A radioligand is made of two parts: a ligand, which can find cancer cells that have a particular surface molecule, and a radioisotope, which emits therapeutic radiation to kill these cells. The radioligand can target cells anywhere in the body.
The radioligand can be customised for diagnostic (imaging) or therapeutic (treatment) purposes by changing the type of radioisotope. Combining the diagnostic and treatment processes is known as theranostics.1 2 Alternatively, changing the ligand can allow targeting of different types of cancer or even other diseases.
Despite progress in many areas of cancer care, important gaps remain. Many people do not have effective treatment options, particularly for aggressive or rare forms of cancer.3 New strategies are needed to improve not just survival, but quality of life.4 One emerging type of treatment is radioligand therapy. It has been shown to improve overall survival and quality of life for many people with neuroendocrine cancers and metastatic castration-resistant prostate cancer that has spread to the bone.1 4-7 However, it has only recently been introduced into cancer care guidelines for these types of tumours.8-17 Radioligand therapy has potential to treat other aggressive or rare forms of cancer.3
Current use of radioligand therapy is variable. Integrating it into clinical practice requires new models of care and multidisciplinary coordination. Download the full report to learn more about radioligand therapy and the actions that may support its greater introduction into cancer care.
Targeted radiation has existed for decades. Radioiodine was first used to treat overactive thyroid glands and subsequently thyroid cancer in the 1940s.18-21 Because the thyroid absorbs significantly more iodine than any other organ, radioiodine is taken directly to the thyroid and delivers radiation to kill cancerous cells. Radioiodine remains central to thyroid cancer treatment today.
This principle of targeted radiation has evolved from organ-level precision to cellular-level precision in line with scientific advances. Radioligands bind to certain types of cancer cells wherever they are located in the body, so they can be used for targeted diagnosis and treatment.
Cancer is currently the second highest cause of mortality and morbidity in Europe, and its burden is expected to continue rising. As our understanding of cancer’s complexity and diversity grows, it becomes increasingly clear that we must have a broad range of adaptable tools. Current cancer care often fails to meet the needs of people with rare cancers, or cancers that are resistant to treatments or have metastasised (spread to other parts of the body).
Radioligand therapy may help to address this gap and provide life-enhancing treatment for people with limited treatment options, playing an important role in realising the potential of personalised, targeted healthcare. However, its uptake across Europe is highly variable. Many people who might benefit from radioligand therapy are unable to access it or face restrictions to its appropriate use.
Optimal cancer care will look different for each individual, but personalisation and multidisciplinary working are essential. People with cancer benefit from a team of experts who can respond in a way that best meets their specific needs. The nature of radioligand therapy makes it highly adaptable, but also necessitates multidisciplinary working between oncologists, nuclear medicine specialists and others. Efforts to facilitate radioligand therapy therefore go hand in hand with wider efforts to improve access to multidisciplinary cancer care.
It is up to decision-makers to act now to ensure that every person with cancer receives appropriate and adaptable care as soon as they need it – including, where appropriate, radioligand therapy. Read our recommendations for better integrating radioligand therapy into cancer care at the link below.
This policy report has been drafted by The Health Policy Partnership, an independent research organisation, with input from a multi‑stakeholder steering committee. Its aim is to create greater awareness of radioligand therapy as an innovative component of cancer care. The steering committee had full editorial control over content, which reflects consensus among the group. All members provided their time for free. The outputs of this project are intended for educational purposes only and do not relate to any particular product.
This project was supported by a grant from Advanced Accelerator Applications, a Novartis company, with additional support from Curium.