So, what exactly is a radiopharmaceutical? We think about it as leveraging the unique characteristics of radioactive isotopes for medicinal purposes. This spans into two areas: diagnostic and therapeutic.
Looking back, the field has gone a long way since the discovery of X-rays over a century ago.
From the therapeutic side, we learned that using external beam radiation and brachytherapy, which is inserting tiny radioactive rods into the tumor sites, are highly effective. In fact, two-thirds of the cancer patients receive some form of radiation therapy today, despite impacting both cancerous and healthy tissues. Modern day radiopharmaceuticals aim to take advantage of this potency, but do so in a more controlled manner.
Structurally, radiopharmaceuticals comprise a tumor-binding portion and a chelator, which holds the radioisotope in place, allowing for precise and specific tumor targeting while minimizing exposure to healthy issues.
Furthermore, we now have the ability to swap in and out radioisotopes that are better for imaging purposes and those optimized for tumor cell killing. This could be a significant cost savings compared with other modalities, which have to wait until the establishment of a therapeutic dose and after testing the candidate in dozens of patients.
In addition, knowing the drug’s biodistribution paves the way for truly precision medicine, in which each patient receives a personalized dose.
We are not there yet, but we are seeing the field encroaching into that territory.
Having established some reasonings behind why radiopharmaceuticals, I think the next logical question is why now. I would list four major reasons why stars are aligned for the field to emerge from a niche space and gain more mainstream status.
First, biotech is driven by clinical data, and the results generated by Novartis’ prostate cancer drug called Pluvicto really put radiopharmaceutical on the map.
They effectively showed that in the most common type of cancer in men, the drug was able to reduce the risk of disease progression by 60%, and the risk of death by 40.
Two, thanks to the advancement and investment in the gene and cell therapy a field that’s covered by another colleague of mine, Sami Corwin—we now have the confidence and experience in solving complex supply chain logistics for drugs that are made on demand.
This is especially pertinent since the half-life of radiopharmaceuticals are measured in days or even hours. Take lutetium-based therapies for example; after a week, you have half of the drug left, so it is essential to make these drugs quickly and ship to where the patient is in a timely manner, while at the same time ensuring proper quality control.
Third, government entities and private sectors both acknowledge the demand for radiopharmaceuticals and are coming together to ensure reliable procurement of medically relevant radioisotopes, which have historically been difficult to source.
And fourth, the initial commercial launch trajectory for Pluvicto and its associated PSMA-based imaging agents have significantly outperformed consensus estimates, giving us confidence that mainstream adoption of radiopharmaceuticals is actually taking place.
Based on our analysis, we believe the global annual sales of radiopharmaceuticals could grow from less than 1 billion in 2021 to over 15 billion under our base-case assumptions and potentially over 37 billion by incorporating more aggressive adoption parameters.