Targeted alpha therapy in prostate cancer: review of available agents in clinical practice

Targeted alpha therapy (TAT) has shown promise in prostate cancer patients, both hormone-sensitive and castration-resistant, with or without prior treatment. TAT's radiobiological properties explain why it is more potent than other forms of ionizing radiation, such as the clinically approved [¹⁷⁷Lu]Lu-PSMA-617. Although most TAT agents used in compassionate care or clinical trials target the prostate-specific membrane antigen (PSMA), some alternatives are yet to be used clinically, some of which aim to address PSMA-negative prostate cancer. These include [²²³Ra]RaCl2, which is approved for palliative bone pain, and a variety of other non-PSMA antigen or receptor-targeting medicines. Whereas this study focuses on TAT medicines that are currently available for clinical use, it also explores these preclinical agents.