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located in other parts of the body . While usually rare these distant ( abscopal ) effects have been shown to be dramatically increased in some patients receiving the checkpoint inhibitors ; particularly of CTLA-4 class like ipilimumab . Such effects may be particularly potent when using fractionated doses of MTR and opens the door for potentially powerful combinations with other immuno-oncology therapies .
Figure 46 : Radiation-induced tumour abscopal effects
Radioligand therapy can increase immune anti-tumour effects
Source : Adapted from ( Harris , Brown , Lopez , & Yap , 2016 ); Created using BioRender . com
Current status and progress
The radiopharmaceutical market is growing and has seen large deals in the past 5 years
A series of multi-billion-dollar acquisitions , including $ 2.9bn for Algeta by Bayer , $ 3.9bn for AAA by Novartis and most recently $ 1.3bn for Sirtex by Varian , reflect the high level of renewed interest in nuclear medicine . Valued at around $ 6.3bn in 2016 , the radiopharmaceutical market is expected to grow further and approach $ 10bn over the next five years . While the first generation of antibody targeted radiopharmaceuticals , such as Bexxar from GSK and Zevalin from Biogen , were generally found to be both safe and highly effective in the treatment of a number of blood cancers , the products were not commercially successful . Handling radiation , complex supply chains and the need to involve partners in nuclear medicine reduced oncologist enthusiasm for the drugs . Bexxar was ultimately withdrawn from the market by GSK . Attention was largely focussed on the development of other forms of targeted therapy . Recent successes from Novartis have led to big pharma ’ s renewed interest in the field .
Figure 47 : Radiopharmaceutical challenges
Source : goetzpartners Research
Supply chains for radiopharmaceuticals are difficult to set up and essential for commercial success
Supply chain the key to success Novartis are a major player in the radioligand field with their approved product Lutathera for neuroendocrine tumours in 2018 . Lutathera sales hit $ 471m in 2022 and $ 475m in 2021 and they subsequently developed the first PSMA targeted radioligand therapeutic approved in 2022 . However , they suffered supply chain issues because of quality issues identified in an FDA site visit . In consequence , their production of radionuclide therapies and diagnostics decreased in 2022 and into 2023 , causing patients to miss doses with Novartis also underestimating demand compounding these issues . Supply issues are common due to the stringent safety , transportation and storage timeline requirements of
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