Total information dominance on radiopharmaceuticals.
Every isotope, ligand, tracer, therapy, target, trial, manufacturer and institution in nuclear medicine, linked together — theranostics and diagnostic imaging alike. The state of the art, the history, the supply chain and what is coming, with a plain-English TL;DR on every page.
862 linked objects, one page each. Every count is a link.
Clinician or physicist
Agents, criteria and dosimetry, cited. Every number links to its source and every object to its neighbours.
Researcher or radiochemist
Chelators, targets, pairs and the literature behind them, linked in both directions.
- TechnologiesChemistry, hardware and imaging methods
- TargetsPSMA, SSTR, FAP, CAIX and the rest
- Key papersThe literature that defines each sub-field
- OpportunitiesDecisions nobody can make today, and what would settle them
- The universeEvery product, trial, paper, abstract, patent and stated unmet need, searchable
Builder, operator or investor
Where the field is stuck: supply, capacity and the programmes aimed at it.
Begin from an isotope, an agent, a target or a question, and follow the links in any direction.
Every radionuclide, every labelled molecule, every target, indication and trial. One page each, plain English first.
What is happening and how strong the evidence is: readouts, approvals, supply, failures and the money.
The theranostic centres, the isotope producers, the companies and the people behind them.
Curated paths through the material, how the site works, and how to make it better.
Openings
Each one is a decision that cannot be made today, with the evidence read, the flags that would sink it and the study that would settle it.
No validated test tells a pancreatic tumour board, before operating, whether a CT-resectable tumour hides peritoneal or small liver metastases, and 41.4% of CT-resectable patients are found unresectable at laparotomy.
When a man with clinically obvious prostate cancer has a negative or low-uptake PSMA PET, nothing tells his clinician whether the disease is genuinely small-volume, PSMA-negative but targetable through another receptor, or dedifferentiated and beyond either.
Before radical cystectomy or before starting enfortumab vedotin, no test shows whether the bladder tumour and the pelvic nodes still express Nectin-4, because the only human Nectin-4 tracer is renally excreted and urinary activity obscures exactly that region.
When serum CEA or a ctDNA assay says a treated colorectal cancer has recurred but CT, MRI and colonoscopy cannot find it, no approved molecular imaging agent localises the disease well enough to plan salvage surgery.
When CT or MRI finds an indeterminate renal mass, nothing tells the clinician whether it is clear cell renal cell carcinoma before committing the patient to surgery, biopsy or surveillance, and up to a fifth of resected small masses prove benign.
A curable cause of hypertension goes untreated because the test that decides who can be cured is invasive, painful, available in few centres and therefore almost never done: fewer than 1% of patients with primary aldosteronism are fully investigated.
Fronts of nuclear medicine
Every way a radionuclide is used to see or to treat, grouped. Each schematic is a working model, not to scale.
Molecular imaging uses a small radioactive tracer injected into the body and a PET or SPECT camera to show where a specific protein sits on a tumour, so doctors can pick the right treatment and check it is working.
Radioligand therapy attaches a radioactive particle to a molecule that homes in on a tumour, so the radiation is delivered from the inside of the cancer rather than from an external beam.
Alpha therapy uses a heavier type of radioactive particle that travels only a few cell widths but hits much harder, aimed at cancer cells that have stopped responding to the gentler beta-particle treatments.
The radioactive ingredients in these medicines are made in a small number of ageing reactors and accelerators worldwide, and demand is now growing faster than that supply.
Making one of these medicines means attaching a radioactive atom to a targeting molecule and getting it sterile and out the door within hours, before it decays away — a manufacturing problem unlike almost any other medicine.
Dosimetry works out exactly how much radiation dose a patient's tumour and healthy organs actually receive, so treatment can in principle be tailored to the person rather than given as one fixed dose to everyone.
Brain PET scans can now show the sticky protein clumps of Alzheimer's disease directly, and are also used to see how far a brain tumour has spread and whether radiotherapy scarring looks like tumour regrowth.
A radioactive tracer injected into the bloodstream lights up on a scanner wherever the heart muscle is getting enough blood flow, so doctors can see blocked arteries without surgery.
The same FDG tracer used to find cancer also lights up sites of infection and inflammation, which helps doctors find hidden abscesses, infected joint replacements or heart-valve infections that scans and blood tests alone can miss.
Some radioactive drugs are built to home in on damaged bone rather than the tumour itself, easing bone pain from cancer that has spread to the skeleton and, in one case, helping patients live longer.
Radioembolisation delivers tiny radioactive beads directly into the blood vessels feeding a liver tumour through a catheter, so the radiation stays concentrated in the liver instead of spreading through the whole body.
Getting one of these radioactive medicines approved and then actually paid for is its own specialised process, separate from ordinary drugs, and the rules for who pays what changed again for 2026 in the US.
Latest updates
Generated from the corpus at each build: approvals by agent, and the latest milestone recorded for each indication.
Approvals in 2026
9 products- DurvalumabHigh-risk NMIBC with BCG
- Florastamin F-18PET imaging of PSMA-positive lesions in men with prostate cancer whose existing imaging suggests recurrence or metastasis
- Floretyrosine F-18 (FET)Use with PET to differentiate recurrent or progressive glioma from treatment-related change, in conjunction with other diagnostic evaluations, in adults and paediatric patients 1 month of age and older
- Florquinitau F-18PET of the brain in adults with cognitive impairment who are being evaluated for Alzheimer's disease, to identify patients with tau neurofibrillary tangle pathology
- Lutetium-177 dotatate (radioligand equivalent)Somatostatin receptor-positive gastroenteropancreatic neuroendocrine tumours (GEP-NETs), including foregut, midgut and hindgut tumours, in adults
- Lutetium-177 vipivotide tetraxetanLabel expansion (July 2026)
- PembrolizumabPlatinum-resistant PD-L1+ ovarian cancer; adjuvant RCC with belzutifan; with sacituzumab govitecan in 1L TNBC
- Piflufolastat F-18 / Pylarify TruVuPylarify TruVu formulation
- Technetium (99mTc) pexiretideSPECT/CT assessment of regional lymph-node metastasis in patients with suspected lung cancer
Latest milestone by indication
2026- Diffuse large B-cell lymphomafrontMIND published in Lancet; EPCORE DLBCL-1 misses OS; frontline bispecific data (EPCORE DLBCL-2) at EHA
- Follicular lymphomaTazemetostat withdrawn worldwideSecondary haematologic malignancies; EZH2 leaves the FL armamentarium.
- Glioma & glioblastomaASCO 2026: NeoVax personalised vaccine immune responses; multi-target CAR-T; tovorafenib EU approval
- Hepatocellular carcinomaEMERALD-3 positive for PFS; LEAP-012 final OS HR 0.98; IMbrave050 update negative; third camrelizumab-rivoceranib CRL (23 July)
- HER2-positive breast cancerT-DXd approved neoadjuvant and post-neoadjuvant; palbociclib maintenance for HR+/HER2+ (PATINA)
- Intermediate hepatocellular carcinoma (BCLC B)EMERALD-3: durvalumab-tremelimumab plus TACE reported positive
- Metastatic hormone-sensitive prostate cancerCapivasertib for PTEN-deficient and 177Lu-PSMA-617 for PSMA-positive disease approved
- Neuroblastoma (paediatric)ANBL1531 MIBG randomisation maturing; ALK arm reports
- Neuroendocrine tumoursFDA accepts 177Lu-edotreotide NDA (PDUFA 28 August); ACTION-1 dosimetry published; pancreatic subgroup of COMPETE at ENETS
- Non-small cell lung cancerChina approves technetium (99mTc) pexiretide for nodal stagingNMPA approval on 2 April 2026 of an integrin alpha-v-beta-3 RGD peptide for SPECT/CT assessment of regional lymph nodes in suspected lung cancer.
Spotlight on prostate cancer
The indication radioligand therapy changed first, and the template every indication page is growing into.
Prostate cancer is the home of theranostics: PSMA PET finds it, PSMA radioligands treat it. Hormonal therapy remains the foundation, with PARP and AKT inhibitors added by genotype.
Theranostic pairing of PSMA PET and Pluvicto.
Pluvicto approved in metastatic hormone-sensitive disease (31 July); capivasertib + abiraterone approved for PTEN-deficient disease:
Neuroendocrine transformation.
Roadmaps
History to horizon for each part of the field.
Alpha particles carry much more energy over a much shorter distance than the beta particles used in Lutathera and Pluvicto, so they can be more powerful against small clusters of cancer cells. The first alpha drug was approved in 2013; a wave of alpha versions of existing beta drugs is now in late-stage testing, and the isotopes are still scarce.
Working out how much radiation a treatment actually delivers to a tumour and to healthy organs, rather than just giving everyone the same fixed amount, could let doctors treat some patients more and some less. The tools to do this patient by patient exist and are used in some specialist centres, but most approved radioligand therapies are still given at one fixed dose to everyone.
The radioactive ingredients that make theranostics work come from a small number of ageing nuclear reactors, generators and accelerators around the world. A shortage anywhere in that chain delays cancer scans and treatments; new non-uranium and accelerator-based production lines are being built to fix that, but they take years and hundreds of millions of dollars.
From a sugar tracer that lights up most cancers to tracers that show a single protein, a stromal cell type, or the immune cells inside a tumour.
Ordinary sugar-based PET scans do not work well in the brain because healthy brain tissue itself uses a lot of sugar. Nuclear medicine had to develop tracers that light up brain tumours specifically, first amino acid tracers for gliomas and then a receptor tracer that also opens the door to a matched radioactive treatment for meningioma.
Prostate-specific membrane antigen was found on prostate cancer cells in 1987. It took until 2020-2022 for scans and treatments that target it to reach approval, but once they did, PSMA PET and Pluvicto changed how metastatic prostate cancer is staged and treated, and the same target is now being tried earlier in the disease and with more powerful alpha particles.
The radiopharmaceutical roadmap runs eighty years from radioactive iodine for thyroid cancer to alpha-emitting drugs for prostate and neuroendocrine cancers, with isotope supply as the limiting factor.
Neuroendocrine tumours were the proving ground for the whole idea of theranostics: find a receptor on the tumour, image it with a low-dose radioactive scan, then treat with a matched higher-dose version of the same molecule. That sequence took thirty years to build and is now being extended with more powerful alpha-particle versions.
Frontier technologies
Early, unproven, and worth watching.
Actinium-225 releases four alpha particles as it decays, but the daughters escape and irradiate the kidneys and salivary glands. Nanocarriers try to hold them in place.
Auger-electron therapy uses radioactive atoms such as iodine-125 or terbium-161 that release cascades of low-energy electrons travelling only nanometres to micrometres, so they kill a cell only if the atom sits on or inside its DNA and spare the neighbours. Terbium-161 can replace lutetium-177 in existing PSMA ligands; true nuclear delivery remains preclinical.
Attaching a radioactive atom to an antibody, so an ADC's targeting is used to deliver radiation instead of chemotherapy.
Adding a PARP or ATR inhibitor to a radioactive drug so the tumour cannot repair the damage the radiation causes.
Like radioligand therapy but with alpha particles: far more destructive over a much shorter range, so single cells can be killed with less collateral damage.
Scanners sensitive enough to image the whole body in seconds at a fraction of the radiation dose, which raises the question of whether healthy people should be scanned at all.
An experimental PET scan that shows whether a tumour carries the TROP2 protein, so doctors could pick the right ADC before giving it.
The centres that run theranostics: who they are, where they are, what they publish.
Map and ranking