RLT delivery costs versus ADC delivery costs15 Jan 2026 10:58
Source Grok:
Q How expensive is delivering therapeutic drugs via radioligand therapy as opposed to drug delivery via antibody-drug conjugates
A Delivering therapeutic drugs via radioligand therapy (RLT) is generally more expensive than via antibody-drug conjugates (ADCs), both in terms of per-treatment/course costs to patients/health systems and underlying manufacturing/production complexities.
Key Cost Comparison
RLT involves short-lived radioisotopes (e.g., lutetium-177) that require specialized, just-in-time production, handling of radioactive materials, and rapid distribution due to decay (often within days). This leads to higher operational and logistical costs.Radioligand Therapy (e.g., Pluvicto [177Lu-PSMA-617] for prostate cancer):Wholesale acquisition cost: Approximately $42,500–$50,000 per dose (based on U.S. pricing data from 2022–2025, with minor adjustments in recent years).
Standard course: Up to 6 doses (every 6 weeks), totaling around $250,000–$300,000 per full treatment course (before insurance/discounts).
Additional factors: Requires specialized nuclear medicine facilities, radiation safety protocols, and waste management, contributing to overall high system costs. Canadian estimates place a full course at around $122,000–$143,000 (including diagnostics). Patient out-of-pocket can be reduced via assistance programs (e.g., $0–$25 per dose for eligible insured patients), but the base price remains elevated.
Manufacturing challenges: Limited isotope supply from few reactors, short half-life necessitating decentralized or rapid production, and high costs for handling radioactivity drive up expenses.
Antibody-Drug Conjugates
(e.g., Enhertu [trastuzumab deruxtecan] or Kadcyla [ado-trastuzumab emtansine] for breast cancer):Per-cycle costs: Around $9,000–$13,000 (e.g., Enhertu at ~$9,000–$10,000 per 21-day cycle in some analyses).
Full course: Often $100,000–$200,000+ depending on duration (until progression), but typically lower per administration than RLT due to longer shelf-life and standard biologic manufacturing.
Manufacturing: More scalable (platform-based for antibodies + chemical conjugation), though complex due to toxic payloads and heterogeneity control. Costs are high (up to 10x traditional mAbs) but generally lower than RLT's radioisotope constraints.
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It's certain Novartis are aware of the following:
If certain BP do not end up using preCISION, the default is they will be developing ADC's, effectively waiting for the next bus.
The BP that will have preCISION in their product catalogue will have gained a large competitive edge, and will have to buy Avacta to enjoy it's benefits.
Throw in that preCISION development costs are one tenth the cost of ADC development, and you arrive at a much better understanding of the term competitive advantage, transforming a want into a need for platform ownership.
Good luck Novartis, who didn't splurge on ADC tech.
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