Radiopharmaceutical Therapy Use Rose 2,000% in a Decade. New Data Define Its Benefits and
Radiopharmaceutical therapies work on a precise logic: attach a radioactive molecule to a carrier that seeks out specific proteins on cancer cell surfaces, inject it into the bloodstream, and let the radiation destroy tumor cells from inside while sparing surrounding tissue. The concept has existed for decades. The clinical reality of widespread use is much newer - and a first-of-its-kind symposium in Palm Desert, California, brought together the data that tell us exactly how fast that reality is developing.
The inaugural Multidisciplinary Radiopharmaceutical Therapy Symposium, sponsored by the American Society for Radiation Oncology (ASTRO) and held in February 2026, presented research spanning clinical efficacy, safety, national utilization trends, and the operational challenges of delivering these therapies outside academic medical centers. Two studies at the meeting stand out for what they quantify about the field's current state.
Seven Trials, 2,500 Patients, One Consistent Signal
The first is a pooled meta-analysis of seven randomized Phase II and III trials involving more than 2,500 patients with metastatic castration-resistant prostate cancer (mCRPC). The trials all compared Lu-177 PSMA-617 - commercially known as Pluvicto, and currently the only FDA-approved radiopharmaceutical therapy targeting PSMA for this indication - against standard-of-care systemic therapies including hormone-based drugs.
The pooled analysis found that patients receiving Lu-177 PSMA-617 achieved significantly better progression-free survival than those receiving standard treatments. Across seven trials with different patient populations, drug comparators, and follow-up durations, the improvement in time-to-progression held up consistently. Grade 3 or higher adverse events did not increase significantly in the treatment arm compared to control.
The overall survival data presented a more complicated picture. The analysis did not show a statistically clear improvement in overall survival. Lead author Mohammad Arfat Ganiyani, a postdoctoral research fellow at Miami Cancer Institute, offered an explanation: "The absence of a clear overall survival signal likely reflects post-progression treatment patterns rather than a lack of efficacy." In several of the included trials, patients in the control arm received Lu-177 PSMA-617 after their cancer progressed - effectively closing the survival gap by giving the control group access to the treatment later. Ganiyani and colleagues argue the data support moving Lu-177 PSMA-617 earlier in the treatment sequence and testing it in combination with other systemic agents.
From 529 to 12,395 Administrations
The second notable study addresses a different question: how rapidly has this treatment category expanded in actual clinical practice? A national analysis of Medicare Part B professional claims data tracked intravenous radiopharmaceutical therapy administrations from 2013 to 2023. The numbers are stark: 529 administrations in 2013; 12,395 in 2023. That is a 2,243 percent increase over ten years.
The analysis also tracked which medical specialties are delivering these therapies. In 2013, nuclear medicine accounted for 53 percent of claims and radiation oncology for 23 percent. By 2023, diagnostic and interventional radiology had grown to 45 percent of claims - the largest single specialty group - while nuclear medicine had declined to 37 percent and radiation oncology to 15 percent.
Lead author Sean Maroongroge, an assistant clinical professor at City of Hope, framed the implication: "These findings reflect the evolving multidisciplinary nature of radiopharmaceutical therapy and underscore the need for cross-disciplinary research, training, credentialing and clinical workflows as adoption continues to expand." One important caveat: Medicare Part B professional claims do not fully capture RPT administered in hospital outpatient settings, meaning the true volume may be higher than the data suggest.
The Operational Challenge
Radiopharmaceutical therapies require specialized handling, dosing, and safety protocols. That complexity has historically limited delivery to academic medical centers with nuclear medicine infrastructure. Several abstracts at the symposium addressed the practical challenge of extending radiopharmaceutical therapy to community-based settings without compromising safety or quality. ASTRO launched training centers to increase the number of physicians certified to provide these treatments and recently published a white paper on safety and quality considerations for RPT delivery - infrastructure investments that reflect the organization's expectation that the 20-fold growth in use over the past decade is only the beginning of a larger expansion.