Nuclear medicine encompasses the use of radioactive particles placed in direct contact with patients for diagnostic or therapeutic purposes. Radioisotopes are usually bound with vectors and then injected into the patient’s bloodstream to specifically target cancerous cells.

While diagnostic radio imagery applications are already relatively well-established, therapeutic uses are still in their infancy. Only a few systemic therapeutic radiopharmaceuticals are on the market, with most targeting rare cancers or being used in palliative care.

However, recent developments confirm that there is an acceleration of interest in this promising technological platform. A number of recent trends offer signs that radiological pharmaceuticals are on their way to being a firmly established part of the therapeutic arsenal against cancer, these include:

• New product approvals: innovative therapeutic radiopharmaceuticals such as Luthathera from Advanced Accelerator Applications have recently gained marketing authorization
• Expanding pipelines: a larger number of drugs are in the development pipeline, with several of them targeting cancers with much higher occurrence such as prostate and breast malignancies, leading to a much larger patient base for this therapeutic technique
• Accelerated investment: the recent M&A activity with the two large acquisitions by Novartis, which acquired Advanced Accelerator Applications and Endocyte for $3.9B and $2.1B, respectively
• The emergence of theranostics: the increasing use of radiopharmaceuticals for combination of diagnostic imagery and treatment use

A diverse mix of companies is placing bets along the value chain, with companies in the following sectors showing special interest in the field:

• Nuclear research organizations, either nuclear reactor or cyclotron owners, focused on the radioisotope production and processing
• Pharmaceutical companies, either clinical-stage biotechnological companies or pharmaceutical groups for the development of new vectors and drugs
• Medical device manufacturers, with a focus on diagnostic equipment and radiotherapy microspheres technology

The development of therapeutic nuclear medicine is heavily dependent on the results of ongoing clinical trials. In addition, a variety of barriers must be overcome for this technology to reach its full potential, specifically:

• Investment is needed in infrastructure, equipment and staff training at hospitals
• Increased education is required to raise awareness and address the concerns of medical practitioners, oncologists and healthcare authorities
• Adjustments must be made to pricing and reimbursement policies to ensure access

If clinical results from the first wave of radiopharmaceuticals for high-incidence cancers are positive, interest in the sector is likely to accelerate, with large pharmaceutical companies leading the charge to increase investment and the pace of M&A in the field.