Radioligand Therapy: The Future of Targeted Cancer Treatment
By Giuseppe Carlucci, Associate Professor, Director of Biomedical Cyclotron, UCLA
Radioligand therapy (RLT) is revolutionizing how we treat cancer, offering a more precise approach by using radioactive probes, or radiopharmaceuticals, to directly target tumor cells. Unlike traditional treatments, which can affect healthy cells, RLT focuses on delivering radiation specifically to cancerous tissues, minimizing collateral damage. With its potential to transform oncology, the market for RLT is on track to grow dramatically, from $750 million in 2022 to an estimated $5.5 billion by 2028.
Currently, >82 different RLTs are undergoing clinical trials targeting various tumors and blood cancers. One of the most promising areas of research is the use of alpha-emitting radioisotopes, which are believed to be more effective and produce fewer side effects than their beta-emitting counterparts. Despite their potential, alpha-emitting treatments are more complex to develop, and the path to widespread clinical use involves navigating significant scientific and logistical hurdles. Radioligand therapy isn’t a new concept—it has been used for over a century, with early applications in cancer treatment. But it’s only in recent years that RLT has gained serious attention, fueled by advancements in imaging technology, lower production costs, and a growing body of evidence supporting its effectiveness. In January 2018 and March 2022, the FDA approved Lutathera and Pluvicto, the first RLT therapeutics for gastroenteropancreatic neuroendocrine tumors and prostate cancer, respectively, marking a milestone for the field. Despite some supply chain challenges, the success of Pluvicto has bolstered confidence in RLT’s potential, and the market is expected to see a significant surge in investment, with funding for RLTs increasing by an impressive 550% in 2023 alone.
Despite the hurdles, the future of radioligand therapy looks promising. With continued investment, research, and collaboration, RLTs are poised to become a critical part of the oncology toolkit, offering a more precise, effective, and less invasive way to treat cancer.
This surge in investment reflects growing interest from large pharmaceutical companies and innovative startups. By the end of 2022, more than 60 companies were active in the RLT space, with a steady increase in new players entering the market. However, the complexities of developing and distributing RLTs present unique challenges that companies must overcome. Beyond the science of radiochemistry, successful RLT development requires expertise in logistics, patient care, and regulatory compliance.
One of the most exciting areas of RLT research is alpha particles, which are much more effective at delivering radiation to cancer cells while causing less damage to surrounding healthy tissues. Alpha-emitting isotopes like Actinium-225 and Lead-212 are being explored for their potential in treating cancer. However, while alpha-emitting RLTs show promise, most approved treatments still rely on beta-emitting isotopes due to the challenges in producing and handling alpha-emitting radioisotopes.
Unlike conventional medications, RLTs must be freshly prepared for each patient and cannot be stored for long periods due to the short half-lives of the radioisotopes involved. This means that RLT production must be done locally, near the treatment centers, to ensure the drugs are delivered on time. Many hospitals and clinics already have the necessary nuclear imaging tools and licenses to work with radioactive materials. Still, as RLT becomes more widely used, facilities will need to update their infrastructure and ensure their staff is trained to handle these complex therapies.
Moreover, companies must choose the right manufacturing partners and establish reliable supply chains to meet the growing demand for RLT. Healthcare facilities must work closely with regulatory bodies to navigate the rules surrounding using radioactive substances and ensure their teams are properly trained and certified.
However, the complexity of RLTs extends beyond production to patient care. These therapies involve multiple medical professionals working together, and patients require additional education about radiation therapy’s potential risks and benefits. This collaborative approach is one of the reasons RLT is so different from traditional treatments. Patients and their doctors must be well-informed about the unique side effects, and smaller companies entering the RLT space must partner with experts in radiopharmacy and oncology to navigate this evolving landscape.
As RLTs continue to evolve, finding the right balance between innovation and patient safety is crucial. For patients with rare or hard-to-treat cancers, RLT offers a new ray of hope, but identifying eligible patients and ensuring they have access to these cutting-edge therapies remains a challenge. Advanced analytics can pinpoint suitable candidates, while specialized cancer centers remain the focal points for RLT delivery.
As the RLT market grows, companies will need to carefully consider how to navigate the complexities of introducing a highly specialized treatment to a broader patient base. Unlike traditional drugs, RLTs require a tailored, patient-specific approach, and healthcare professionals must be trained to manage the unique logistics of treatment. Identifying the right physicians, educating patients, and ensuring smooth distribution processes will be key to bringing RLTs to more patients in need.
Despite the hurdles, the future of radioligand therapy looks promising. With continued investment, research, and collaboration, RLTs are poised to become a critical part of the oncology toolkit, offering a more precise, effective, and less invasive way to treat cancer. As the market continues to expand, it’s clear that radioligand therapy is not just a trend—it’s the future of cancer treatment.