Major advances in radioligand therapy and cancer care

Radioligands are an innovation driven by our increasing understanding of the molecular biology of cancer and the role of radiation in cancer care. This timeline explores the history and future of radioligand therapy (on the right) alongside other innovations in oncology (on the left).


First positive preliminary results from a phase III trial on the use of radioligand therapy for mCRPC1


Approval of radioligand therapy for progressive midgut NETs in the US2

First approval of gene therapy (alters the person’s immune cells (T-cells) to fight cancer, also known as CAR-T therapy)3 4


Approval of radioligand therapy for progressive midgut NETs in the EU5


Approval of bone-directed radiotherapy in mCRPC in the EU6 and US7

First approval of immune checkpoint inhibitor (for malignant melanoma)8


Further studies into radioligand therapy for bone metastases9


First radioimmunotherapy approved for lymphoma in the EU10


First radioimmunotherapy approved for lymphoma in the US11


Approval of bone-directed radiotherapy for pain in bone metastases in EU countries12 13

First monoclonal antibody immunotherapy treatment approved8


Early trials of radioimmunotherapy for lymphoma14


Early studies and use of radioligand therapy for NETs15-18


Early trials of bone-directed radiotherapy for bone metastases19


First scans of endocrine-related tumours using targeted radioisotopes20 21

First anti-cancer vaccine against hepatitis B virus (a risk factor for liver cancer)3


First hormone therapy approved that blocks the effect of oestrogen8


First use of chemotherapy after surgery (known as adjuvant chemotherapy)3


First PET scanner developed22

First use of chemotherapy3


Early trials of radioactive strontium to treat metastatic bone cancer23

Discovery of hormone therapy for prostate cancer8


First use of radioiodine to treat thyroid cancer (this was the first example of using a radionuclide for cancer treatment)24

First approach combining surgery and radiation8


First use of radiotherapy to cure cancer3

  1. Novartis. Novartis announces positive result of phase III study with radioligand therapy 177Lu-PSMA-617 in patients with advanced prostate cancer. Available from: [Accessed 23/03/2021]
  2. National Cancer Institute. FDA Approves New Treatment for Certain Neuroendocrine Tumors. Available from: [Accessed 12/04/21]
  3. American Society of Clinical Oncology. Cancer progress timeline. Available from: [Accessed 08/09/19]
  4. Immunotherapy: Timeline of key events. Available from: [Accessed 09/09/2019]
  5. European Medicines Agency. Lutathera. [Updated 02/04/19]. Available from: [Accessed 21/01/20]
  6. European Medicines Agency. Xofigo. [Updated 10/01/20]. Available from: [Accessed 21/01/20]
  7. ASCO. FDA Approves Xofigo for Castration-Resistant Prostate Cancer. Available from: [Accessed 12/04/21]
  8. National Cancer institute at the National Institutes of Health. Milestones in cancer research and discovery. Available from: [Accessed 08/09/2019]
  9. Bander NH, Milowsky MI, Nanus DM, et al. 2005. Phase I trial of 177lutetium-labeled J591, a monoclonal antibody to prostate-specific membrane antigen, in patients with androgen-independent prostate cancer. Journal of Clinical Oncology 23(21): 4591-601
  10. European Medicines Agency. Zevalin ibritumomab tiuxetan. [Updated 09/03/20]. Available from: [Accessed 07/07/20]
  11. Cancer Network. First Radioimmunotherapy Approved by FDA. Available from: [Accessed 06/04/21]
  12. Medicines and Healthcare products Regulatory Agency. 2016. SUMMARY OF PRODUCT CHARACTERISTICS: METASTRON. Available from: [Accessed 08/01/20]
  13. Haute Autorite de Sante – Medical EaPHAD. 2014. TRANSPARENCY COMMITTEE: Opinion 1 October 2014 METASTRON. Available from: [Accessed 08/12/19]
  14. Grillo-López AJ. 2002. Zevalin: the first radioimmunotherapy approved for the treatment of lymphoma. Expert Rev Anticancer Ther 2(5): 485-93
  15. Levine R, Krenning EP. 2017. Clinical history of the theranostic radionuclide approach to neuroendocrine tumors and other types of cancer: historical review based on an interview of Eric P. Krenning by Rachel Levine. Journal of Nuclear Medicine 58(Supplement 2): 3S-9S
  16. Krenning EP, Bakker WH, Breeman WA, et al. 1989. Localisation of endocrine-related tumours with radioiodinated analogue of somatostatin. Lancet (London, England) 1(8632): 242-4
  17. 2019. What is PRRT? Available from: [Accessed 08/09/19]
  18. Krenning EP, Kooij PP, Bakker WH, et al. 1994. Radiotherapy with a radiolabeled somatostatin analogue, [111In-DTPA-D-Phe1]-octreotide. A case history. Annals of the New York Academy of Sciences 733: 496-506
  19. Reddy EK, Robinson RG, Mansfield CM. 1986. Strontium 89 for palliation of bone metastases. Journal of the National Medical Association 78(1): 27-32
  20. Nakajo M, Shapiro B, Copp J, et al. 1983. The normal and abnormal distribution of the adrenomedullary imaging agent m-[I-131]iodobenzylguanidine (I-131 MIBG) in man: evaluation by scintigraphy. Journal of nuclear medicine : official publication, Society of Nuclear Medicine 24(8): 672-82
  21. Francis IR, Glazer GM, Shapiro B, et al. 1983. Complementary roles of CT and 131I-MIBG scintigraphy in diagnosing pheochromocytoma. AJR American journal of roentgenology 141(4): 719-25
  22. US Department of Energy – Molecular Nuclear Medicine Legacy. History of PET and MRI. Available from: [Accessed 08/09/2019]
  23. Pecher C. 1942. Biological investigations with radioactive calcium and strontium; preliminary report on the use of radioactive strontium in the treatment of metastatic bone cancer. Berkeley, Los Angeles, USA: University of California Press
  24. McCready VR. 2017. Radioiodine – the success story of Nuclear Medicine. Eur J Nuclear Med Mol Imaging 44(2): 179-82

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