Radiopharmaceutical therapy in cancer: clinical advances and challenges
A review, written for drug developers, of how radioactive cancer drugs work, which ones had reached patients by 2020, and what stands in the way of making more of them.
Overview
This review by Sgouros, Bodei, McDevitt and Nedrow surveys the state of radiopharmaceutical therapy (RPT) as of 2020: the physics of alpha, beta and Auger emitters, the targeting chemistry (small molecules, peptides, antibodies), the theranostic pairing of imaging and therapy isotopes, and the clinical evidence behind approved and late-stage agents (iodine-131, radium-223, lutetium-177 dotatate, and the then-emerging lutetium-177 and actinium-225 PSMA agents). It frames RPT's central advantage - imageable biodistribution paired with cytotoxic effect, and a favourable toxicity profile relative to most systemic cytotoxic therapies - and its central bottlenecks: isotope supply, dosimetry standardisation, and the absence of a companion-diagnostic regulatory pathway equivalent to that for drugs.
The review does not report new clinical data; its contribution is a structured account of the field's trajectory and the translational problems (manufacturing scale, radiobiology of low dose-rate irradiation, patient selection biomarkers) that a decade of subsequent approvals (Pluvicto, Lutathera label expansions) had to solve.
It is widely cited as a field-level reference in subsequent radiopharmaceutical papers and grant applications, alongside the companion 2020 Lancet Oncology roadmap by Herrmann and colleagues.
- Surveys approved and late-stage radiopharmaceutical therapies as of 2020 (iodine-131, radium-223, 177Lu-dotatate, emerging PSMA agents) and their radiobiological basis.
- Identifies isotope supply, standardised dosimetry, and regulatory pathways for companion imaging diagnostics as the principal translational bottlenecks for the field.
- Frames radiopharmaceutical therapy's comparative advantage as imageable biodistribution combined with generally lower toxicity than systemic cytotoxic chemotherapy.
This paper is a map of the radioactive-cancer-drug field at a pivotal moment, explaining to non-specialists and drug developers alike why these treatments work differently from chemotherapy and what needed to be fixed - supply, dosing science, regulation - before more of them could reach patients.
- As a narrative review, it synthesises published data rather than presenting new trial results, and reflects the evidence base and pipeline as they stood in 2020.
- Note the journal is Nature Reviews Drug Discovery (the corpus records this under the closest matching journal entry, Nature Medicine, as Nature Reviews Drug Discovery is not separately catalogued); consult the DOI/PMID for the exact source.
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