Readiness for radioligand therapy

Radioligand therapy is an innovative approach to treating certain types of cancer. It delivers radiation to cancer cells in a targeted and precise way, with a minimal effect on healthy cells,1 which allows for greater efficiency.


The Radioligand Therapy Readiness Assessment Framework is a tool to evaluate the extent to which radioligand therapy is currently integrated into a health system, focusing on five key areas. It can be applied to establish what is needed to successfully integrate radioligand therapy into cancer care.

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.2 Radioligand therapy may help address some of these challenges. It has shown to significantly improve survival and quality of life for people with certain types of neuroendocrine neoplasms, lymphoma and prostate cancer.3-9 Current use of radioligand therapy is variable, so integrating it into every aspect of a health system is essential to ensuring its availability.

With many new therapies on the horizon, we need to prepare for the future of cancer care while also improving use of existing treatments. We must look at all relevant pillars of the health system to effectively plan for a full integration of radioligand therapy into cancer care.

The framework has been initially applied in the US and the UK. We hope it can be used by researchers, clinicians and patient organisations to encourage evidence-based planning for radioligand therapy within other national contexts.

Readiness for radioligand therapy Radioligand Therapy Readiness Assessment Framework

What is radioligand therapy?

Radioligand therapy has evolved from targeted radioisotope therapies, well established as a treatment option for thyroid cancer10 11 and bone metastases due to prostate cancer,12 among other clinical indications. While targeted radioisotope therapies offer organ-level precision, radioligand therapy enables precision at the cellular level.

Radioligands bind to certain types of cancer cells wherever they are located in the body and can be used for diagnosis and treatment. Radioligand therapy is currently licensed for use for certain types of neuroendocrine neoplasms, lymphoma and metastatic castration-resistant prostate cancer. 13-17 It also looks promising in other cancers as well as non-cancer conditions.

What are radioligands?

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 cancer cells. The ligand can target radiation to specific cells anywhere in the body.

Readiness for radioligand therapy

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 18 Alternatively, changing the ligand can allow targeting of different types of cancer or even other diseases. Sometimes the ligand used is an antibody, in which case the approach is known as radioimmunotherapy.

About the project

The readiness assessment project has been led by The Health Policy Partnership, an independent research organisation, with input from three multidisciplinary Expert Advisory Groups at the international, UK and US levels. The project aims to create greater awareness of, and readiness for, radioligand therapy as an innovative component of cancer care. The Expert Advisory Groups had full editorial control over content of all materials, which reflect 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 with funding from Advanced Accelerator Applications, a Novartis company, with additional support from Nordic Nanovector.

  1. Virgolini I, Decristoforo C, Haug A, et al. 2018. Current status of theranostics in prostate cancer. Eur J Nucl Med Mol Imaging 45(3): 471-95
  2. Rahbar K, Bode A, Weckesser M, et al. 2016. Radioligand Therapy With 177Lu-PSMA-617 as A Novel Therapeutic Option in Patients With Metastatic Castration Resistant Prostate Cancer. Clin Nucl Med 41(7): 522-8
  3. Strosberg J, El-Haddad G, Wolin E, et al. 2017. Phase 3 Trial of (177)Lu-Dotatate for Midgut Neuroendocrine Tumors. New Engl J Med 376(2): 125-35
  4. Marinova M, Mücke M, Fischer F, et al. 2019. Quality of life in patients with midgut NET following peptide receptor radionuclide therapy. Eur J Nucl Med Mol Imaging 46(11): 2252-59
  5. Cheson BD. 2003. Radioimmunotherapy of non-Hodgkin lymphomas. Blood 101(2): 391-98
  6. Kolstad A, Madsbu U, Beasley M, et al. 2018. LYMRIT 37-01: A phase I/II study of 177lu-lilotomab satetraxetan (Betalutin®) antibody-radionuclide-conjugate (ARC) for the treatment of relapsed non-Hodgkin’s lymphoma (NHL) — analysis with 6-month follow-up. Blood 132: 2879
  7. Herrmann K, Schwaiger M, Lewis JS, et al. 2020. Radiotheranostics: a roadmap for future development. Lancet Oncol 21(3): e146-e56
  8. Novartis. Novartis announces positive result of phase III study with radioligand therapy 177Lu-PSMA-617 in patients with advanced prostate cancer. Available from: [Accessed 23/03/21]
  9. Khan S, Krenning EP, van Essen M, et al. 2011. Quality of life in 265 patients with gastroenteropancreatic or bronchial neuroendocrine tumors treated with [177Lu-DOTA0,Tyr3]octreotate. J Nucl Med 52(9): 1361-8
  10. McCready VR. 2017. Radioiodine – the success story of Nuclear Medicine. Eur J Nucl Med Mol Imaging 44(2): 179-82
  11. Filetti S, Durante C, Hartl D, et al. 2019. Thyroid cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol: 10.1093/annonc/mdz400
  12. Poeppel TD, Handkiewicz-Junak D, Andreeff M, et al. 2018. EANM guideline for radionuclide therapy with radium-223 of metastatic castration-resistant prostate cancer. Eur J Nucl Med Mol Imaging 45(5): 824-45
  13. Hennrich U, Kopka K. 2019. Lutathera(®): The First FDA- and EMA-Approved Radiopharmaceutical for Peptide Receptor Radionuclide Therapy. Pharmaceuticals 12(3):
  14. Cancer Network. First Radioimmunotherapy Approved by FDA. Available from: [Accessed 06/04/21]
  15. European Medicines Agency. Zevalin ibritumomab tiuxetan. Available from: [Accessed 07/07/20]
  16. US Food & Drug Administration. FDA approves Pluvicto for metastatic castration-resistant prostate cancer. Available from: [Accessed 14/11/2022]
  17. European Society for Medical Oncology. EMA recommends granting a marketing authorisation for Lutetium (177Lu) vipivotide tetraxetan. Available from: [Accessed 14/11/2022]
  18. Herrmann K, Larson SM, Weber WA. 2017. Theranostic Concepts: More Than Just a Fashion Trend-Introduction and Overview. J Nucl Med 58(Suppl 2): 1s-2s

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