New research highlighting the growing potential of radiopharmaceutical therapies (RPT) to improve outcomes for people with cancer was presented at the inaugural Multidisciplinary Radiopharmaceutical Therapy Symposium, which took place in Palm Desert, California, and online on February 17 and 18. Studies at the meeting, sponsored by the American Society for Radiation Oncology (ASTRO), spanned established uses of RPT and early signals for new indications, while also addressing what clinics need in place to safely offer these treatments as they move into routine care.
RPTs are a specialized type of injectable cancer drug that deliver targeted radiation directly to cancer cells while limiting exposure to surrounding tissues, offering the potential for better tumor control with fewer side effects. While standard radiation therapy typically involves external-beam treatments or brachytherapy, RPTs are delivered systemically with radioactive agents that target specific biomarkers on tumor cells. When the treatments, also known as radioligand therapies, bind to these biomarkers, they release radiation directly to the tumor cells. A growing body of research indicates that RPTs offer an important new option for people with cancer.
Only two RPTs have been approved by the U.S. Food and Drug Administration (FDA) in the past decade, though many additional agents are being tested in clinical trials. Studies at the meeting reflected the expanding pipeline of next-generation agents, collectively addressing a wide range of disease sites under active investigation including hematologic, gastrointestinal, and other common cancers.
As more agents reach clinics and patient demand grows, providers are also seeking expert guidance to build and sustain RPT services in their local communities. This new ASTRO-sponsored symposium paired science with operational insight, offering practical guidance for multidisciplinary teams delivering RPT in clinical settings.
Some noteworthy abstracts are highlighted below.
Progression-Free Survival in Metastatic Prostate Cancer: RPT vs Standard Therapies
In a pooled analysis of seven randomized trials involving more than 2,500 patients with metastatic castration-resistant prostate cancer (mCRPC), the RPT lutetium Lu-177–labeled PSMA-617 (LuPSMA-617) significantly improved progression-free survival rates compared with standard-of-care systemic therapy (Abstract 1). Patients who received the RPT did not experience significantly more grade 3 or higher side effects than those who received standard treatments, including hormone-based drugs. The meta-analysis did not show a difference in overall survival, though researchers noted this finding may be influenced by patients in control arms receiving RPT after their cancer progressed in some trials.
“PSMA-targeted radioligand therapy works differently than traditional androgen-signaling therapies by delivering radiation directly to prostate cancer cells. Across randomized trials, the consistency of progression-free survival benefit with favorable tolerability was striking, and the absence of a clear overall survival signal likely reflects postprogression treatment patterns rather than a lack of efficacy. Together, these data support continued evaluation of [RPT] earlier in the disease course and in combination with other systemic therapies,” said lead author Mohammad Arfat Ganiyani, MBBS, a postdoctoral research fellow at the Miami Cancer Institute, part of Baptist Health South Florida. The study was conducted under the leadership of Rohan Garje, MD, principal investigator and senior author.
LuPSMA-617 is currently the only FDA-approved RPT targeting prostate-specific membrane antigen for patients with mCRPC, although studies such as the phase II LUNAR trial suggest the potential of additional RPT approaches for this disease.
20-Fold Increase in RPT Use Over the Past Decade
A new analysis of Medicare claims data points to dramatic growth in RPT delivery over the past decade (Abstract 11). Intravenous administrations increased from 529 instances in 2013 to 12,395 instances in 2023, representing a rise of more than 2,000%.
Researchers also examined the medical specialties responsible for delivering RPT, finding substantial growth across diagnostic and interventional radiology (45% of 2023 claims), nuclear medicine (37%), radiation oncology (15%) and medical oncology/hematology (2.5%). RPT administrations increased in absolute volume across specialties during the study period, though the relative distribution of administrations changed as intravenous RPT scaled nationally. Radiology accounted for the largest shift during the study period (growing from 24% to 45% of claims), while nuclear medicine (from 53% to 37%) and radiation oncology (from 23% to 15%) accounted for smaller shares of RPT administrations over time.
“Despite widespread recognition that [RPTs] are expanding rapidly, the scale and pace of adoption had not been well characterized using national data,” said lead author Sean Maroongroge, MD, MBA, Assistant Clinical Professor of Radiation Oncology at City of Hope Comprehensive Cancer Center in Duarte, California. “We observed substantial growth in overall use across specialties, with measurable shifts in relative participation over time. These findings reflect the evolving multidisciplinary nature of RPT and underscore the need for cross-disciplinary research, training, credentialing, and clinical workflows as adoption continues to expand.”
The analysis was based on Medicare Part B professional claims, which do not fully capture some treatments delivered in hospital outpatient settings and may therefore undercount total RPT use, researchers explained.
Models for RPT Delivery
Several abstracts share guidance for establishing and maintaining high-quality RPT programs, including those in community-based settings (Abstract 17) and large academic health systems (Abstract 13). Studies also describe clinical pathways and models for multidisciplinary care integrating radiation oncology, nuclear medicine, and other specialties (Abstract 14 and Abstract 16).
ASTRO also recently published a white paper outlining safety and quality considerations for RPT delivery, and launched training centers to increase the number of physicians certified to provide these treatments.
