Radioligand therapy (RLT) is projected to expand the pool of patients eligible for RLT by a factor of 10-15 by 2035 — and, with hundreds of clinical trials already underway and supported by a unique industrial ecosystem, is poised to be a major turning point in oncology. At a recent national summit in Belgium, clinicians, researchers, and policymakers urged its rapid incorporation into the country’s upcoming Cancer Plan.

RLT is no longer a marginal innovation. It is poised to become one of the pillars of tomorrow’s oncology — provided health systems are ready to keep pace. That was the central issue at the “Scaling up nuclear medicine” summit, which recently brought together clinicians, researchers, and policymakers in Belgium to discuss one key question: How to avoid leaving patients behind as this targeted therapy expands.

Scaling Treatment Capacity

By 2035, the number of patients with cancer who could benefit from RLT may increase by a factor of 10-15. Experts say that projection requires a rapid transformation of infrastructure, care organization, and reimbursement frameworks.

Targeted Personalized Therapy

RLT is based on a concept that is simple in principle but technologically sophisticated. It combines two elements: a ligand — a molecule that specifically recognizes certain tumor cells — and a radioisotope, which delivers targeted radiation.

Once injected into the bloodstream, the radioligand binds to receptors on the surface of cancer cells.The radioisotope emits localized radiation that destroys the tumor cells while minimizing damage to surrounding healthy tissue.

This targeting is one of RLT’s chief advantages. Unlike chemotherapy or some forms of external-beam radiation therapy, this approach limits side effects and allows patients to maintain a better quality of life — a particularly valuable feature in advanced disease.

Today, the therapy is used mainly for two indications: neuroendocrine tumors and metastatic prostate cancer. But that scope could expand rapidly.

Expanding Clinical Trials

Nearly 400 clinical studies are currently underway worldwide to extend RLT to other cancer types. Some have already reached the final clinical phases, suggesting a rapid diversification of indications in the coming years.

That scientific momentum is fueling growing political interest. “We must prepare now,” said Sarah Baatout, deputy director of the Nuclear Medical Applications Department at the Belgian Nuclear Research Centre (SCK CEN). The challenge is twofold: anticipate the scale‑up and ensure fair access to these treatments.

Belgium’s Nuclear Hub

Belgium has major assets in this race for innovation. The country ranks among the world leaders in nuclear medicine, with a structured and high-performing ecosystem.

In 2025, Belgium helped treat nearly 13 million patients worldwide using medical isotopes, a figure that underscores the country’s central role in this therapeutic supply chain.

“Nuclear medicine is a real sector of excellence for our country,” said Energy Minister Mathieu Bihet. “That gives us both a responsibility and an opportunity.”

Overcoming Structural Barriers

Despite these advantages, large-scale deployment of RLT is hindered by several obstacles. The RLT4Belgium action plan specifically identifies an uneven distribution of PET scanners, a shortage of therapy rooms, limited reimbursement, and the requirement for an overnight hospital stay, which reduces capacity.

There is also growing demand for radioisotopes, requiring significant industrial and logistical investment.

Care organization is a key issue as well. Experts call for more systematic inclusion of nuclear medicine specialists on multidisciplinary oncology teams.

“Broader reimbursement would make it possible to assess diagnosis and treatment response in a single step,” said Nadia Withofs, Division of Nuclear Medicine and Oncological Imaging, Department of Medical Physics, CHU of Liège, Liège, Belgium. “Reducing hospitalization time would immediately free up capacity.”

A Growing Political Issue

RLT’s rise is already reflected in the political debate. Two resolutions have been introduced in the Belgian Chamber of Representatives, signaling growing interest in the technology.

These initiatives aim to put RLT on the political agenda and prepare for its integration into health policy. The “Scaling up nuclear medicine” summit contributes to this effort by offering a framework for discussion and concrete recommendations.

Integrating RLT

Timing is strategic. Belgian authorities — Federal Public Service Public Health, Food Chain Safety, and Environment; the National Institute for Health and Disability Insurance; and Sciensano — are currently working on the next Cancer Plan (2026-2030).

That plan aims to strengthen the entire care pathway, from prevention to follow-up, including screening and treatments. In that context, RLT could establish itself as a major new therapeutic modality.

The Federal Agency for Medicines and Health Products supports that evolution. “We want to contribute to the development and anchoring of radioligand therapy as a therapeutic option,” said Hugues Malonne, the agency’s director general.

Organizing RLT Scale-Up

The challenge goes beyond medical innovation. It is about organizing a systemwide scale-up: adapting infrastructure, training professionals, securing access to isotopes, and ensuring adequate funding.

The challenge goes beyond medical innovation: behind the numbers lies a clinical reality — patients with limited treatment options who could benefit from this targeted approach.

RLT by the numbers

• 5000 professionals active in the sector.
• 350 physicians specialized in nuclear medicine.
• 18 theranostic centers of excellence.
• Belgium hosts two reference institutions at the heart of global radioisotope production: SCK CEN in Mol, Belgium, and Institut National des Radioéléments, Fleurus, Belgium.
• 35,000 annual shipments of radioisotopes worldwide.

This story was translated from MediQuality, part of the Medscape Professional Network.