Radiopharmaceuticals drive precision medicine
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Radiopharmaceuticals drive precision medicine
Innovative and fast-growing specialist companies such as ITM and Telix look best place to take early successes in the radiopharmaceuticals market
Internal pipeline plus nuclide supply chain is key to success
Figure 43 : Radiopharmaceutical structures
Source : goetzpartners Research , Created with BioRender . com
Utility recognised by FDA panel
Radiopharmaceuticals have seen something of a renaissance over the past five years . Previously constrained by the need for a complex supply chain and availability of suitable radionuclides , the wide scale use of PET / CT has seen these problems diminish . With a range of high value big pharma deals , a handful of successful products and a growing understanding of the potential synergy between radio- and immune-therapy , radiopharmaceuticals are attracting the attention of both the industry and investors . With the need to secure and maintain a complex and limited supply chain , competent first movers should enjoy a substantial advantage over later market entrants who will struggle to gain a foothold . A handful of innovative and fast-growing specialist radiopharmaceutical companies have already emerged with the infrastructure to take advantage of this opportunity , in our view . ADCs have recently seen a huge upturn in interest and investment , and we predict radiopharmaceuticals to do likewise , given the similarities of combining precision targeting with a specialised cytotoxic moiety . Companies currently establishing pipelines and / or supply chains for radiopharmaceuticals will be well placed to capitalise on future market interest in this space .
Success based on building robust supply chains Historically complex supply chains and the difficulty in sourcing appropriate radionuclides hindered radiopharmaceutical development . Interest was also eclipsed by the success of immunotherapies . Supply chain issues have been greatly mitigated by the widespread adoption of PET / CT . Improving access to scanners and the development of reliable supply chains for an increasing broad variety of radiotracers has seen the technology widely adopted throughout developed markets . More than 10,000 hospitals now use radioisotopes ; 90 % for oncology . The huge focus on extending the efficacy of immunotherapy and the increasing appreciation of its potential synergy with RT ( De Martino , Daviaud , & Vanpouille-Box , 2021 ) is now driving interest in radiopharmaceuticals . Novartis were the first larger company to invest heavily in the production of nuclides and have the infrastructure in place to expand production for a larger number of patients . The establishment of reliable supply chains remain key . Emerging players such as Australia-based Telix Pharmaceuticals , or the German radiopharmaceuticals company ITM , who have established nuclide manufacturing and / supply chain capabilities will have distinct advantages both with regards to developing and commercialising their own products as well as being valuable partners for other companies , in our view .
Synergy with immunotherapy driving interest Radiopharmaceuticals consist of a radiation emitting isotope attached to a targeted ligand that binds to cancer cells . Delivered at an optimised dose and treatment regimen , radiopharmaceuticals deliver an effective , but discretely localised cytotoxic effect on tumours . While this broadly limits collateral damage to non-tumour cells , this can also lead to the triggering of a robust anti-tumour response , making radiopharmaceuticals ideal for combination with immune therapies and other cancer therapies . This has further stimulated interest and investment in radiopharmaceuticals and could lead to large acquisition deals . The pipeline strategy for radiopharmaceutical companies leads with a diagnostic version of the drug followed closely with a therapeutic version , usually with the same targeted ligand but a more potent radionuclide with the diagnostic version providing early PoC . Lantheus have a PD-L1 diagnostic radiopharmaceutical in their pipeline to help identify responders to pembrolizumab , we believe a therapeutic radiopharmaceutical for combination with pembrolizumab is not far behind .
Targeted and effective imaging and treatment Use of immuno-PET for imaging provides not only a means of selecting patients for the therapeutic version , but in many cases , it can provide a sensitive means of staging disease , detecting occult metastases , detecting minimal residual or recurrent disease , and monitoring response to therapy . In contrast to other targeted ( non-radionuclide ) therapies which may only destroy cells carrying the specific marker , MTR destroys both the cells carrying the specific marker as well as other cancer cells in proximity not carrying the marker or not accessed by the targeting antibody , as well as cells supporting tumour growth such as : blood vessels , fibroblasts , and co-opted pro-tumour immune cells . This may be an advantage in highly heterogeneous solid tumours , but also in blood cancers where the ‘ mature ’ cancer cells which express the relevant surface marker may be in close proximity to parental non-target carrying stem cells .
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