}],"companies":[{"id":"novartis","kind":"company","name":"Novartis","route":"/companies/novartis/"}],"recruiting":1},{"drug":{"id":"fpi-2265","kind":"drug","name":"FPI-2265","route":"/drugs/fpi-2265/"},"status":"phase-2","modality":"radioligand","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"target":{"key":"target","id":"psma","name":"PSMA","href":"/targets/psma/"},"trials":[{"id":"nct07611110","kind":"trial","name":"AZD2265 Compared With Standard of Care in PSMA-positive Metastatic Castration-resistant Prostate Cancer (VECTRA-01)","route":"/trials/nct07611110/"}],"companies":[{"id":"astrazeneca","kind":"company","name":"AstraZeneca","route":"/companies/astrazeneca/"}],"recruiting":2},{"drug":{"id":"iomab-b","kind":"drug","name":"Iomab-B","route":"/drugs/iomab-b/"},"status":"phase-3","modality":"Radioimmunotherapy conditioning agent (anti-CD45 antibody labelled with iodine-131)","cancers":[{"id":"aml","kind":"cancer","name":"Acute myeloid leukaemia","route":"/cancers/aml/"}],"target":{"key":"target","id":"ptprc","name":"PTPRC","href":"/targets/ptprc/"},"trials":[{"id":"nct02665065","kind":"trial","name":"Study of Iomab-B vs. Conventional Care in Older Subjects With Active, Relapsed or Refractory Acute Myeloid Leukemia","route":"/trials/nct02665065/"}],"companies":[{"id":"actinium-pharmaceuticals","kind":"company","name":"Actinium Pharmaceuticals","route":"/companies/actinium-pharmaceuticals/"}],"recruiting":1}],"components":[{"key":"target","label":"Target","values":[{"key":"target","id":"psma","name":"PSMA","href":"/targets/psma/","count":7,"drugIds":["lu177-psma-it","aaa817","ac225-psma","fpi-2265","pluvicto","radium-223","samarium-153-lexidronam"],"states":{"approved":3,"development":4,"stopped":0,"unclear":0}},{"key":"target","id":"sstr2","name":"Somatostatin receptor 2","href":"/targets/sstr2/","count":4,"drugIds":["itm-11","alphamedix","ryz101","lutathera"],"states":{"approved":1,"development":3,"stopped":0,"unclear":0}},{"key":"target","id":"cd20","name":"CD20","href":"/targets/cd20/","count":1,"drugIds":["ibritumomab-tiuxetan"],"states":{"approved":1,"development":0,"stopped":0,"unclear":0}},{"key":"target","id":"fap","name":"FAP","href":"/targets/fap/","count":1,"drugIds":["fap-2286"],"states":{"approved":0,"development":1,"stopped":0,"unclear":0}},{"key":"target","id":"net","name":"Norepinephrine transporter","count":1,"drugIds":["i131-mibg"],"states":{"approved":1,"development":0,"stopped":0,"unclear":0}},{"key":"target","id":"ptprc","name":"PTPRC","href":"/targets/ptprc/","count":1,"drugIds":["iomab-b"],"states":{"approved":0,"development":1,"stopped":0,"unclear":0}},{"key":"target","id":"nis","name":"Sodium-iodide symporter (NIS)","count":1,"drugIds":["radioactive-iodine"],"states":{"approved":1,"development":0,"stopped":0,"unclear":0}}],"route":"/pipeline/engine/radioligand/#table"},{"key":"isotope","label":"Isotope","values":[{"key":"isotope","id":"lu-177","name":"Lutetium-177","href":"/isotopes/#lu-177","count":5,"drugIds":["itm-11","lu177-psma-it","fap-2286","lutathera","pluvicto"],"states":{"approved":2,"development":3,"stopped":0,"unclear":0}},{"key":"isotope","id":"ac-225","name":"Actinium-225","href":"/isotopes/#ac-225","count":4,"drugIds":["aaa817","ryz101","ac225-psma","fpi-2265"],"states":{"approved":0,"development":4,"stopped":0,"unclear":0}},{"key":"isotope","id":"i-131","name":"Iodine-131","href":"/isotopes/#i-131","count":3,"drugIds":["i131-mibg","iomab-b","radioactive-iodine"],"states":{"approved":2,"development":1,"stopped":0,"unclear":0}},{"key":"isotope","id":"pb-212","name":"Lead-212","href":"/isotopes/#pb-212","count":1,"drugIds":["alphamedix"],"states":{"approved":0,"development":1,"stopped":0,"unclear":0}},{"key":"isotope","id":"ra-223","name":"Radium-223","href":"/isotopes/#ra-223","count":1,"drugIds":["radium-223"],"states":{"approved":1,"development":0,"stopped":0,"unclear":0}},{"key":"isotope","id":"sm-153","name":"Samarium-153","count":1,"drugIds":["samarium-153-lexidronam"],"states":{"approved":1,"development":0,"stopped":0,"unclear":0}},{"key":"isotope","id":"y-90","name":"Yttrium-90","href":"/isotopes/#y-90","count":1,"drugIds":["ibritumomab-tiuxetan"],"states":{"approved":1,"development":0,"stopped":0,"unclear":0}}],"route":"/pipeline/engine/radioligand/#table"},{"key":"emission","label":"Emission","values":[{"key":"emission","id":"beta","name":"Beta emitter","href":"/technologies/radioligand-therapy/","count":10,"drugIds":["i131-mibg","itm-11","lu177-psma-it","fap-2286","ibritumomab-tiuxetan","iomab-b","lutathera","pluvicto","radioactive-iodine","samarium-153-lexidronam"],"states":{"approved":6,"development":4,"stopped":0,"unclear":0}},{"key":"emission","id":"alpha","name":"Alpha emitter","href":"/technologies/targeted-alpha-therapy/","count":6,"drugIds":["alphamedix","aaa817","ryz101","ac225-psma","fpi-2265","radium-223"],"states":{"approved":1,"development":5,"stopped":0,"unclear":0}}],"route":"/pipeline/engine/radioligand/#table"},{"key":"ligand","label":"Ligand class","values":[{"key":"ligand","id":"small-molecule","name":"Small-molecule ligand","count":6,"drugIds":["i131-mibg","lu177-psma-it","aaa817","ac225-psma","fpi-2265","pluvicto"],"states":{"approved":2,"development":4,"stopped":0,"unclear":0}},{"key":"ligand","id":"peptide","name":"Peptide","href":"/technologies/prrt/","count":5,"drugIds":["itm-11","alphamedix","ryz101","fap-2286","lutathera"],"states":{"approved":1,"development":4,"stopped":0,"unclear":0}},{"key":"ligand","id":"antibody","name":"Antibody","href":"/technologies/radioimmunotherapy/","count":2,"drugIds":["ibritumomab-tiuxetan","iomab-b"],"states":{"approved":1,"development":1,"stopped":0,"unclear":0}},{"key":"ligand","id":"bone-seeker","name":"Bone-seeking mimetic","count":2,"drugIds":["radium-223","samarium-153-lexidronam"],"states":{"approved":2,"development":0,"stopped":0,"unclear":0}},{"key":"ligand","id":"substrate","name":"Transporter substrate","count":1,"drugIds":["radioactive-iodine"],"states":{"approved":1,"development":0,"stopped":0,"unclear":0}}],"route":"/pipeline/engine/radioligand/#table"},{"key":"chelator","label":"Chelator","values":[{"key":"chelator","id":"dota","name":"DOTA","count":6,"drugIds":["itm-11","alphamedix","ryz101","fap-2286","lutathera","pluvicto"],"states":{"approved":2,"development":4,"stopped":0,"unclear":0}},{"key":"chelator","id":"dotaga","name":"DOTAGA","count":1,"drugIds":["lu177-psma-it"],"states":{"approved":0,"development":1,"stopped":0,"unclear":0}},{"key":"chelator","id":"edtmp","name":"EDTMP","count":1,"drugIds":["samarium-153-lexidronam"],"states":{"approved":1,"development":0,"stopped":0,"unclear":0}}],"route":"/pipeline/engine/radioligand/#table"}],"companies":[{"company":{"id":"novartis","kind":"company","name":"Novartis","route":"/companies/novartis/"},"country":"CH","companyType":"pharma","drugs":[{"id":"aaa817","kind":"drug","name":"AAA817","route":"/drugs/aaa817/"},{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"}],"approved":2,"phase3":3},{"company":{"id":"lantheus","kind":"company","name":"Lantheus","route":"/companies/lantheus/"},"country":"US","companyType":"radiopharma","drugs":[{"id":"i131-mibg","kind":"drug","name":"131I-MIBG (iobenguane I-131) therapy","route":"/drugs/i131-mibg/"},{"id":"lu177-psma-it","kind":"drug","name":"177Lu-PSMA-I&T","route":"/drugs/lu177-psma-it/"},{"id":"samarium-153-lexidronam","kind":"drug","name":"Samarium-153 lexidronam","route":"/drugs/samarium-153-lexidronam/"}],"approved":2,"phase3":1},{"company":{"id":"bayer","kind":"company","name":"Bayer","route":"/companies/bayer/"},"country":"DE","companyType":"pharma","drugs":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"radium-223","kind":"drug","name":"Radium-223 dichloride","route":"/drugs/radium-223/"}],"approved":1,"phase3":1},{"company":{"id":"curium","kind":"company","name":"Curium","route":"/companies/curium/"},"country":"FR","companyType":"radiopharma","drugs":[{"id":"lu177-psma-it","kind":"drug","name":"177Lu-PSMA-I&T","route":"/drugs/lu177-psma-it/"},{"id":"samarium-153-lexidronam","kind":"drug","name":"Samarium-153 lexidronam","route":"/drugs/samarium-153-lexidronam/"}],"approved":1,"phase3":1},{"company":{"id":"astrazeneca","kind":"company","name":"AstraZeneca","route":"/companies/astrazeneca/"},"country":"GB","companyType":"pharma","drugs":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"fpi-2265","kind":"drug","name":"FPI-2265","route":"/drugs/fpi-2265/"}],"approved":0,"phase3":2},{"company":{"id":"acrotech-biopharma","kind":"company","name":"Acrotech Biopharma","route":"/companies/acrotech-biopharma/"},"country":"US","companyType":"pharma","drugs":[{"id":"ibritumomab-tiuxetan","kind":"drug","name":"Ibritumomab tiuxetan","route":"/drugs/ibritumomab-tiuxetan/"}],"approved":1,"phase3":0},{"company":{"id":"advanced-accelerator-applications","kind":"company","name":"Advanced Accelerator Applications (Novartis)","route":"/companies/advanced-accelerator-applications/"},"country":"FR","companyType":"radiopharma","drugs":[{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"}],"approved":1,"phase3":0},{"company":{"id":"actinium-pharmaceuticals","kind":"company","name":"Actinium Pharmaceuticals","route":"/companies/actinium-pharmaceuticals/"},"country":"US","companyType":"radiopharma","drugs":[{"id":"iomab-b","kind":"drug","name":"Iomab-B","route":"/drugs/iomab-b/"}],"approved":0,"phase3":1},{"company":{"id":"bms","kind":"company","name":"Bristol Myers Squibb","route":"/companies/bms/"},"country":"US","companyType":"pharma","drugs":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"}],"approved":0,"phase3":1},{"company":{"id":"fusion-pharma","kind":"company","name":"Fusion Pharmaceuticals (AstraZeneca)","route":"/companies/fusion-pharma/"},"country":"CA","companyType":"radiopharma","drugs":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"}],"approved":0,"phase3":1},{"company":{"id":"itm","kind":"company","name":"ITM Isotope Technologies Munich","route":"/companies/itm/"},"country":"DE","companyType":"radiopharma","drugs":[{"id":"itm-11","kind":"drug","name":"177Lu-edotreotide","route":"/drugs/itm-11/"}],"approved":0,"phase3":1},{"company":{"id":"orano-med","kind":"company","name":"Orano Med","route":"/companies/orano-med/"},"country":"FR","companyType":"radiopharma","drugs":[{"id":"alphamedix","kind":"drug","name":"212Pb-DOTAMTATE","route":"/drugs/alphamedix/"}],"approved":0,"phase3":0},{"company":{"id":"radiomedix","kind":"company","name":"RadioMedix","route":"/companies/radiomedix/"},"country":"US","companyType":"radiopharma","drugs":[{"id":"alphamedix","kind":"drug","name":"212Pb-DOTAMTATE","route":"/drugs/alphamedix/"}],"approved":0,"phase3":0},{"company":{"id":"rayzebio","kind":"company","name":"RayzeBio (BMS)","route":"/companies/rayzebio/"},"country":"US","companyType":"radiopharma","drugs":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"}],"approved":0,"phase3":1},{"company":{"id":"sanofi","kind":"company","name":"Sanofi","route":"/companies/sanofi/"},"country":"FR","companyType":"pharma","drugs":[{"id":"alphamedix","kind":"drug","name":"212Pb-DOTAMTATE","route":"/drugs/alphamedix/"}],"approved":0,"phase3":0}],"trials":[{"trial":{"id":"action-1","kind":"trial","name":"ACTION-1","route":"/trials/action-1/"},"nct":"NCT05477576","phase":"3","status":"recruiting","setting":"SSTR-positive GEP-NETs progressing after 177Lu somatostatin-analogue therapy: 225Ac-DOTATATE (RYZ101) vs investigator's choice","sponsor":"BMS (RayzeBio)","cancers":[{"id":"neuroendocrine","kind":"cancer","name":"Neuroendocrine tumours","route":"/cancers/neuroendocrine/"}],"drugs":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"}]},{"trial":{"id":"nct05939414","kind":"trial","name":"An Open-label Study Comparing Lutetium (177Lu) Vipivotide Tetraxetan Versus Observation in PSMA Positive OMPC.","route":"/trials/nct05939414/"},"nct":"NCT05939414","phase":"3","status":"recruiting","setting":"An International, Prospective, Open-label, Multi-center, Randomized Phase III Study Comparing Lutetium (177Lu) Vipivotide Tetraxetan (AAA617) Versus Observation to Delay Castration or Disease Recurrence in Adult Male Patients With Prostate-specific Membrane Antigen (PSMA) Positive Oligometastatic Prostate Cancer (OMPC)","sponsor":"Novartis Pharmaceuticals","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"drugs":[{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"}],"enrolled":450},{"trial":{"id":"nct07611110","kind":"trial","name":"AZD2265 Compared With Standard of Care in PSMA-positive Metastatic Castration-resistant Prostate Cancer (VECTRA-01)","route":"/trials/nct07611110/"},"nct":"NCT07611110","phase":"3","status":"recruiting","setting":"A Phase III, Multicentre, Randomised Controlled Study to Evaluate the Efficacy and Safety of AZD2265 (FPI-2265) ²²⁵Ac-PSMA-I&T Compared With Standard of Care in Patients With PSMA-positive Metastatic Castration-resistant Prostate Cancer (VECTRA-01)","sponsor":"AstraZeneca","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"}],"drugs":[{"id":"fpi-2265","kind":"drug","name":"FPI-2265","route":"/drugs/fpi-2265/"}],"enrolled":670},{"trial":{"id":"nct06855277","kind":"trial","name":"Study Comparing AAA817+ARPI Versus Standard of Care in Adult Participants With PSMA-positive mCRPC","route":"/trials/nct06855277/"},"nct":"NCT06855277","phase":"3","status":"recruiting","setting":"A Phase III, Open-label, Multi-center, Randomized Study Comparing AAA817+ARPI Versus Standard of Care in Adult Participants With PSMA-positive Metastatic Castration Resistant Prostate Cancer","sponsor":"Novartis Pharmaceuticals","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"}],"drugs":[{"id":"aaa817","kind":"drug","name":"AAA817","route":"/drugs/aaa817/"}],"enrolled":940},{"trial":{"id":"nct06520345","kind":"trial","name":"The Study of 177Lu-TLX591 Plus SOC Versus SOC Alone in Patients With mCRPC (ProstACT Global)","route":"/trials/nct06520345/"},"nct":"NCT06520345","phase":"3","status":"recruiting","setting":"A Multinational, Multicenter, Prospective, Randomized, Controlled, Open-Label, Phase 3 Study of Lutetium (177Lu) Rosopatamab Tetraxetan in Combination With Standard of Care Versus Standard of Care Alone in Patients With PSMA Positive Metastatic Castration-Resistant Prostate Cancer Previously After Androgen Receptor Pathway Inhibitor Treatment","sponsor":"Telix Pharmaceuticals (Innovations) Pty Limited","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"}],"drugs":[{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"}],"enrolled":520},{"trial":{"id":"nct04939610","kind":"trial","name":"A Study of 177Lu-FAP-2286 in Advanced Solid Tumors","route":"/trials/nct04939610/"},"nct":"NCT04939610","phase":"1/2","status":"recruiting","setting":"LuMIERE: A Phase 1/2, Multicenter, Open-label, Non-randomized Study to Investigate Safety and Tolerability, Pharmacokinetics, Dosimetry, and Preliminary Activity of 177Lu-FAP-2286 in Patients With an Advanced Solid Tumor","sponsor":"Novartis Pharmaceuticals","cancers":[{"id":"metastatic-cancer","kind":"cancer","name":"Metastatic cancer (cancer that has spread)","route":"/cancers/metastatic-cancer/"}],"drugs":[{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"}],"enrolled":222},{"trial":{"id":"nct05413850","kind":"trial","name":"Anti-tumour Activity of (177Lu) rhPSMA-10.1 Injection","route":"/trials/nct05413850/"},"nct":"NCT05413850","phase":"1/2","status":"recruiting","setting":"An Open-label, Multicentre, Integrated Phase 1 & 2 Study to Evaluate the Safety, Tolerability, Radiation Dosimetry and Anti-tumour Activity of Lutetium (177Lu) rhPSMA-10.1 Injection in Men With Metastatic Castrate-resistant Prostate Cancer","sponsor":"Blue Earth Therapeutics Ltd","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"}],"drugs":[{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"}],"enrolled":82},{"trial":{"id":"nct06780670","kind":"trial","name":"Open-label Study Comparing AAA817 Versus Standard of Care in the Treatment of Previously Treated PSMA-positive mCRPC Adults Who Have Disease Progressed on or After [177Lu]Lu-PSMA Targeted Therapy","route":"/trials/nct06780670/"},"nct":"NCT06780670","phase":"2/3","status":"recruiting","setting":"PSMAcTION: A Phase II/III, Open-label, International, Multicenter, Randomized Study of AAA817 Versus Standard of Care in the Treatment of Adult Participants With PSMA Positive Metastatic Castration-resistant Prostate Cancer Who Progressed on or After [177Lu]Lu-PSMA Targeted Therapy","sponsor":"Novartis Pharmaceuticals","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"},{"id":"prostate-mcrpc","kind":"cancer","name":"Metastatic castration-resistant prostate cancer","route":"/cancers/prostate-mcrpc/"}],"drugs":[{"id":"aaa817","kind":"drug","name":"AAA817","route":"/drugs/aaa817/"}],"enrolled":443},{"trial":{"id":"nct07590934","kind":"trial","name":"Phase Ib/II Platform Study of Multiple Anti-Cancer Agents in Participants With Metastatic Prostate Cancer","route":"/trials/nct07590934/"},"nct":"NCT07590934","phase":"1/2","status":"recruiting","setting":"A Phase Ib/II, Open-label, Multi-centre, Platform Study to Assess the Safety, Tolerability, Pharmacokinetics, Pharmacodynamics, and Preliminary Efficacy of Multiple Anti-Cancer Agents in Metastatic Prostate Cancer","sponsor":"AstraZeneca","cancers":[{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"drugs":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"fpi-2265","kind":"drug","name":"FPI-2265","route":"/drugs/fpi-2265/"}],"enrolled":152},{"trial":{"id":"nct07219238","kind":"trial","name":"Study to Evaluate the Diagnostic Performance of GEH300079 (68Ga) Injection PET/CT for Detection of PC in Patients With Colorectal, Gastric, Ovarian, o","route":"/trials/nct07219238/"},"nct":"NCT07219238","phase":"2/3","status":"recruiting","setting":"A Phase 2/3, Multicenter, Open-Label, Non-Randomized Study to Evaluate Diagnostic Performance of GEH300079 (68Ga) Injection Positron-Emission Tomography (PET)/Computed Tomography (CT) for Detection of Peritoneal Carcinomatosis (PC) in Patients With Colorectal, Gastric, Ovarian, or Pancreatic Cancers (PERISCOPE)","sponsor":"GE Healthcare","cancers":[{"id":"colorectal","kind":"cancer","name":"Colorectal cancer","route":"/cancers/colorectal/"},{"id":"ovarian","kind":"cancer","name":"Ovarian cancer","route":"/cancers/ovarian/"},{"id":"pancreatic","kind":"cancer","name":"Pancreatic ductal adenocarcinoma","route":"/cancers/pancreatic/"}],"drugs":[{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"}],"enrolled":175}],"registry":{"drugs":17,"recruiting":70,"fetched":"2026-09-21"},"sideEffects":{"terms":[],"events":[{"group":"Nausea or vomiting","drugs":4,"maxGrade3":7,"maxAnyGrade":36,"examples":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"}]},{"group":"Dry mouth","drugs":3,"maxAnyGrade":39,"examples":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"radioactive-iodine","kind":"drug","name":"Radioactive iodine (I-131)","route":"/drugs/radioactive-iodine/"}]},{"group":"Low lymphocytes (lymphopenia)","drugs":3,"maxGrade3":47,"maxAnyGrade":85,"examples":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"}]},{"group":"Low platelets (thrombocytopenia)","drugs":3,"maxGrade3":9,"examples":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"}]},{"group":"Low red cells (anaemia)","drugs":3,"maxGrade3":15,"maxAnyGrade":64,"examples":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"}]},{"group":"Tiredness (fatigue)","drugs":3,"maxAnyGrade":48,"examples":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"}]},{"group":"Kidney problems","drugs":2,"examples":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"}]},{"group":"Blood chemistry or blood count changes (other)","drugs":1,"maxGrade3":4,"examples":[{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"}]},{"group":"High blood sugar","drugs":1,"maxGrade3":4,"examples":[{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"}]},{"group":"Liver inflammation or raised liver enzymes","drugs":1,"maxGrade3":20,"examples":[{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"}]}],"drugsWithToxicity":6},"resistance":[{"id":"ar-pathway","drugClass":"Androgen receptor pathway inhibitors (abiraterone, enzalutamide)","tldr":"Prostate cancer keeps the androgen receptor working without hormones (amplification, splice variants), or abandons it and becomes a neuroendocrine cancer.","route":"/resistance/#ar-pathway","exemplars":[{"id":"capivasertib","kind":"drug","name":"Capivasertib","route":"/drugs/capivasertib/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"olaparib","kind":"drug","name":"Olaparib","route":"/drugs/olaparib/"}],"mechanisms":[{"name":"AR amplification and ligand-binding-domain mutations","category":"on-target","categoryLabel":"On-target","how":"More receptor, or mutations (F877L, T878A) that turn antagonists into agonists.","frequency":"AR amplification ~30 to 50% of CRPC","route":"/resistance/#ar-pathway-ar-amplification-and-ligand-binding-domain-mutations"},{"name":"AR splice variants (AR-V7)","category":"on-target","categoryLabel":"On-target","how":"Truncated receptor lacking the ligand-binding domain is constitutively active and invisible to enzalutamide.","route":"/resistance/#ar-pathway-ar-splice-variants-ar-v7"},{"name":"Lineage plasticity to neuroendocrine prostate cancer","category":"lineage","categoryLabel":"Lineage switch","how":"RB1/TP53 loss enables transdifferentiation; AR-indifferent, DLL3-positive, PSMA-negative.","frequency":"~15 to 20% of CRPC","route":"/resistance/#ar-pathway-lineage-plasticity-to-neuroendocrine-prostate-cancer"},{"name":"PI3K/AKT activation via PTEN loss","category":"bypass","categoryLabel":"Bypass","how":"Reciprocal feedback between AR and PI3K pathways.","frequency":"PTEN loss ~40% of mCRPC","route":"/resistance/#ar-pathway-pi3k-akt-activation-via-pten-loss"},{"name":"Glucocorticoid receptor substitution","category":"bypass","categoryLabel":"Bypass","how":"GR drives an AR-like transcriptional programme under enzalutamide.","route":"/resistance/#ar-pathway-glucocorticoid-receptor-substitution"}],"sources":[{"label":"CAPItello-281 (FDA approval Q2 2026, AACR digest)","url":"https://www.aacr.org/blog/2026/07/02/fda-approvals-in-oncology-april-june-2026/"}]}],"papers":[{"id":"paper-netter-2-lancet-2024","kind":"paper","name":"NETTER-2: lutetium-177 dotatate as first treatment for higher-grade gastroenteropancreatic neuroendocrine tumours","route":"/key-papers/paper-netter-2-lancet-2024/","year":2024,"journal":"The Lancet","paperType":"rct","tldr":"Using the radioactive drug lutetium dotatate as the first treatment for faster-growing neuroendocrine tumours, rather than saving it for later, nearly tripled the time without progression compared with high-dose octreotide.","via":[{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"paper-vision-nejm-2021","kind":"paper","name":"VISION: lutetium-177 PSMA-617 radioligand therapy extends survival in advanced prostate cancer","route":"/key-papers/paper-vision-nejm-2021/","year":2021,"journal":"New England Journal of Medicine","paperType":"rct","tldr":"A radioactive drug that homes to the PSMA protein on prostate cancer cells helped men with heavily pretreated metastatic prostate cancer live about four months longer, launching radioligand therapy as a mainstream treatment.","via":[{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"paper-pryma-high-specific-activity-i131-mibg-ppgl-jnm-2019","kind":"paper","name":"Efficacy and safety of high-specific-activity 131I-MIBG therapy in advanced pheochromocytoma or paraganglioma","route":"/key-papers/paper-pryma-high-specific-activity-i131-mibg-ppgl-jnm-2019/","year":2019,"journal":"Journal of Nuclear Medicine","paperType":"observational","tldr":"A purified radioactive form of MIBG, taken up by adrenaline-producing tumour cells, let a quarter of patients halve their blood pressure medication for at least six months and shrank tumours in about one in five, leading to the first approved radiopharmaceutical for these tumours.","via":[{"id":"i131-mibg","kind":"drug","name":"131I-MIBG (iobenguane I-131) therapy","route":"/drugs/i131-mibg/"}]}],"eras":[{"roadmap":{"id":"adc-generations","kind":"roadmap","name":"ADC roadmap: from Mylotarg to bispecific and dual-payload ADCs","route":"/roadmaps/adc-generations/"},"era":"2026-2030","title":"Fourth generation, wave 2: new payload logic","status":"emerging","step":6,"route":"/roadmaps/adc-generations/#story-step-5","refs":[{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/"}]},{"roadmap":{"id":"paediatric-oncology-roadmap","kind":"roadmap","name":"Paediatric oncology roadmap: cooperative-group cures → engineered immunity → drugs developed for children first","route":"/roadmaps/paediatric-oncology-roadmap/"},"era":"1994-2015","title":"Immunotherapy for neuroblastoma, and counting the cost of cure","status":"historic","step":2,"route":"/roadmaps/paediatric-oncology-roadmap/#story-step-1","refs":[{"id":"i131-mibg","kind":"drug","name":"131I-MIBG (iobenguane I-131) therapy","route":"/drugs/i131-mibg/"},{"id":"mibg-theranostics","kind":"technology","name":"MIBG imaging and 131I-MIBG therapy","route":"/technologies/mibg-theranostics/"}]},{"roadmap":{"id":"cure-paths","kind":"roadmap","name":"Paths to cures: interception, eradication, control","route":"/roadmaps/cure-paths/"},"era":"Eradication: next","title":"Killing the last cell, wherever it is hiding","status":"emerging","step":4,"route":"/roadmaps/cure-paths/#story-step-3","refs":[{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"},{"id":"radionuclide-parp-combination","kind":"technology","name":"Radioligand plus DNA-repair inhibitor combinations","route":"/technologies/radionuclide-parp-combination/"}]},{"roadmap":{"id":"frontier-2035","kind":"roadmap","name":"Radical oncology: what could change the war by 2035","route":"/roadmaps/frontier-2035/"},"era":"By 2027 (early clinical, readouts imminent)","title":"Living drugs, logic gates, and designed proteins reach decision points","status":"emerging","step":2,"route":"/roadmaps/frontier-2035/#story-step-1","refs":[{"id":"radionuclide-parp-combination","kind":"technology","name":"Radioligand plus DNA-repair inhibitor combinations","route":"/technologies/radionuclide-parp-combination/"}]},{"roadmap":{"id":"frontier-2035","kind":"roadmap","name":"Radical oncology: what could change the war by 2035","route":"/roadmaps/frontier-2035/"},"era":"By 2030 (physics and chemistry maturing)","title":"Radiation and radiopharmaceuticals get a second act","status":"emerging","step":3,"route":"/roadmaps/frontier-2035/#story-step-2","refs":[{"id":"alpha-nanogenerators","kind":"technology","name":"Alpha-emitter nanogenerators and daughter trapping","route":"/technologies/alpha-nanogenerators/"}]},{"roadmap":{"id":"radiopharma-roadmap","kind":"roadmap","name":"Radiopharmaceutical roadmap: iodine → lutetium → actinium","route":"/roadmaps/radiopharma-roadmap/"},"era":"2013-2018","title":"Radium-223 and Lutathera","status":"historic","step":2,"route":"/roadmaps/radiopharma-roadmap/#story-step-1","refs":[{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"}]},{"roadmap":{"id":"radiopharma-roadmap","kind":"roadmap","name":"Radiopharmaceutical roadmap: iodine → lutetium → actinium","route":"/roadmaps/radiopharma-roadmap/"},"era":"2020-2022","title":"PSMA theranostics","status":"current","step":3,"route":"/roadmaps/radiopharma-roadmap/#story-step-2","refs":[{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"}]},{"roadmap":{"id":"radiopharma-roadmap","kind":"roadmap","name":"Radiopharmaceutical roadmap: iodine → lutetium → actinium","route":"/roadmaps/radiopharma-roadmap/"},"era":"2023-2026","title":"Earlier lines, consolidation, and an M&A wave","status":"current","step":4,"route":"/roadmaps/radiopharma-roadmap/#story-step-3","refs":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"}]},{"roadmap":{"id":"radiopharma-roadmap","kind":"roadmap","name":"Radiopharmaceutical roadmap: iodine → lutetium → actinium","route":"/roadmaps/radiopharma-roadmap/"},"era":"2026-2029","title":"Alpha emitters and new targets","status":"emerging","step":5,"route":"/roadmaps/radiopharma-roadmap/#story-step-4","refs":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"}]},{"roadmap":{"id":"radiopharma-roadmap","kind":"roadmap","name":"Radiopharmaceutical roadmap: iodine → lutetium → actinium","route":"/roadmaps/radiopharma-roadmap/"},"era":"2029+","title":"Speculative: radioligands as a standard modality","status":"speculative","step":6,"route":"/roadmaps/radiopharma-roadmap/#story-step-5","refs":[{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/"}]},{"roadmap":{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"},"era":"1895-1990s","title":"From X-rays to conformal beams","status":"historic","step":1,"route":"/roadmaps/radiation-roadmap/#story-step-0","refs":[{"id":"radioactive-iodine","kind":"drug","name":"Radioactive iodine (I-131)","route":"/drugs/radioactive-iodine/"}]},{"roadmap":{"id":"radiation-roadmap","kind":"roadmap","name":"Radiotherapy roadmap: X-rays → shaped beams → fewer fractions, particles and FLASH","route":"/roadmaps/radiation-roadmap/"},"era":"2028+","title":"Radiation as an immune primer, and radiation from inside","status":"speculative","step":7,"route":"/roadmaps/radiation-roadmap/#story-step-6","refs":[{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/"},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"},{"id":"radionuclide-parp-combination","kind":"technology","name":"Radioligand plus DNA-repair inhibitor combinations","route":"/technologies/radionuclide-parp-combination/"}]},{"roadmap":{"id":"trop2-adc-roadmap","kind":"roadmap","name":"TROP2 ADC roadmap: sacituzumab govitecan → Dato-DXd → sac-TMT → bispecifics and PET","route":"/roadmaps/trop2-adc-roadmap/"},"era":"2027+","title":"Next generation: bispecific and next-payload TROP2 ADCs","status":"speculative","step":7,"route":"/roadmaps/trop2-adc-roadmap/#story-step-6","refs":[{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/"}]}],"ideas":[{"id":"idea-mfbg-pet-replaces-mibg","kind":"idea","name":"18F-MFBG PET replacing 123I-MIBG scintigraphy","route":"/ideas/idea-mfbg-pet-replaces-mibg/","maturity":"early-clinical","tldr":"A same-day PET tracer could replace the two-day, low-resolution MIBG scan children now undergo repeatedly.","via":[{"id":"mibg-theranostics","kind":"technology","name":"MIBG imaging and 131I-MIBG therapy","route":"/technologies/mibg-theranostics/"}]},{"id":"idea-reg-medical-isotope-reactor-reserve","kind":"idea","name":"A coordinated reserve and shared schedule for the world's medical isotope reactors","route":"/ideas/idea-reg-medical-isotope-reactor-reserve/","maturity":"early-clinical","tldr":"A handful of ageing research reactors make most cancer isotopes. Coordinating their maintenance and funding reserve capacity would prevent the shortages that stop treatments.","via":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"idea-fund-academic-radiopharma-pipeline","kind":"idea","name":"A university cyclotron network with shared regulatory files for new tracers","route":"/ideas/idea-fund-academic-radiopharma-pipeline/","maturity":"early-clinical","tldr":"Most new cancer imaging agents and radioactive drugs start in university hospitals. A network sharing production, quality files and regulatory paperwork would get them into multi-centre trials years faster.","via":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"}]},{"id":"idea-reg-yb176-enrichment-capacity","kind":"idea","name":"Build Western ytterbium-176 enrichment so lutetium-177 has more than one supplier","route":"/ideas/idea-reg-yb176-enrichment-capacity/","maturity":"early-clinical","tldr":"The lutetium used in approved prostate and neuroendocrine cancer treatments is made from an enriched metal that comes mostly from Russia. Making it elsewhere would secure supply.","via":[{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"idea-caix-theranostics","kind":"idea","name":"CAIX theranostics: 89Zr-girentuximab PET and 177Lu/225Ac-girentuximab therapy","route":"/ideas/idea-caix-theranostics/","maturity":"early-clinical","tldr":"Almost every clear-cell kidney cancer carries the CAIX protein. Image it with one radioactive antibody, then treat with the same antibody carrying a therapeutic isotope.","via":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"},{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/"}]},{"id":"idea-net-dosimetry-prrt","kind":"idea","name":"Dosimetry-personalised PRRT instead of four fixed cycles","route":"/ideas/idea-net-dosimetry-prrt/","maturity":"early-clinical","tldr":"Measure the radiation each patient's tumour and kidneys actually absorb and adjust the number and size of doses, instead of giving everyone four identical cycles.","via":[{"id":"itm-11","kind":"drug","name":"177Lu-edotreotide","route":"/drugs/itm-11/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},{"id":"prrt","kind":"technology","name":"Peptide receptor radionuclide therapy (PRRT)","route":"/technologies/prrt/"}]},{"id":"idea-fap-theranostics-pancancer","kind":"idea","name":"FAP theranostics as a pan-cancer stromal strategy","route":"/ideas/idea-fap-theranostics-pancancer/","maturity":"early-clinical","tldr":"Instead of finding a different target for each cancer, hit the scaffolding cells that almost all solid tumours share.","via":[{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"}]},{"id":"idea-reg-mutual-recognition-inspections-atmp","kind":"idea","name":"Mutual recognition of GMP inspections for cell, gene and radiopharmaceutical plants","route":"/ideas/idea-reg-mutual-recognition-inspections-atmp/","maturity":"early-clinical","tldr":"Factories making living or radioactive cancer medicines are inspected separately by each country. Accepting each other's inspections would free up inspectors and speed supply.","via":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"idea-reg-legacy-radium-recovery-ac225","kind":"idea","name":"Recover legacy radium-226 sources worldwide as the feedstock for actinium-225","route":"/ideas/idea-reg-legacy-radium-recovery-ac225/","maturity":"early-clinical","tldr":"Thousands of old radium sources sit in hospital and industrial storage. They are exactly the raw material needed to make actinium-225, the scarcest cancer isotope.","via":[{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"}]},{"id":"idea-reg-ac225-accelerator-pharmacopoeia","kind":"idea","name":"Regional cyclotron hubs for actinium-225 with an agreed actinium-227 impurity limit","route":"/ideas/idea-reg-ac225-accelerator-pharmacopoeia/","maturity":"early-clinical","tldr":"Actinium-225 can be made in particle accelerators, but the product contains a trace of a long-lived impurity that regulators have not agreed how to handle. Settle the limit and build the hubs.","via":[{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"}]},{"id":"idea-reg-regional-radiopharmacy-hubs","kind":"idea","name":"Regional radiopharmacy hubs and harmonised transport rules for short-lived isotopes","route":"/ideas/idea-reg-regional-radiopharmacy-hubs/","maturity":"early-clinical","tldr":"Radioactive cancer drugs decay while they travel and get stuck at borders. Regional production and simpler transport rules would get more doses to patients on time.","via":[{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"idea-fund-translational-institutes-gmp","kind":"idea","name":"Regional translational institutes with academic GMP suites and IND teams","route":"/ideas/idea-fund-translational-institutes-gmp/","maturity":"early-clinical","tldr":"Build a handful of publicly-funded centres where academic discoveries can be manufactured to clinical grade and written up for regulators, so good ideas do not die for lack of a factory and a filing.","via":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"idea-net-antagonist-ligands","kind":"idea","name":"SSTR antagonist radioligands to increase tumour dose","route":"/ideas/idea-net-antagonist-ligands/","maturity":"early-clinical","tldr":"Radioligand therapy for neuroendocrine tumours built on somatostatin receptor antagonists rather than the agonists used today: antagonists bind the receptor in every state and are not internalised, so they occupy several times more sites per cell and deliver more radiation per dose. The test is a randomised phase 2 against agonist lutetium therapy.","via":[{"id":"prrt","kind":"technology","name":"Peptide receptor radionuclide therapy (PRRT)","route":"/technologies/prrt/"}]},{"id":"idea-total-body-pet-dosimetry","kind":"idea","name":"Total-body PET for personalised radioligand dosing","route":"/ideas/idea-total-body-pet-dosimetry/","maturity":"early-clinical","tldr":"Ultra-sensitive whole-body scanners can measure exactly where a radioactive drug goes at tiny tracer doses, allowing each patient's therapeutic dose to be tailored.","via":[{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"idea-efflux-agnostic","kind":"idea","name":"Efflux-agnostic therapy for mesenchymal TNBC","route":"/ideas/idea-efflux-agnostic/","maturity":"preclinical-evidence","tldr":"Some tumours pump out every drug. Use treatments the pumps cannot touch: radiation, radioligands, immune cells, and payloads designed to evade them.","via":[{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/"}]},{"id":"idea-fus-plus-adc-glioma","kind":"idea","name":"Focused-ultrasound BBB opening to deliver ADCs and radioligands to glioma","route":"/ideas/idea-fus-plus-adc-glioma/","maturity":"preclinical-evidence","tldr":"Brain tumours have targets that ADCs could hit, but antibodies cannot cross the barrier. Open the barrier with ultrasound first.","via":[{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/"}]},{"id":"idea-reg-alpha-emitter-portfolio","kind":"idea","name":"Fund alpha emitters beyond actinium-225: lead-212, terbium-149 and astatine-211","route":"/ideas/idea-reg-alpha-emitter-portfolio/","maturity":"preclinical-evidence","tldr":"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.","via":[{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"}]},{"id":"idea-bio1-tumour-on-chip-penetration","kind":"idea","name":"Tumour-on-a-chip with blood flow to test whether big drugs actually get in","route":"/ideas/idea-bio1-tumour-on-chip-penetration/","maturity":"preclinical-evidence","tldr":"Large drugs such as antibody-drug conjugates must cross vessel walls and travel through dense tissue. A chip with flowing channels and human tissue can measure how far they get.","via":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"idea-chip-risk-modifiers","kind":"idea","name":"Which patients' blood clones will become leukaemia after treatment?","route":"/ideas/idea-chip-risk-modifiers/","maturity":"preclinical-evidence","tldr":"PARP inhibitors, platinum, and radioligand drugs can push pre-existing blood-cell clones toward leukaemia in a few patients. Predicting who could let us choose therapies more safely.","via":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"}]},{"id":"idea-reg-isotope-supply-observatory","kind":"idea","name":"A global medical isotope supply observatory with forecasts and shortage alerts","route":"/ideas/idea-reg-isotope-supply-observatory/","maturity":"speculative","tldr":"Nobody publishes how much cancer isotope is made, where, or when supply will fall short. A public observatory would let hospitals and investors plan.","via":[{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"}]},{"id":"idea-alpha-after-adc","kind":"idea","name":"Alpha radioligands after ADC failure","route":"/ideas/idea-alpha-after-adc/","maturity":"speculative","tldr":"When ADCs against a surface protein stop working because the payload no longer kills, use the same protein to deliver radiation instead.","via":[{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"},{"id":"radioimmunotherapy","kind":"technology","name":"Radio-antibody & radio-ADC","route":"/technologies/radioimmunotherapy/"}]},{"id":"idea-alpha-first-mhspc","kind":"idea","name":"Alpha-emitting PSMA therapy at first metastatic diagnosis","route":"/ideas/idea-alpha-first-mhspc/","maturity":"speculative","tldr":"If Pluvicto helps at first diagnosis, an alpha version might do more against microscopic disease, when tumour burden is smallest.","via":[{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"radioligand-therapy","kind":"technology","name":"Radioligand therapy (beta emitters)","route":"/technologies/radioligand-therapy/"},{"id":"targeted-alpha-therapy","kind":"technology","name":"Targeted alpha therapy","route":"/technologies/targeted-alpha-therapy/"}]}],"manufacturing":{"sites":[{"id":"curium-petten","name":"Curium Petten","operator":"Curium","operatorRoute":"/companies/curium/","ownership":"cdmo","city":"Petten","country":"NL","capabilities":["radioisotope","radiopharmaceutical"],"capabilityLabels":["Radioisotope production","Radiopharmaceutical manufacturing"],"drugs":[],"source":{"label":"Curium","url":"https://www.curiumpharma.com/"}},{"id":"eckert-ziegler-berlin","name":"Eckert & Ziegler Berlin","operator":"Eckert & Ziegler","operatorRoute":"/companies/eckert-ziegler/","ownership":"cdmo","city":"Berlin","country":"DE","capabilities":["radioisotope","radiopharmaceutical"],"capabilityLabels":["Radioisotope production","Radiopharmaceutical manufacturing"],"drugs":[],"source":{"label":"Eckert & Ziegler","url":"https://www.ezag.com/"}},{"id":"itm-garching","name":"ITM Garching","operator":"ITM Isotope Technologies Munich","operatorRoute":"/companies/itm/","ownership":"cdmo","city":"Garching","country":"DE","capabilities":["radioisotope","radiopharmaceutical"],"capabilityLabels":["Radioisotope production","Radiopharmaceutical manufacturing"],"drugs":[{"id":"itm-11","kind":"drug","name":"177Lu-edotreotide","route":"/drugs/itm-11/"}],"source":{"label":"ITM","url":"https://itm-radiopharma.com/"}},{"id":"northstar-beloit","name":"NorthStar Medical Radioisotopes Beloit","operator":"NorthStar Medical Radioisotopes","operatorRoute":"/companies/northstar-medical-radioisotopes/","ownership":"cdmo","city":"Beloit, Wisconsin","country":"US","capabilities":["radioisotope","radiopharmaceutical"],"capabilityLabels":["Radioisotope production","Radiopharmaceutical manufacturing"],"drugs":[],"source":{"label":"NorthStar Medical Radioisotopes","url":"https://www.northstarnm.com/"}},{"id":"novartis-indianapolis","name":"Novartis Indianapolis","operator":"Novartis","operatorRoute":"/companies/novartis/","ownership":"in-house","city":"Indianapolis, Indiana","country":"US","capabilities":["radiopharmaceutical"],"capabilityLabels":["Radiopharmaceutical manufacturing"],"drugs":[{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"}],"source":{"label":"Novartis radioligand manufacturing","url":"https://www.novartis.com/"}},{"id":"novartis-millburn","name":"Novartis Millburn","operator":"Novartis","operatorRoute":"/companies/novartis/","ownership":"in-house","city":"Millburn, New Jersey","country":"US","capabilities":["radiopharmaceutical"],"capabilityLabels":["Radiopharmaceutical manufacturing"],"drugs":[{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"}],"source":{"label":"Novartis radioligand manufacturing","url":"https://www.novartis.com/"}},{"id":"novartis-zaragoza","name":"Novartis Zaragoza","operator":"Novartis","operatorRoute":"/companies/novartis/","ownership":"in-house","city":"Zaragoza","country":"ES","capabilities":["radiopharmaceutical"],"capabilityLabels":["Radiopharmaceutical manufacturing"],"drugs":[{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"}],"source":{"label":"Novartis radioligand manufacturing","url":"https://www.novartis.com/"}},{"id":"orano-med-plano","name":"Orano Med Plano","operator":"Orano Med","operatorRoute":"/companies/orano-med/","ownership":"cdmo","city":"Plano, Texas","country":"US","capabilities":["radioisotope","radiopharmaceutical"],"capabilityLabels":["Radioisotope production","Radiopharmaceutical manufacturing"],"drugs":[{"id":"alphamedix","kind":"drug","name":"212Pb-DOTAMTATE","route":"/drugs/alphamedix/"}],"source":{"label":"Orano Med","url":"https://www.oranomed.com/"}},{"id":"shine-janesville","name":"SHINE Technologies Janesville","operator":"SHINE Technologies","operatorRoute":"/companies/shine-technologies/","ownership":"cdmo","city":"Janesville, Wisconsin","country":"US","capabilities":["radioisotope"],"capabilityLabels":["Radioisotope production"],"drugs":[],"source":{"label":"SHINE Technologies","url":"https://www.shinefusion.com/"}},{"id":"terrapower-isotopes-philadelphia","name":"TerraPower Isotopes Philadelphia","operator":"TerraPower Isotopes","operatorRoute":"/companies/terrapower-isotopes/","ownership":"cdmo","city":"Philadelphia, Pennsylvania","country":"US","capabilities":["radioisotope"],"capabilityLabels":["Radioisotope production"],"drugs":[],"source":{"label":"TerraPower Isotopes","url":"https://www.terrapower.com/isotopes"}}],"capabilities":["Radioisotope production","Radiopharmaceutical manufacturing"],"chain":{"id":"isotopes","name":"Radiopharmaceuticals and isotopes","summary":"Research reactors for lutetium and molybdenum, cyclotrons for fluorine, gallium and copper, generators, the actinium scramble, and release of a drug that decays.","route":"/manufacturing/#chain-isotopes","technologies":[{"id":"research-reactor-isotope-production","kind":"technology","name":"Research reactors for medical isotopes (Mo-99, Lu-177, I-131)","route":"/technologies/research-reactor-isotope-production/"},{"id":"cyclotron-isotope-production","kind":"technology","name":"Cyclotron isotope production (F-18, Ga-68, Cu-64, Zr-89, At-211)","route":"/technologies/cyclotron-isotope-production/"},{"id":"radionuclide-generators-kits","kind":"technology","name":"Radionuclide generators and cold kits","route":"/technologies/radionuclide-generators-kits/"},{"id":"actinium-225-supply","kind":"technology","name":"Actinium-225 supply: thorium stocks, accelerators and radium targets","route":"/technologies/actinium-225-supply/"},{"id":"therapy-isotope-supply-chain","kind":"technology","name":"Therapeutic isotope supply chain (Mo-99, Lu-177, Ac-225)","route":"/technologies/therapy-isotope-supply-chain/"},{"id":"radiopharmaceutical-gmp-release","kind":"technology","name":"Radiopharmaceutical GMP and releasing a drug that decays","route":"/technologies/radiopharmaceutical-gmp-release/"},{"id":"radiopharmacy-network","kind":"technology","name":"Radiopharmacy and cyclotron networks","route":"/technologies/radiopharmacy-network/"},{"id":"pet-tracer-manufacturing","kind":"technology","name":"PET tracer manufacturing and distribution","route":"/technologies/pet-tracer-manufacturing/"},{"id":"medical-cyclotrons-synthesis-modules","kind":"technology","name":"Medical cyclotrons, hot cells, and synthesis modules","route":"/technologies/medical-cyclotrons-synthesis-modules/"}],"companies":[{"id":"novartis","kind":"company","name":"Novartis","route":"/companies/novartis/"},{"id":"curium","kind":"company","name":"Curium","route":"/companies/curium/"},{"id":"itm","kind":"company","name":"ITM Isotope Technologies Munich","route":"/companies/itm/"},{"id":"ire","kind":"company","name":"IRE (Institut national des Radioéléments)","route":"/companies/ire/"},{"id":"ntp-radioisotopes","kind":"company","name":"NTP Radioisotopes","route":"/companies/ntp-radioisotopes/"},{"id":"ansto","kind":"company","name":"ANSTO (Australian Nuclear Science and Technology Organisation)","route":"/companies/ansto/"},{"id":"bruce-power","kind":"company","name":"Bruce Power","route":"/companies/bruce-power/"},{"id":"nordion","kind":"company","name":"Nordion (Sotera Health)","route":"/companies/nordion/"},{"id":"eckert-ziegler","kind":"company","name":"Eckert & Ziegler","route":"/companies/eckert-ziegler/"},{"id":"shine-technologies","kind":"company","name":"SHINE Technologies","route":"/companies/shine-technologies/"},{"id":"northstar-medical-radioisotopes","kind":"company","name":"NorthStar Medical Radioisotopes","route":"/companies/northstar-medical-radioisotopes/"},{"id":"terrapower-isotopes","kind":"company","name":"TerraPower Isotopes","route":"/companies/terrapower-isotopes/"},{"id":"nusano","kind":"company","name":"Nusano","route":"/companies/nusano/"},{"id":"isotopia","kind":"company","name":"Isotopia Molecular Imaging","route":"/companies/isotopia/"},{"id":"orano-med","kind":"company","name":"Orano Med","route":"/companies/orano-med/"},{"id":"telix","kind":"company","name":"Telix Pharmaceuticals","route":"/companies/telix/"},{"id":"lantheus","kind":"company","name":"Lantheus","route":"/companies/lantheus/"},{"id":"petnet-solutions","kind":"company","name":"PETNET Solutions (Siemens Healthineers)","route":"/companies/petnet-solutions/"},{"id":"cardinal-health","kind":"company","name":"Cardinal Health Nuclear & Precision Health Solutions","route":"/companies/cardinal-health/"}],"products":[{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},{"id":"lu177-psma-it","kind":"drug","name":"177Lu-PSMA-I&T","route":"/drugs/lu177-psma-it/"},{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"radium-223","kind":"drug","name":"Radium-223 dichloride","route":"/drugs/radium-223/"},{"id":"ga68-dotatate","kind":"drug","name":"Gallium-68 DOTATATE (and Cu-64 DOTATATE)","route":"/drugs/ga68-dotatate/"}]},"technologies":[{"id":"therapy-isotope-supply-chain","kind":"technology","name":"Therapeutic isotope supply chain (Mo-99, Lu-177, Ac-225)","route":"/technologies/therapy-isotope-supply-chain/","tldr":"Where the radioactive atoms for imaging and therapy actually come from: ageing reactors, new accelerators, and a scramble for actinium."},{"id":"actinium-225-supply","kind":"technology","name":"Actinium-225 supply: thorium stocks, accelerators and radium targets","route":"/technologies/actinium-225-supply/","tldr":"Actinium-225 is the alpha-emitting atom behind the most promising next wave of radioligand therapies, and there is not enough of it. Almost all of it used to come from one decaying stock of thorium in a US national laboratory. New routes use accelerators and old radium."},{"id":"research-reactor-isotope-production","kind":"technology","name":"Research reactors for medical isotopes (Mo-99, Lu-177, I-131)","route":"/technologies/research-reactor-isotope-production/","tldr":"Most of the world's therapeutic and scanning isotopes are made by putting targets into about half a dozen ageing research reactors and flying the product out within days. When two reactors were down at once in 2009 and 2010, hospitals worldwide ran short of the most used scan isotope."},{"id":"cyclotron-isotope-production","kind":"technology","name":"Cyclotron isotope production (F-18, Ga-68, Cu-64, Zr-89, At-211)","route":"/technologies/cyclotron-isotope-production/","tldr":"Proton-rich isotopes for PET scans and some therapies are made by hitting a target with a beam from a cyclotron. Fluorine-18 is made every morning within driving distance of the scanner; gallium-68 comes from either a generator or a cyclotron; copper-64 and zirconium-89 last long enough to ship across a country."},{"id":"radiopharmaceutical-gmp-release","kind":"technology","name":"Radiopharmaceutical GMP and releasing a drug that decays","route":"/technologies/radiopharmaceutical-gmp-release/","tldr":"A radioactive medicine loses activity every hour, so it is made to order, tested in hours and often injected before the sterility test has finished. The rules for that are different from ordinary drugs, and the handful of plants that make lutetium therapies have had their own shortages."},{"id":"radiopharmacy-network","kind":"technology","name":"Radiopharmacy and cyclotron networks","route":"/technologies/radiopharmacy-network/","tldr":"The factories and courier routes that make and deliver short-lived radioactive tracers to hospitals within hours."}]},"drugs":[{"id":"i131-mibg","kind":"drug","name":"131I-MIBG (iobenguane I-131) therapy","route":"/drugs/i131-mibg/"},{"id":"itm-11","kind":"drug","name":"177Lu-edotreotide","route":"/drugs/itm-11/"},{"id":"lu177-psma-it","kind":"drug","name":"177Lu-PSMA-I&T","route":"/drugs/lu177-psma-it/"},{"id":"alphamedix","kind":"drug","name":"212Pb-DOTAMTATE","route":"/drugs/alphamedix/"},{"id":"aaa817","kind":"drug","name":"AAA817","route":"/drugs/aaa817/"},{"id":"ryz101","kind":"drug","name":"Actinium-225 DOTATATE","route":"/drugs/ryz101/"},{"id":"ac225-psma","kind":"drug","name":"Actinium-225 PSMA agents","route":"/drugs/ac225-psma/"},{"id":"fap-2286","kind":"drug","name":"FAP-2286 (177Lu / 68Ga)","route":"/drugs/fap-2286/"},{"id":"fpi-2265","kind":"drug","name":"FPI-2265","route":"/drugs/fpi-2265/"},{"id":"ibritumomab-tiuxetan","kind":"drug","name":"Ibritumomab tiuxetan","route":"/drugs/ibritumomab-tiuxetan/"},{"id":"iomab-b","kind":"drug","name":"Iomab-B","route":"/drugs/iomab-b/"},{"id":"lutathera","kind":"drug","name":"Lutetium-177 dotatate","route":"/drugs/lutathera/"},{"id":"pluvicto","kind":"drug","name":"Lutetium-177 vipivotide tetraxetan","route":"/drugs/pluvicto/"},{"id":"phosphorus-32","kind":"drug","name":"Phosphorus-32 (radiophosphorus)","route":"/drugs/phosphorus-32/"},{"id":"radioactive-iodine","kind":"drug","name":"Radioactive iodine (I-131)","route":"/drugs/radioactive-iodine/"},{"id":"radium-223","kind":"drug","name":"Radium-223 dichloride","route":"/drugs/radium-223/"},{"id":"samarium-153-lexidronam","kind":"drug","name":"Samarium-153 lexidronam","route":"/drugs/samarium-153-lexidronam/"}],"note":"Every section is read from existing corpus records and names them (from, via, exemplars, refs); a section with nothing behind it is empty. Medicines of a format are the open drug engine's (/pipeline/engine/); technologies are listed in src/lib/modular-formats.ts. CC BY-NC 4.0, attribute Data from OnCo (onco.cc). Not medical advice."}