Pivotal Phase 3 Theranostic Trials: Future Indications

There are several ongoing phase 3 randomized trials involving radiopharmaceutical therapies (RPTs), which are expected to provide practice-changing evidence in the coming years. This review covers ongoing pivotal phase 3 trials designed to expand applications for RPTs. Trials such as PSMAcTION, STAMPEDE2, PSMA-DC, and PSMAddition focus on prostate-specific membrane antigen-directed treatments for patients with prostate cancer. NETTER-3, ACTION-1, and COMPOSE evaluate somatostatin receptor-targeted radiopharmaceuticals in individuals with neuroendocrine neoplasms. Expansion of phase 3 registration trials has been driven by increased industry investment. Ongoing RPT phase 3 trials serve as hybrids, merging nuclear medicine procedures for imaging and drug application with oncology-driven standards of care and endpoint definitions. Despite the challenges associated with this integration, phase 3 RPT trials present an opportunity to revolutionize future cancer care by introducing and expanding the use of image-guided RPT.