Radiopharmaceutical Therapy in Oncology: Perspectives from Transatlantic Experts

Radiopharmaceutical therapy (RPT), the administration of a radioactive element coupled with a targeting vector, is one of the most promising innovations in oncology, supported by clinical trials. A theranostic approach-the pairing of diagnostic and therapeutic RPTs sharing the same target-facilitates selective delivery of therapeutic radiation to cancer cells. Its advantages and limitations are determined by the molecular targeting mechanisms employed, as well as the types of ionising radiation emitted. Therefore, understanding the biology of cell-surface targets and molecular mechanisms governing target expression in cancers is critical to the development and clinical use of these agents. This review provides an overview of the latest advances in the application of targeted RPTs within oncology, as discussed at the Fourth Transatlantic Exchange in Oncology, a hybrid conference held in March 2025 that brought together experts from Dana-Farber Cancer Institute (Boston, MA, USA) and Gustave Roussy (Paris, France). Key topics included the targeting of prostate-specific membrane antigen (PSMA) for both imaging and therapy purposes in prostate cancer. In particular, PSMA-based imaging-encompassing both positron emission tomography (PET) and single-photon emission computed tomography (SPECT)-has become a fundamental tool for patient selection, evaluation of treatment response, and personalisation of therapeutic strategies. While theranostic approaches continue to pose challenges, they should increasingly enable improved treatment selection for patients with cancer, and more effective prediction of response and toxicity. Lessons learned from PSMA may apply to other emerging theranostic targets in prostate cancer and other tumour types, expanding the future potential of RPT applications. Beyond current achievements, new molecules and intensive translational research programs may optimise, potentiate and direct RPT. The impact of the expanding use of RPTs on healthcare systems was also addressed, defining strategies to overcome barriers and provide broader access to innovations in RPT in both clinical and research settings.