Recurrent and metastatic cancers remain formidable challenges. But a recent radiopharmaceutical revival after years of stagnation could bring new options to the table. And If the drugs deliver on promises to expand into new types of cancer, they’ll unlock a vast market.
Radiopharmaceuticals have been in use since the 1951 approval of radioactive iodine for thyroid conditions. However, safety issues — due to broad toxicity that can harm healthy tissues along with cancerous cells — have limited their applicability.
Now, technological advances have led to new radiopharmaceuticals that target specific receptors and deliver a precision blast of radiation to tumors while minimizing off-target effects. These developments have reignited interest in the field, driving a spate of acquisitions, including Bristol Myers Squibb’s $4.1 billion RayzeBio acquisition and Eli Lilly’s $1.4 billion purchase of Point Biopharma.
A reviving class
The radiopharmaceutical market is still nascent, said Thijs Spoor, CEO of Perspective Therapeutics, which is testing an alpha-emitting isotope, Pb-212, to target cancer cells with radiation more precisely by using peptides.
Outside of smaller companies like Perspective, pharma giants have brought several products through the regulatory gauntlet, including Bayer’s Xofigo for prostate cancer, Novartis’s potential blockbuster Pluvicto for prostate cancer, and the neuroendocrine tumor treatment Lutathera, also from Novartis.
But much of the field’s promise is untapped.
“I've heard various Big Pharma players say they believe only 7% of all tumors that could be addressed with radiopharmaceuticals are being addressed,” Spoor said. “So there’s an awful lot of opportunity.” ]
“Everyone's looking for a pipeline — they’re looking for drugs with IP they can run with."
Thijs Spoor
CEO, Perspective Therapeutics
Oncology targets could include head, neck, gynecologic, genitourinary, gastrointestinal and lung cancers.
“There are all kinds of applications,” Spoor said. “We haven’t even scratched the surface of what the radiopharmaceuticals can do.”
These treatments are uniquely suited to metastatic disease, but they’re not limited just to cancer that has spread and could fill a void in the oncology market for patients who don’t respond to other options.
Around a dozen startups are working in the space, including Ratio Therapeutics, Radiopharm Theranostics and Aktis Oncology, and are developing treatments for various cancers.
Perspective’s formula uses a radioactive imaging agent to detect a target peptide that then drives the attack on the tumor and cancer cells that have spread.
“With the radiopharmaceuticals, all we have to do is bind to the cell, and then we just blow it up like a mine on the ship,” Spoor said.
An early-stage trial of Perspective’s radiotherapy VMT-a-NET for neuroendocrine tumors showed that the treatment was safe and kept eight of nine patients stable. Six of the nine patients saw their tumors shrink, but only one had a confirmed response.
The trial drew some fire because it fell short of an earlier investigator-led study, raising questions about its approach and causing a drop in the company’s stock price last fall. However, the results allowed the company to move forward with dose escalation.
Perspective is also advancing a phase 1/2a treatment for melanoma, which recently gained FDA fast track designation, along with several preclinical programs.
Radiopharmaceuticals still have to meet critical milestones to become primary players in the oncology landscape. One of the most pressing issues for drug developers is building the necessary infrastructure. Many recent market acquisitions have aimed to give these drugs the scaffolding they’ll need to climb into the mainstream, Spoor said.
“There are a lot of people in the space trying to create isotope supply, trying to create manufacturing capacity,” he said.
Once these foundational elements are in place, the next challenge will be identifying the most promising candidates.
“Everyone's looking for a pipeline — they’re looking for drugs with IP they can run with,” Spoor said.
