To evaluate global trends, we analyzed RDC-related clinical trials using the Informa Database (https://pharma.id.informa.com/). As of August 2024, a total of 361 trials have been identified during the decade (Supplementary Fig. S1.). However, only 52.9% of these trials are actively in the pipeline, and of the 75 completed trials, 66% are in early development phases (I/II) (Supplementary Fig. S2.). Notably, the majority of ongoing trials remain in Phase I or II, with only 10.2% reaching Phase III (Fig. 1A). β-emitting radionuclides were predominant in terms of radiation type, but drug development for α radiation is gradually emerging. For the biotargeting part of RDCs, small molecule targeting is most prevalent in the β-rays and antibody in the α-rays (Fig. 1B). Lutetium 177-labeled drugs are all the rage, and interest in targeted α therapies, represented by actinium 225-labeled drugs, is rising rapidly (Fig. 1C). RDCs focus primarily on oncology, targeting prostate cancer and neuroendocrine tumors. Research into other cancers, including lung, non-Hodgkin’s lymphoma, and central nervous system (CNS) tumors, is also progressing (Fig. 1D). The two most common targets in RDC development are somatostatin receptors (SSTR) and prostate-specific membrane antigen (PSMA), which are selectively expressed in neuroendocrine and prostate cancers, respectively, thereby minimizing effects on normal tissues and improving efficacy (Fig. 1E). In global participation, the United States leads with 157 clinical trials, followed by China, France, and Australia. These countries benefit from robust nuclear infrastructure, which supports radiopharmaceutical research and development (Supplementary Tab. S1).

The clinical landscape of RDCs. (A) Clinical phase of RDCs. (B) The rays and biotargeting types of RDCs. (C) Types and percentage of nuclides in RDCs. (D) Types of diseases targeted by RDCs. (E) Distribution of the main targets of RDCs