A comprehensive review published in the Medical Journal of Peking Union Medical College Hospital details 15 years of progress in radionuclide drug conjugate research, revealing how these agents are reshaping oncology by integrating diagnosis and therapy. The study, available at https://xhyxzz.pumch.cn/article/doi/10.12290/xhyxzz.2024-0577, analyzes clinical development trends and policy frameworks that are accelerating the adoption of these precision radiopharmaceuticals.
Radionuclide drug conjugates function by coupling radioactive isotopes with targeting molecules like antibodies, peptides, or small molecules, enabling precise tumor targeting for both imaging and localized radiotherapy. This dual capability allows clinicians to visualize tumors with high sensitivity while simultaneously delivering therapeutic radiation, creating a streamlined clinical workflow that represents a significant advancement over traditional separate diagnostic and treatment approaches. The technology's importance lies in its potential to improve patient outcomes through more accurate tumor detection, targeted treatment, and real-time monitoring of therapeutic response within a single platform.
The review categorizes RDCs into three structural types: antibody-based, peptide-based, and small-molecule-based conjugates, each offering distinct pharmacological advantages. Notably, cyclic peptide conjugates have gained prominence due to their low toxicity and high tumor selectivity. These structural innovations are supported by policy reforms, including technical guidelines issued by regulatory agencies since 2020 that have standardized clinical evaluation, non-clinical research, and radiochemical quality control. These regulatory developments create a more predictable environment for innovation and translation of RDCs from laboratory research to clinical application.
Professor Hongyun Wang, senior author of the review, emphasized that RDCs represent the only class of therapeutics capable of achieving true integration of diagnosis and treatment. Despite challenges in radiochemical synthesis, stability, and regulatory alignment, the field is experiencing unprecedented enthusiasm and cross-disciplinary collaboration. With continued innovation in targeting ligands and isotope design, RDCs are positioned to redefine approaches to tumor detection, treatment monitoring, and personalized therapy. The review underscores the need for stronger innovation capacity, improved isotope supply chains, and streamlined approval processes to support RDC development and implementation.
As aging populations and cancer incidence continue to rise globally, demand for next-generation radiopharmaceuticals like RDCs is expected to grow substantially. The technology's ability to provide simultaneous imaging, treatment, and response monitoring addresses critical needs in oncology care, particularly for cancers that are difficult to diagnose or treat with conventional methods. Through coordinated scientific, industrial, and regulatory efforts, RDCs are expected to become a central component of future oncology care, offering patients more accurate diagnoses and safer, more effective treatment pathways that could significantly improve survival rates and quality of life for cancer patients worldwide.
