Studies Provide Clinical Evidence for Approved Agents, Novel and Emerging Indications and Rapid Growth of Radiopharmaceutical Therapies

The inaugural Multidisciplinary Radiopharmaceutical Therapy Symposium, taking place February 17-18, 2026, in Palm Desert, California, cosponsored by the American Society for Radiation Oncology (ASTRO), the American Society of Clinical Oncology (ASCO), and the Society for Immunotherapy of Cancer (SITC), brings together specialists from radiation, medical, and surgical oncology to address emerging evidence and optimize patient care.

Expect presentations highlighting the growing potential of radiopharmaceutical therapies (RPT) to improve outcomes for patients diagnosed with cancer. Studies at the meeting span established uses of RPT and early signals for new indications, while also addressing what clinics need in place to safely offer these treatments as they move into routine care.

Among the noteworthy abstracts are a meta-analysis showing longer progression‑free survival (PFS) with Lu‑177 PSMA‑617 and a national review documenting a twenty‑fold rise in Medicare claims for RPT over the past decade.

Targeted treatment
Radiopharmaceuticals are specialized injectable cancer drugs that deliver targeted radiation directly to cancer cells while limiting exposure to surrounding tissues, offering the potential for better tumor control with fewer side effects. While standard radiation therapy typically involves external-beam treatments or brachytherapy, RPTs are delivered systemically with radioactive agents that target specific biomarkers on tumor cells. When treatments, also known as radioligand therapies, bind to these biomarkers, they deliver radiation directly to tumor cells. A growing body of research indicates that RPTs offer an important new option for people with cancer.

Only two RPTs have been approved by the U.S. Food and Drug Administration (FDA) in the past decade, though many additional agents are being tested in clinical trials. Studies at the meeting reflect the expanding pipeline of next-generation agents, collectively addressing a wide range of disease sites under active investigation, including hematologic, gastrointestinal, and other common cancers.

As more agents reach clinics and patient demand grows, providers are also seeking expert guidance to build and sustain RPT services in their local communities. This new ASTRO-sponsored symposium pairs science with operational insight, offering practical guidance for multidisciplinary teams delivering RPT in clinical settings.

Highlighted studies and meeting keynotes include a meta-analysis demonstrating that RPT consistently prolongs progression-free survival without adding severe side effects for patients with advanced prostate cancer.

Abstract 1: Safety and efficacy of Lu-177 PSMA-617 versus established therapies in mCRPC: Pooled evidence from randomized phase II/III trials

Lu-177 PSMA-617 delivers targeted β-radiation to prostate cancer cells, offering a distinct mechanism beyond androgen-signaling inhibition in metastatic castration-resistant prostate cancer (mCRPC).

In a pooled analysis of seven randomized trials involving more than 2,500 patients with metastatic castration-resistant prostate cancer (mCRPC), the radiopharmaceutical drug Lu-177 PSMA-617 significantly improved progression-free survival rates compared with standard-of-care systemic therapy.

Patients who received the radiopharmaceutical drug commonly known as Pluvicto did not experience significantly more severe (grade 3 or higher) side effects than those who received standard treatments, including hormone-based drugs. The meta-analysis did not show a difference in overall survival, though researchers noted this finding may be influenced by patients in control arms receiving RPT after their cancer progressed in some trials.

“PSMA-targeted radioligand therapy works differently than traditional androgen-signaling therapies by delivering radiation directly to prostate cancer cells. Across randomized trials, the consistency of progression-free survival benefit with favorable tolerability was striking, and the absence of a clear overall survival signal likely reflects post-progression treatment patterns rather than a lack of efficacy,” explained lead author Mohammad Arfat Ganiyani, MBBS, postdoctoral research fellow at the Miami Cancer Institute, part of Baptist Health South Florida.

“Together, these data support continued evaluation of radiopharmaceutical therapy earlier in the disease course and in combination with other systemic therapies,” Ganiyani added.

The authors of the study, conducted under the leadership of Rohan Garje, MD, principal investigator and senior author, conclude that the available data collectively reinforce Lu-177 PSMA-617 as a well-tolerated, effective radioligand option for advanced mCRPC, warranting continued integration into earlier disease settings and combination strategies.

Lu-177 PSMA-617 is currently the only FDA-approved RPT targeting PSMA for patients with mCRPC, although studies such as the phase 2 LUNAR trial suggest the potential of additional radiopharmaceutical approaches for this disease.

A20-fold increase in RPT use
Abstract 11: Multispecialty expansion in radiopharmaceutical therapy: National trends in Medicare from 2013-2023

A new analysis of Medicare claims data indicates dramatic growth in the delivery of radiopharmaceutical therapy over the past decade. Intravenous administrations increased from 529 in 2013 to 12,395 in 2023, a rise of more than 2,000%.

Researchers also examined the medical specialties responsible for delivering RPT, finding substantial growth across diagnostic and interventional radiology (45% of 2023 claims), nuclear medicine (37%), radiation oncology (15%), and medical oncology/hematology (2.5%). RPT administrations increased in absolute volume across specialties during the study period, though the relative distribution of administrations changed as intravenous RPT scaled nationally. Radiology accounted for the largest shift during the study period (growing from 24% to 45% of claims), while nuclear medicine (from 53% to 37%) and radiation oncology (from 23% to 15%) accounted for smaller shares of RPT administrations over time.

“Despite widespread recognition that radiopharmaceutical therapies are expanding rapidly, the scale and pace of adoption had not been well characterized using national data,” noted lead author Sean Maroongroge, MD, MBA, an assistant clinical professor of radiation oncology at the City of Hope Comprehensive Cancer Center in Duarte, California.

“We observed substantial growth in overall use across specialties, with measurable shifts in relative participation over time. These findings reflect the evolving multidisciplinary nature of radiopharmaceutical therapy and underscore the need for cross-disciplinary research, training, credentialing, and clinical workflows as adoption continues to expand,” Maroongroge added.

The analysis was based on Medicare Part B professional claims, which do not fully capture some treatments delivered in hospital outpatient settings and may therefore undercount total RPT use, researchers explained.

Models for radiopharmaceutical delivery
Several other abstracts share guidance for establishing and maintaining high-quality RPT programs, including those in community-based settings (abstract 17) and large academic health systems (abstract 13). Some studies describe clinical pathways and models for multidisciplinary care integrating radiation oncology, nuclear medicine, and other specialties (e.g., abstracts 14, and 16). ASTRO also recently outlined safety and quality considerations for RPT delivery and launched training centers to increase the number of physicians certified to provide these treatments. [1]

Note:* Full schedule details are available in the conference planner.

Clinical trials
177-Lutetium-PSMA Before Stereotactic Body Radiotherapy for the Treatment of Oligorecurrent Prostate Cancer, The LUNAR Study (LUNAR) – ClinicalTrials.gov ID NCT05496959

Reference
[1] Zoberi JE, Charara Y, Clements J, Escorcia FE, Hobbs RF, St James S, Mulugeta PG, Patel RB, Srivastava S, Phillips J. Quality and Safety Considerations for Radiopharmaceutical Therapy in the Radiation Oncology Environment: An ASTRO Safety White Paper. Pract Radiat Oncol. 2025 Sep-Oct;15(5):428-450. doi: 10.1016/j.prro.2025.03.006. Epub 2025 Apr 4. PMID: 40366324.

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