Nuclide
opportunities

opportunities

Where a clinical decision cannot be made today and a radiopharmaceutical could settle it: the unmet need, the most advanced agent anywhere, the evidence on five domains and a traffic light on six.

1,229 more ideas computed from the whole radiopharmaceutical universeCross-links across 1,557 registered products, 7,634 trials, 134,026 papers, 36,024 congress abstracts, 35,812 patents and 17,975 published unmet needs, each idea with its evidence.

What the scanner found in this corpus

18 candidates across 5 of 6 lenses; 1 found nothing

The records below were written by hand from primary sources. These are the leads the graph flags on its own: targets, diseases, isotopes and registrations that fit one of the same lenses and have not been worked up yet. Counts are literal — a lens with no hits is left empty.

Theranostic gap

2 new · 2 written up

Which targets have a therapy in the clinic and no diagnostic paired with it?

  • CD20 — 2 therapeutic radiopharmaceuticals against this target in the corpus, no imaging agent
  • Norepinephrine transporter (NET) — 2 therapeutic radiopharmaceuticals against this target in the corpus, no imaging agent

Target crossover

1 new · 3 written up

Which targets are validated by an antibody, ADC or bispecific with no radioligand against them?

  • PARP — 1 non-radioactive agent against this target, no radioligand

Unmet need first

6 new · 6 written up

Which diseases in the corpus have no radiopharmaceutical at all?

Non-US registry

1 new · 1 written up

What is registered outside ClinicalTrials.gov and therefore invisible to US-centred pipeline tracking?

  • proPSMA — registered as ANZCTR12617000005358, outside ClinicalTrials.gov

Maturing preclinical

0 new · 0 written up

Which preclinical agents are close enough to the clinic to belong in a clinical-stage funnel?

Nothing in this corpus meets the rule today.

Supply and isotope

8 new · 0 written up

Which isotopes have no agent using them, so the opportunity is production or delivery rather than the molecule?

  • Astatine-211 — no agent in the corpus uses this isotope
  • Bismuth-213 — no agent in the corpus uses this isotope
  • Radium-224 — no agent in the corpus uses this isotope
  • Scandium-44 — no agent in the corpus uses this isotope
  • Scandium-47 — no agent in the corpus uses this isotope
  • Terbium-161 — no agent in the corpus uses this isotope
  • Thorium-227 — no agent in the corpus uses this isotope
  • Yttrium-86 — no agent in the corpus uses this isotope
13 opportunities
How it was found
CAIX imaging of the indeterminate renal mass
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.
Scans find small kidney lumps all the time and cannot tell which are cancer. Up to one in five that are surgically removed turn out to be harmless. A scan that recognises the commonest kidney cancer would spare those operations, and it needs no drug to be useful.
CXCR4 imaging instead of adrenal vein sampling
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.
A common and curable cause of high blood pressure is almost never cured, because finding out which adrenal gland is at fault needs an invasive procedure few hospitals do well. A PET scan can answer the same question, and one is now heading into a registrational trial.
FAP imaging to stop futile pancreatic surgery
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.
Four in ten pancreatic cancer patients whose scans say the tumour can be removed turn out, once opened up, to have disease that cannot be removed. A scan that lights up the scar tissue around tumour deposits sees more of that hidden disease than the standard one.
GRPR imaging when the PSMA scan is negative
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.
Prostate cancer imaging and treatment both rely on one protein, PSMA. In a minority of men the tumour does not carry it, and for those men a negative scan is a dead end. A second receptor, GRPR, is the best-studied alternative, and the honest reading of the head-to-head studies is that it finds fewer lesions overall but different ones.
A liver-cleared Nectin-4 tracer for urothelial cancer
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.
An approved bladder cancer drug works by latching onto a protein called Nectin-4, and half of patients lose that protein as the disease spreads. The one scan built to show it is cleared through the kidneys, so the bladder and the nearby lymph nodes glow with waste tracer and are the hardest places to read.
Alpha-synuclein PET: works for MSA, not for Parkinson's
There is no way to see pathological alpha-synuclein in a living brain, so ambiguous parkinsonian syndromes cannot be told apart at the molecular level and no anti-alpha-synuclein drug can demonstrate that it engaged its target.
Parkinson's disease is defined by a protein clumping in the brain, and no scan can see it. The first tracer to reach patients does light up a rarer, related disease but not Parkinson's itself, while a spinal-fluid test already identifies Parkinson's with high accuracy.
An inflammation tracer that does not need a diet
No non-invasive test reliably establishes whether myocardial inflammation is active right now, because FDG PET depends on imperfect dietary suppression, endomyocardial biopsy has sensitivity of roughly 20 to 30%, and no serum biomarker exists.
Deciding whether to put a patient on long-term steroids for heart sarcoidosis depends on a scan that only works if the patient's heart has been starved of sugar for a day, and a biopsy that misses the disease most of the time. A different tracer would not need the diet.
CEACAM5 imaging for occult colorectal recurrence
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.
After bowel cancer surgery, a rising blood marker often signals that the cancer is back, but scans frequently cannot say where. The one scan ever approved for that exact problem was withdrawn from the market in 2005 and nothing has replaced it.
Claudin-18.2 imaging when one biopsy says negative
When a gastric cancer biopsy reads CLDN18.2-negative, no test distinguishes a truly negative tumour from a false negative caused by sampling, so patients may be denied an approved antibody or CAR-T on a result that a single core gets right only about six times in ten.
Stomach cancer patients now get a drug only if a biopsy shows a protein called claudin-18.2. One biopsy core finds it only about six times in ten when the whole tumour has it, so patients are being refused a treatment on a test that misses.
DLL3 imaging for small-cell lung cancer
Before starting a DLL3-directed T-cell engager, no test shows whether every metastatic site in a patient with small-cell lung cancer still expresses DLL3, or whether some lesions have lost it; the decision rests on one biopsy from one place.
A drug that attacks small-cell lung cancer through a protein called DLL3 is already approved, but there is no approved scan that shows whether a patient's tumours still carry that protein. Doctors decide from a single biopsy taken from one place, which cannot show what the rest of the disease is doing.
GPC3 imaging of the indeterminate liver nodule, led from China
When a nodule in a cirrhotic liver is categorised LR-3 or LR-4, no test says whether it is cancer now, and the default is three to six months of serial imaging in a disease where delay costs the chance of curative treatment.
Cirrhotic livers throw up nodules that scans cannot classify, and the usual answer is to wait three to six months to see if they grow. Several Chinese hospital programmes are testing tracers that recognise a protein carried by most liver cancers, and almost none of that work appears in Western pipeline reviews.
HER3 imaging, and why three tracers stalled
There is no non-invasive way to measure HER3 across all of a patient's disease, including its rise after EGFR-inhibitor therapy, but it is also not established that knowing HER3 expression changes who benefits from a HER3-directed drug.
HER3 sits on most lung cancers and there are drugs aimed at it, so a scan showing which tumours carry it looks obvious. Three attempts were made and all three stopped, largely because the drug's own trials could not show that how much HER3 a tumour has predicts whether the drug works.
TROP2 imaging where no tissue test is required
Neither approved TROP2 antibody-drug conjugate requires a test for TROP2, and no validated blood or tissue assay exists, so when a patient stops responding nobody can tell whether the target has been lost or the payload has failed.
Two approved breast cancer drugs work through a protein called TROP2, and neither requires any test for it before use. Tumours vary a lot in how much they carry, and a quarter of patients lose it over time, so nobody currently knows who is being treated for a target that is no longer there.