Next generation radiotheranostics promoting precision medicine

Radiotheranostics is a field of rapid growth with some approved treatments including ¹³¹I for thyroid cancer, ²²³Ra for osseous metastases, ¹⁷⁷Lu-DOTATATE for neuroendocrine tumors, and ¹⁷⁷Lu-PSMA (prostate-specific membrane antigen) for prostate cancer, and several more under investigation. In this review, we will cover the fundamentals of radiotheranostics, the key clinical studies that have led to current success, future developments with new targets, radionuclides and platforms, challenges with logistics and reimbursement and, lastly, forthcoming considerations regarding dosimetry, identifying the right line of therapy, artificial intelligence and more.