Q&A: Why Community Oncology Should Act Now to Implement Radiopharmaceutical Therapies

Guy Messer, MBA, BS-HCM, AS-NMT, is vice president Imaging and Radiation at American Oncology Network (AON) and the resident expert on building innovative and financially sustainable radiopharmaceutical programs for community oncology practices.

1. What is driving investment in radiopharmaceutical therapies across oncology?

Several forces are converging to accelerate growth. Most notably, there are currently hundreds of clinical trials underway exploring radioligand therapies across a wide range of cancers, including prostate, breast, lung, colorectal, bladder, liver, glioblastoma, pancreatic, ovarian, lymphomas, and osteosarcoma. Even if only a fraction of these therapies gain approval, they could significantly expand treatment options. In parallel, earlier FDA approvals were limited to narrow patient populations, but newer therapies are moving earlier in the disease course, increasing their applicability. Financially, these therapies also offer meaningful margins today, making them attractive to providers seeking to offset declining reimbursement for traditional oncology services. While current radiopharmaceutical therapies have limited markets, innovative community oncology practices are taking a longer view and preparing today for a brighter tomorrow.

2. How do modern radiopharmaceuticals differ from earlier nuclear medicine approaches, and why are they considered transformative?

The concept of linking radioactive isotopes to compounds that target specific areas of the body has been used in diagnostic imaging for decades. What has changed is the ability to deliver therapeutic doses of radiation directly to cancer cells. Modern radiopharmaceuticals use targeted ligands to deliver beta- or alpha-emitting isotopes that destroy cancer at the cellular level by damaging DNA. Unlike earlier approaches, which were often limited in scope, these therapies can circulate systemically, making them particularly effective for metastatic disease. Advances in targeting precision have improved efficacy, bringing long-standing scientific concepts into practical, high-impact cancer treatments.

3. Why are radiopharmaceutical therapies becoming more financially attractive and operationally viable for community oncology practices?

Traditional chemotherapy margins have steadily declined, pushing practices to seek alternative revenue streams. Radiopharmaceuticals offer a compelling opportunity, with current margins around 14% at Medicare rates. Startup costs for a basic program can be relatively modest – approximately $250,000 for a small, well-designed setup – and can be recouped quickly with consistent patient volume. For example, even a small number of patients receiving multiple treatment cycles can cover the initial investment within a year. As more therapies are approved, overall treatment volume is expected to grow significantly, allowing practices to remain financially sustainable even if per-treatment margins decrease over time. Installing the infrastructure now can also help community practices host clinical trials, providing another way to help patients.

4. What infrastructure, staffing, and regulatory requirements must a community cancer center meet to start a radiopharmaceutical program?

Launching a program requires several key components. Facilities need a “hot lab” to receive and handle radioactive materials, as well as shielded infusion rooms and bathrooms to ensure the safety of patients and staff. Practices must also obtain a radioactive materials license and comply with all associated regulations. From a staffing perspective, an authorized user — typically a radiation oncologist or nuclear medicine physician — is required to oversee treatments, and a certified nuclear medicine technologist is required to administer doses. Full-time staffing is probably financially prohibitive, but contract technicians can staff the one or two days per week that the center offers radioligand treatments. While practices with existing nuclear medicine or PET capabilities have an advantage, even those without such infrastructure can build a streamlined program at a lower cost.

5. How can AON support oncology practices in evaluating, building, and operating a radiopharmaceutical program from startup through ongoing operations?

AON provides end-to-end support, significantly reducing the complexity and learning curve for practices. This includes evaluating patient populations to determine feasibility, guiding facility design and construction, and assisting with regulatory requirements, such as obtaining radioactive materials licenses. AON also leverages established relationships with construction firms, physician networks, and technical staff, including authorized users and technologists. Beyond setup, AON remains involved in operational oversight, helping ensure compliance, efficiency, and integration into the broader practice. This comprehensive support enables practices to launch programs more quickly and with less risk.

6. Why is it important to expand radiopharmaceutical treatment capabilities into community cancer centers rather than limiting them to large academic institutions?

Limiting these therapies to large institutions creates access barriers for many patients, particularly those in rural or underserved areas who often need to travel long distances for care. Radiopharmaceuticals are not fundamentally new or overly complex and can be safely administered in community settings with the appropriate precautions. Expanding access through community oncology practices ensures that more patients can benefit from these therapies closer to home. It also helps accelerate the adoption of emerging treatments, making advanced cancer care more equitable and widely available.