A myriad of landmark breakthroughs from 2025 demonstrate that the clinical impact of modern therapeutics – including radioligand therapy for prostate cancer – depends as much on disciplined hospital pharmacy implementation as it does on scientific innovation, as Dr João Gonçalves PhD explains as he shares part two of his top five highlights from 2025.
Radioligand therapy in prostate cancer matured into a more operationally demanding phase in 2025 as evidence and analyses strengthened the case for earlier positioning in the treatment algorithm.
The final overall survival and safety analyses from the phase 3 PSMAfore trial of [¹⁷⁷Lu]Lu-PSMA-617 versus a change in androgen receptor pathway inhibitor in taxane-naive metastatic castration-resistant prostate cancer consolidated both its efficacy and a clearer understanding of risks over time.1
When a therapy is moved earlier in the care pathway, it enters a higher-volume, more standardised setting. In the case of radioligand therapy, the shift is less a nuclear medicine challenge than a hospital system one, testing whether institutions can deliver complex therapies reliably and safely at scale.
For hospital pharmacy, the key scientific-to-operational translation is that radioligand therapy is not a single episode of care. It is a repeated-cycle process requiring scheduling, product availability, radiation safety, supportive care, laboratory monitoring and coordinated follow-up across specialties.
A technical and managerial role in radioligand therapy
Fragmented ownership – where nuclear medicine ‘owns the dose’, oncology ‘owns the patient’, and pharmacy ‘owns the procurement’ – leads to predictable failure modes including delays, avoidable toxicity-related admissions, inconsistent patient education and gaps in medication reconciliation. As radioligand therapy expands, these gaps are magnified by throughput.
The pharmacist’s role is both technical and managerial. From a technical perspective, pharmacy is positioned to standardise co-medication management, to enforce laboratory monitoring protocols and to integrate safety checks during care transitions.
Pharmacy managers can lead the development of a standardised pathway for radioligand therapy that makes the process auditable by defining clear entry criteria – including imaging confirmation – as well as setting standards for cycle timing, establishing metrics for dose delivery reliability, monitoring adverse events and ensuring full cost transparency beyond drug procurement, which includes staffing and supportive care costs.
These scientific advances should therefore be viewed as a call to treat radioligand therapy as a high-reliability service line. Hospitals that adopt this approach will transform trial-level benefits into real-world outcomes; those that do not may create variability that weakens both safety and perceived value.1
Next, read part three of this 2025 highlights series on tirzepatide in heart failure, part four on oral gepotidacin for gonorrhoea and part five on medication safety and artificial intelligence, and catch up on part one on CAR-T therapy for autoimmune disease.
Author
João Gonçalves PharmD PhD
Faculty of Pharmacy, University of Lisbon and Imed Research Institute for Medicines, Lisbon, Portugal
Reference
1 Fizazi K et al; PSMAfore Investigators. Final overall survival and safety analyses of the phase III PSMAfore trial of [¹⁷⁷Lu]Lu-PSMA-617 versus change of androgen receptor pathway inhibitor in taxane-naive patients with metastatic castration-resistant prostate cancer. Ann Oncol 2025;36(11):1319–30.
