Next Radiopharmaceutical Targets After PSMA
Beyond PSMA: Which Emerging Targets Will Define the Next Era of Radioligand Therapy?
The approval of lutetium PSMA therapy for advanced prostate cancer changed the whole sector. It proved that targeted radioligand therapy works at commercial scale. It gave the industry a clear blueprint: find a target with high tumour expression, pair it with a precision ligand, add a companion imaging test, and select patients well. Now every company in this space is asking the same question. What comes next?
The answer is taking shape. A 2025 review in Cancers found that more than 400 clinical trials were active by mid-2025, testing new targets, new isotopes and new drug combinations across solid and blood cancers. The pipeline is broad. The pace is fast. The investment is real.
The Targets Getting the Most Attention
No clear successor to PSMA has emerged yet. But several targets are drawing serious capital and producing data worth watching.
DLL3 is one of the most talked about. It sits almost only on cancer cells in adults, with very little presence on healthy tissue. That profile gives it a strong safety case from the start. It shows up at high levels in small-cell lung cancer and in neuroendocrine prostate cancer. Both are hard to treat. Both are often caught late, when surgery and external radiation are no longer viable. Early trial data on DLL3-targeted therapy looks good. The main challenge is market size. These patient groups are smaller than the standard prostate cancer market. The commercial case grows if DLL3 programmes expand across both tumour types and move into earlier lines of therapy.
FAP takes a different approach. Rather than hitting the cancer cell itself, it targets cells in the tissue around the tumour. This opens potential across many solid tumour types. Early data has shown responses in thyroid, lung, breast and ovarian cancers. That broad reach is both its appeal and its risk. FAP also shows up in some healthy tissue, which raises questions about dose limits. Companies pursuing FAP need a clear view of which cancer to lead with and a firm answer on the safety profile.
GRPR has a known role in prostate cancer imaging and now draws interest as a treatment target in breast cancer. CXCR4 is active in lymphoma trials. HER2, proven across many cancer drug types, is being tested in radioligand form for patients with drug-resistant disease. CAIX has a clear role in kidney cancer, where it shows up in low-oxygen tumour tissue and offers a strong theranostic case for patients who have run out of late-line options.
What Separates a Viable Target from a Good Idea
PSMA worked because it got four things right at once. High expression on tumour cells. Low expression on healthy tissue. A clear PET imaging test to pick the right patients. A large patient group. Matching all four in a new setting is harder than the list makes it sound.
DLL3 covers a smaller group than PSMA unless programmes move into neuroendocrine prostate cancer and earlier therapy lines. FAP needs firm answers on dose limits before it can scale. GRPR in breast cancer needs larger trial data to confirm the right patients and the right treatment order. Each target has gaps that must close before the commercial case holds.
One structural strength of this drug class is the theranostic model itself. Using the same targeting molecule to both image and treat is central to what made PSMA work. Any new target that cannot be imaged with precision is missing a core part of the model. Teams that build the companion diagnostic in from day one move faster and select patients better.
The People Behind the Science
The science is moving fast. The workforce is not keeping up. As Nucleus RadioPharma’s April 2026 workforce report found, more drugs are reaching late-stage trials but the talent to support that growth is not scaling at the same rate. Skills in radiochemistry, drug production and nuclear medicine site delivery take years to build. Right now, demand runs well ahead of supply.
For companies building around new targets, hiring the right team matters as much as picking the right molecule. Radiochemists with targeted therapy know-how are rare. Regulatory staff who know the EMA or FDA radioligand review process are hard to find. Nuclear medicine physicians with hands-on delivery experience are in short supply. Clinical trial leads who have run a radioligand study from site set-up to data lock are scarcer still. These roles need a recruiter with real sector knowledge, not a broad life sciences search.
Finding the Right Team
Skills Alliance places staff across the radiopharmaceutical sector. We work with early-stage biotech firms building their first clinical team and with larger companies scaling up across Europe and North America. If you are hiring for a radioligand therapy programme, get in touch with Skills Alliance to find out how we can help.
By Jasmine Stewart, Associate Director, Skills Alliance
