The Power of Precision: Unravelling the Radiobiology of Targeted Radionuclide Therapy

Targeted radionuclide therapy (TRT) involves systemic administration of a radionuclide attached to a cancer-targeting moiety. It has been proven to be a promising approach for primary cancer and metastasis treatment with minimal damage to surrounding tissues. TRT integrates the precision of molecular targeting with the therapeutic efficacy of radiation. While the field of TRT is growing, its radiobiological understanding remains incomplete thereby hampering progress and clinical impact. The field is expanding beyond beta particle emitters to include alpha particle and Auger electron emitters, yet most radiobiological principles remain based on external beam X-ray radiotherapy or beta emitter ¹³¹I. This review describes current radiobiological knowledge in TRT, highlights existing gaps, and explores strategies for future advancements. An improved understanding of therapeutic potential, the underlying mechanisms of it, potential synergistic therapy approaches, treatment resistance, and conceivable toxicities, specific to TRT, are still needed.