NUKED: Our nuclear future, with Novartis, Wilsons Advisory and Cyclotek

Drone-deliveries of radioactive medicines and diagnostics to Australia's far-flung towns. Radiopharmaceuticals matched with genetic information to tailor precisely the right dose and isotope to a person's cancer. Pan-cancer drugs that fix many tumours, not just one. Miniature particle accelerators. 

These are the hopes, dreams and expectations we canvas in our last episode on radiopharmaceutical 'theranostics', the old-now-new cancer technology that is sweeping the globe and capturing imaginations in the world of biotech. 

In the final episode of our series NUKED, we speak with Novartis Australia and New Zealand country manager Matt Zeller, Wilsons Advisory equity analyst Dr Melissa Benson, and Cyclotek partnerships and innovation manager Sam Graf about what is happening now to advance this modality into the coming years, and what the distant future might hold.

Chapters

• 2:35 Novartis Australia & New Zealand country manager Matt Zeller
• 12:10 Wilson's Advisory equity analyst Dr Melissa Benson
• 24:49 Cyclotek partnerships and innovation manager Sam Graf

Transcript

Rachel Williamson: 0:00

What would you say if I told you that one day drone deliveries might include small vials of radioactive material. Would it be something clever like that won't fly? Well, do I have news for you. 

I'm Rachel Williamson, and this is Phase III. 

From the most recent foray into radiopharmaceuticals there are just two - yes, just two - therapies approved anywhere in the world. There is so much money flowing through the sector and so much activity, you might think they're a bit further on than that. But there is a long way to go yet. 

In this episode, we will explore what the future might hold for this new modality. To kick it off, I'll give you a few examples of what people are trying. 

- Since about 2011, the idea of a cyclotron on a chip - that is a particle accelerator on a chip - has been popping up in different labs around the world. No one has figured it out yet, but the US defence innovation agency, DARPA, keeps funding projects that are trying to miniaturise these devices. 

- In Australia, the Florey Institute is using radio tracers to look what's going on in schizophrenia brains. Monash university research fellow, Dr Bianca Jupp, is working with flourine 18. She wants to see where the psilocybin might be a treatment for traumatic brain injury. She linked the isotope with a serotonin-binding compound to follow the psychedelic's path through the rat brains she was looking at. Early data suggests it might just work. 

- And this year, University of Tennessee researchers released a diagnostic tool using that workhorse of radio tracers, technetium 99, to look for the Alzheimer's of the heart. That's a nasty disease caused by a buildup of amyloid proteins in organs. 

But the real action is of course still in cancer, which is why we invited the local boss of the biggest radiopharmaceutical player in the world to come on the show. Novartis Australia country head Matt Zeller. Novartis has eight different radio therapies and diagnostics in development and 15 clinical trials underway right now. 

Matt, thank you for coming on the show. Very excited to have you.

Matt Zeller: 2:41

It's good to be here, Rachel.

Rachel Williamson: 2:42

Prostate and neuroendocrine cancers, they are really the first of, um, the cancers to be treated and diagnosed by, uh, radiopharmaceuticals. But what can this new modality do? What do you think it might be able to do in the future with, say, cancers that it can't work with now?

Matt Zeller: 3:04

It's been a big focus on prostate and neuroendocrine cancers to start. And this is a great place to start given the nature of these tumours, the high unmet need and the resistance to current treatments. And in many ways, what that's given us is sort of the proof of concept for nuclear medicine. So we've shown that RLT works extend lives and that personalised approach has a potential to enhance quality of life just because impact nf healthy cells is limited.

Rachel Williamson: 3:28

RLT, for our listeners, is radioligand therapy, which is another way of describing radiopharmaceuticals.

Matt Zeller: 3:35

There's no shortage of acronyms in this space. Uh, Rachel, I, I, I completely agree with you but getting to your question about what else they can do, I think we started to look at solid tumours more broadly and engineering treatments that work on multiple tumour types. Really, all cancers, as you well know, have an underlying different biology, so one approach is not going to work, and that's what's so cool and exciting about RLT, and the language and the acronyms, isotopes, ligands, chelators, materials, alpha beta emitters, they can all be used to diagnose, monitor, and or treat an array of solid tumours, But to use language my 10 year old son Evan would, would understand, it's like interchangeable Lego blocks, and the applications are in many ways endless.

Rachel Williamson: 4:18

What about things other than cancer that it might be useful for?

Matt Zeller: 4:23

Just if you purely just step back and went back a few decades and said, 20 years ago, today, would we be editing genes to prevent treat or even cure some diseases or supercharging our immune systems to fight cancer? I mean, it literally sounds like Star Trek, but yesterday's science fiction is today's standard of care. 

So, people are still dying of cancer, unfortunately, and almost 4,000 deaths, deaths in Australia from prostate cancer just last year. So the unmet need is huge. I think RLT research is also now starting to look at rare, less common solid tumour cancers and even blood cancer. But if you, if you think about it, you know, cancer is the current focus, but the application of radioligands is, is also to be invested in any non cancer disease as well. Because in principle for any disease, the goal is to identify that disease early, identify where it is, and then deliver that nuclear payload and as targeted as way as possible. So one example could be a non-invasive method for the diagnosis of atherosclerosis. And I think the more we now have that proof of concept in the space of RLT, the attention, the money, the research, and the expertise is just going to be pouring into the space. And so I think we're going to be surprised at the number of applications that emerge.

Rachel Williamson: 5:37

It does seem like for non cancer diagnostics, it could have a really, really interesting place. It will need for diagnostics to be paid for in a slightly different way, I imagine, across the board, not just for in cancer though.

Matt Zeller: 5:53

Yeah. And I think radio ligand therapies or nuclear medicine and theranostics in many ways, they're super exciting, but they're also showing some of the challenges that exist in the system. Because whether that's, as you said, the reimbursement for diagnostic tests or where along the journey, do you want to start paying for these? And then how do you do the application and what does it look like? And is the healthcare ecosystem set up to identify patients, bring them through the system and help them through, um, along the way? It's really hard. And I think we're also highlighting, not just in Australia, but around the world, some of the challenges that exist. But, uh, for now, I think the exciting bit is that let's let the science lead the way in the applications are in many ways, endless.

Rachel Williamson: 6:36

Where is Novartis pushing the boundaries with what is possible with radiopharmaceuticals right now?

Matt Zeller: 6:42

Where, because we're going first, uh, in many ways globally, unfortunately, well, fortunately and unfortunately, almost everything we're doing is pushing the boundaries and we're trying to help to accelerate the maturation of this space, building a global scalable manufacturing network. I know that's an area that you spent several of the last few episodes of this podcast on - which I'm a huge fan of - is one area which underscores our commitment to the space, Not only does the intricate production process occur in a matter of days, but we also have to build new ways to implement a consistent and reliable supply chain and work with those customers who have to build their supply chain, their physical spaces, their capabilities to be able to provide theranostic safely on time and at scale. And so...

Rachel Williamson: 7:25

Yeah cause Novartis had, you had a few hiccups with Pluvicto in those first 12 months. What have you guys learned that you're taking forward or what you're innovating on from that in order to ensure that the next therapy or the next diagnostic does not run into the same issues?

Matt Zeller: 7:46

It's, it's a good point because any time you're driving and you're the first, as you mentioned, and pushing the boundaries and finding that new space, there's going to be surprises. And so I think from a learning perspective, now that not just Novartis but also the space has really starting to wrap its head around what the true potential is, uh, in nuclear medicine and theranostics. I think we're also in focusing on investing early at scale, building that supply, not just continuity, but also from a wide range of locations and global manufacturing footprint and figuring out how do we, not just do the great research in the space, but also then prepare for providing these. therapies at scale, uh, to a wide range of customers across the world. And so...

Rachel Williamson: 8:33

Following on from that, particularly around the supply chain side, the logistics side, how are you seeing that this industry is going to evolve over time?

Matt Zeller: 8:43

Yeah. I mean, going back to my science fiction analogy, what we saw in say gene therapy or immuno oncology, it starts with a number of biotechs and a lot of great research, exciting research, focusing on R&D, but then sort of more traditional players or larger players started to come on board as things mature. And then you see, you know, as you've well reported, partnerships and mergers and acquisitions, and really to support this depth of research and development programs. But ultimately, I think in the future, you're going to see a large mix of players internationally as well as locally, you're going to see a wide range of supply chains, approaches, modalities, cancer, non cancer applications. But also now the health system in both Australia and globally, we're going to have to think very differently about some of these pieces for RLT to be delivered at scale, but I hope that science will lead the way as it has in other modalities in the past.

Rachel Williamson: 9:34

Can you give an example of one of those ways that we will have to think differently?

Matt Zeller: 9:39

I think the ecosystem, both in terms of the reimbursement and the delivery and the organization, the patient identification and treatment is still in its infancy. And so, uh, the example would be, how do you have this great research and how do you then get it to the patients that need it? Because ultimately that's the only thing that matters. Can we have broad, consistent and equitable access to patients? Uh, can they be supplied at scale to all Australians? Um, and it's gonna be a challenge. We're gonna have to have public players, private payers, government stakeholders all work together to navigate and involve the access pathways. But what's so exciting and unique about Australia is that Australia could and should be one of the absolute leaders in radioligand therapy. But to answer your question, how are things going to have to evolve? Research now has to move to broad application and that's gonna be the challenge for all of us to solve together.

Rachel Williamson: 10:32

My final question is always to ask you to look into your crystal ball. What do you think radiopharmaceuticals will look like in 40, 50 years? And what do you hope it will be able to do?

Matt Zeller: 10:47

50 years, that's that's a long time, Rachel. Uh, but I hope we are living in a world where genomics and radiopharma collide. I hope that there is a suite of radioligand therapies that can be customised to the person, to the disease at the right dose, uh, can be utilised to identify early and treat various cancers and that that whole range is not just known, but also available to clinicians and patients across all of Australia. I hope we have a, a future where personalised medicines are reimbursed and accessible to everyone. And I hope that the health ecosystem is set up to deliver those therapies safely and at scale and as early in the patient journey as possible. And, uh, lastly, I would just say if we're, if we're hoping together this morning, I hope where we have a world where we've mastered personalised treatments to the point that all people with cancer are living well, or maybe even cancer is a chronic disease. Maybe it's a disease of the past.

Rachel Williamson: 11:49

That was Novartis Australia country manager, Matt Zeller. 

The future of radiopharmaceuticals in cancer could be a pan cancer therapy. That's one idea bubbling around in the brain of Dr Melissa Benson, an analyst with Wilsons Advisory and our next guest. 

So the current trend in radiopharmaceuticals is that it's something of a land grab right now by large companies mostly looking to buy up isotope supplies. So what are you seeing would be the next stage in investment and M&A?

Melissa Benson: 12:26

So I think the, the isotope supply is really interesting and super important, but, then there's the step between having an isotope and then getting it into a human as a finished drug. And so I think, you know, we've seen a big land grab in isotope supply, but perhaps not so much yet on that middle stage of the contract manufacturing and really the fill and finish. And so that sounds simple. But, you know, generating an isotope and then you've got to conjugate it to its linker, get it to its targeting molecule and get that in a vial in a sterile manner to a patient, that's really quite something to do. That is not something that I guess the traditional contract manufacturers are really done in the past. And so I think there's material investment that needs to go into this side as well, to produce that finished clinical dose product. There's a little bit of a parallel perhaps we could draw to like cell and gene therapies where they had a similar challenge in that the specialized contract manufacturing infrastructure really wasn't there to support their market. But since you've seen the emergence of these specialised CDMOs just on those modalities, so that's something I expect we could see coming down the pipeline in radiopharma.

Rachel Williamson: 13:39

So are you almost looking at that sector of the industry as an example of where radiopharmaceuticals could go?

Melissa Benson: 13:47

Look, I think there are some parallels perhaps on the, the manufacturing logistics challenges side, but I think to me the bigger parallel of where radiopharma could go is more something like the immune checkpoint inhibitors and really they're almost a 15 year old market, but they're still growing. They're still expanding. They're still going into new indications and they've really become a new pillar of oncology. That to me is probably the bigger parallel I draw to, to radiopharma.

Rachel Williamson: 14:16

Why?

Melissa Benson: 14:18

I think because you've seen, immune checkpoint inhibitors really started out with, you know, one indication like melanoma was it. And that was really the focus for a little, for quite a while, actually, before we then saw it expand into so many other cancer indications. And I kind of think of, of radiopharma a little bit in the same way that, you know, prostate cancer today. And whilst it's not the first approved radiopharma indication, it's really been the one that I guess has shone a spotlight on it. But we can see down the line, like the breadth of indications where this modality could have benefit is so significant.

Rachel Williamson: 14:55

So are there any therapeutic areas or biological aspects that you are keeping an eye on as the next big thing or which, where investment is likely to converge? 

Melissa Benson: 15:07

It's interesting, um, investment is absolutely still converging in, in the therapeutic areas we know today, because I guess they're lower risk, and that's prostate cancer and neuroendocrine tumours. They're proven concepts. So there's a lot of investment going there, but there's absolutely a lot of investment going into new cancer indications that obviously require new targets. And the thing that I think is super exciting, uh, some of these new pan cancer targets. So they are, when you're looking at a target, and this is kind of the opposite of PSMA, which is obviously focused on prostate cancer. This is where you've got a target that's expressed on, on many different types of cancers. There's three, I guess, that are kind of high on my list that I kind of follow closely. Things like GRPR, you know, Clarity and Novartis both have programs there. CA9 is something that Telix and Debiopharm both working on and, and GCP1 is another interesting one where GlyTherix are focused.

Rachel Williamson: 16:07

It's time for some acronym explainers. The simplistic explainer is that these are all things that are expressed on a tumour surface. The kind of things the targeting agent that a radiopharmaceutical is programmed to look for. GRPR is gastrin releasing peptide receptor. It's on breast cancer tumours, some prostate ones and a few others. CA9 is carbonic anhydrase nine. And GCP1 is glypican1. Both of these are specific to tumour cells. But not for specific cancers. This is where that really exciting, because it means that one drug could trade several cancers at a time. And that is a dream asset for pharmaceutical companies. 

What kind of milestones industry wise, should we be looking out for as an indication of how it will sort of evolve in the future?

Melissa Benson: 17:07

Well, I think, um, thinking about reimbursement, we've already seen huge progress on that front this year, which could be validated, you know, early next year. Um, and that's really come about from the centers for Medicaid and Medicare in the US, the major kind of reimbursing government body there. They've proposed a change to how radiopharmaceutical diagnostics are going to be reimbursed and that's really kind of groundbreaking. So rather than having them have this kind of honeymoon transitional pass through period when they first get to market, and then they get typically would have been bundled into the cost of care. So something like the cost with the PET CT scan. Um, and then they've which is how we've seen other diagnostic PET agents paid for in the past. But they've implemented this proposed change where these would be separately paid for outside of that bundling. And I think that's really quite pivotal for a couple of things for the pricing stability of those products. So the investment that people can see, including, you know, investors, big pharma into diagnostic side of the market, where I think everyone has been traditionally very focused on the therapeutics.

Rachel Williamson: 18:15

Yeah, it certainly makes diagnostics worthwhile, worth the effort as, as something other than just a testing ground for your therapeutics.

Melissa Benson: 18:23

Correct. And I think it's also validation of how important these diagnostics are and how much clinical value they're adding versus some of the prior, you know, simpler diagnostics in that they're really critical for, for diagnosis and clinical intervention, but they're also really critical for evaluating a patient for regular ligand therapy. So they're so much more closely tied to, and that's obviously the concept of theranostics, right, is tying the two together. And I think that proposed change that if it, if it's finalised and goes through the beginning of next year, January next year, we will see that. And I think that really validates, the clinical utility, but also I guess the, the investment opportunity in diagnostics, which I think was probably, previously just wasn't as much of a sure thing.

Rachel Williamson: 19:12

Where are the key obstacles that might prevent this industry evolving into something bigger in future?

Melissa Benson: 19:21

Look, I think, key obstacles. With any new kind of, uh, clinical development of things are obviously often just skepticism, right? So for some, I often think of revolutionary worked examples are the best way to move, move the market forward. And that's exactly what I think is happening in prostate cancer right now with Pluvicto and those PSMA diagnostic agents. So you're already changing the mindset of investors that, This is a real industry that is no longer just academic, you know, it's been around a long time, but it can be pharmaceuticalised. So there's value here. 

Clinicians who I think, you know, medical oncologists previously probably didn't work with their nuclear medicine, um, colleagues that often we're seeing a lot more of that cross collaboration. 

Having said that, of course, logistics and supply chain is a fairly unique part of this industry that is always going to be the challenge. The one thing I think that actually could help that a lot is diversification of isotopes. So when you're working with something like a limited precursor stockpile, you've only got so much. So you know, instead of over reliance on one or two. You know, isotopes alone, you know, we've already seen constraints with lutetium 177 and actinium 225 already at this early point. And so we're not saying that there doesn't need to be key investment in those isotopes, but I think broadening the isotope register can really help with that. And so I think when we've seen, um, advancements in things like copper 67 and and lead 212. I think diversification builds redundancy, but also helps with some of those supply constraints. So I think that's something that that could help with that logistical obstacle.

Rachel Williamson: 21:06

And the crystal ball question what is going to be happening with this industry in future? Okay. Will we be treating cancer with laser guns?

Melissa Benson: 21:14

Uh, maybe not laser guns from a safety perspective, but I think, and I've already kind of mentioned it, and I think immune checkpoint inhibitors are the best example here, really, because some may think, oh, well that was first developed 15 years ago, but even today, we're still seeing new indications, new novel combinations, that market continues to grow and defy expectations. And I think it is because of that kind of pan cancer nature. So, if we see significant development in radiopharma, you know, in a multitude of indications, we move to earlier lines of therapy. 

But also there's investment in the logistics and the supply constraints, which I absolutely think can be overcome, now there's a commercial impetus to invest here before you really didn't have, have that. And the one, the one thing that I think radiopharma has going for it, which makes it perhaps a little easier than some other modalities is really that it relies less on complex signalling mechanisms. You know, you're not really reliant on the biological activity of the drug. We know there are so many failed drugs in R&D pipelines of big pharma around the world that may have been amazing targeting agents, but really struggled to hit the biological activity hurdles. And so becoming a new key pillar in in oncology treatment today, um, that brings diagnostic imaging with it, which I think is something that we've underutilised today, but we've seen how powerful it can be.

Rachel Williamson: 22:46

How big an industry do you think this will be in 10 years time, 20 years time? And how big do you think it can get in Australia?

Melissa Benson: 22:59

Look, maybe I'll take the Australia question first. I think Australia, we we already have one of the, you know, the dominant radio pharmaceutical companies in the world based out of Australia. It was a small biotech Telix. They've gone and established themselves as a self, you know, you know, self supporting their expanding infrastructure, you know, potentially multiple agents in market soon. So I think we're already batting above our weight there. We also have other other really exciting companies like Clarity and Advancell, GlyTherix all here in Australia. We have, you've already heard from some of the other, um, on the manufacturing side, we've also well ahead. 

In terms of size. I mean, it's always so difficult to put a number on things. I mean, I think of though the estimates we had years ago before Pluvicto was approved and launched about the size of what we thought that industry could be. And it's exceeded them already, you know, multiples three and four fold of what we already thought just within two plus short years. So I think we're constantly underestimating the size of the industry. I think assuming we can kind of get these pan cancer targets, we can solve for the logistical kind of manufacturing challenges. But I think that's the kind of the mega contribution it could make to, to oncology.

Rachel Williamson: 24:19

That was Dr, Melissa Benson, equity analyst from Wilsons Advisory. 

Some say flying radioactive material to patients using drones will never get off the ground. But Sam Graf, the head of innovation at Australia's largest cyclotron operator Cyclotek, is a believer. It's a while away yet, but using drones to fly radiopharmaceuticals to patients is one idea his company is piloting. 

You guys are, at Cyclotek are quite a significant part of this complex supply chain. You're the biggest cyclotron owner and operator in Australia and New Zealand. Can you give me an idea of your scale in terms of sites, in terms of cyclotrons and your R&D?

Sam Graf: 25:10

Yeah, absolutely. Um, so Cyclotek, as you, as you mentioned, is the biggest commercial scale radiopharmaceutical manufacturing supplier in Australia and New Zealand. We have six manufacturing sites across the eastern seaboard of Australia, uh, in Queensland, New South Wales and Victoria. Um, we have a site at the moment in Wellington, New Zealand as well. And across those sites, we own and operate eight cyclotrons. I'd like to think of Cyclotek as starting out as a traditional manufacturing company, but now, um, with such a, uh, an established network, um, in Australia, we're sort of flipping into a, a, um, sort of biotech role, and we're, investigating the research and, and development of, of novel radiopharmaceutical products, both for diagnosis and therapy.

Rachel Williamson: 26:02

Wow. So you guys are reverse engineering yourselves into a, into a biotech starting as an isotope supplier and moving backwards or forwards, I guess, depending on which, which direction you're looking at it from. That's really interesting. So your R&D, it's in that biotech space, or is it in the cyclotron tech space?

Sam Graf: 26:23

Our R&D is very much in that biotech space. So we're looking at new molecule development development of novel targeting vectors a combination of novel targeting vectors with exotic isotopes...

Rachel Williamson: 26:38

What kind of isotopes are you looking at?

Sam Graf: 26:41

Yeah, so we're still looking primarily at R& D and the development of new products for the diagnosis and treatment of various cancers. we're also sort of invested in novel logistic strategies.

Rachel Williamson: 26:56

Tell me about those.

Sam Graf: 26:57

Yeah, so those, really and we're getting into blue sky ideas here, but there have been some announcements around the construction of new, uh, PET CT imaging facilities in these rural areas to try and increase, um equity and access for rural patients. But the challenge of, delivering radiopharmaceutical to these areas still stands. So whatCyclotek is doing is we've partnered with an advanced air mobility company called V-Star Powered Lift and what Cyclotekand V-Star are working on at the moment is utilising what's known as eVTOL. So electric vertical takeoff and landing vehicles, which are essentially remotely operated drones, which have about a six metre...

Rachel Williamson: 27:41

Flying medical taxis.

Sam Graf: 27:43

Yeah, medical taxis. But the R&D side of this program will be on first testing and sort of certifying these drones for use in Australia and then developing a specialised cargo hold or nose cone in these remotely operated aircraft such that they can take a radioactive package. The complexity around there or the need for this R&D stems from radiation actually affecting, and degrading the really finely tuned aeronautic and telemetry and electronic components in these, in these aircraft. Um, so we need to, uh, create and develop, I guess, a really specialised sort of package, um, to shield the, the radioactive product so that it doesn't interfere with any of the electronics in the, in the aircraft.

Rachel Williamson: 28:34

That's crazy. How fast can these things go and how far away are you?

Sam Graf: 28:40

Yeah, so, uh, the E at the start of eVTOL stands for electric. So these are hybrid electric vehicles, and in order to optimize their range, I believe the, um, the optimal speed would be around 180 kilometers per hour. We're, we're quite close, I would say, um, yeah, CycloTek and V-Star have been collaborating for some time and, uh, within, I'd say a few years, uh, we will be, yeah, testing these aircraft precision medicine requires precision logistics and supply. And that's what we're doing.

Rachel Williamson: 29:15

And how have the aircraft and air freight regulators responded to this idea.

Sam Graf: 29:24

Cyclotek and V-STAR work quite closely with, uh the Australian regulator CASA to ensure that these drones are fail safe. And there are multiple redundancies built into these these aircraft. Uh, so we do work quite closely with the regulator to, uh, understand what's required from a safety perspective to ensure that this, uh, technology becomes, uh, the norm.

Rachel Williamson: 29:48

What other blue sky ideas are you guys working on and what else are you personally hoping the future holds?

Sam Graf: 29:57

What I'm personally very much interested in is the use of radiopharmaceuticals in combination with other traditional therapies. Radiopharmaceuticals at the moment, uh, are utilized usually in the late stages of a disease. But what I'd like to see is the combination of radiopharmaceutical therapies, for example, in the context of cancer with other traditional cancer medicines such as immunotherapy. Or chemotherapy, for example. I think there's great promise for the use of these therapies in earlier stages. I'll take the example of prostate cancer, for someone with newly diagnosed prostate cancer. Prostate cancer, there's an option for if it's not too far advanced, a curative surgical treatment but sometimes there is some, uh, metastatic or single cells of disease left over from that surgery that you can't quite capture, uh, or notice using, um, uh, various treatments. techniques. So, uh, as an idea, if a prostate cancer patient was to have a curative surgery followed by a few treatments with a radiopharmaceutical therapy, the idea would be to mop up I'd say those leftover metastatic or micrometastatic cells. And that would I would hope greatly enhance survival outcomes.

Rachel Williamson: 31:19

Yeah, the these novel isotopes and the development of, radio pharmaceuticals using them is leading to some cyclotron technology. Innovations. So can you tell me a little bit about what is happening in that space right now?

Sam Graf: 31:34

So cyclotrons are essentially just small particle accelerators, and they shoot particles, protons, um, usually at a target to, um, essentially conduct what many hundreds of years ago in the Gothic times that alchemists were trying to do. They were trying to change lead into gold. Um, and that's what we're really doing with these cyclotrons, which is when you think about it, quite amazing. Um, and also the size, downscaling or miniaturising...

Rachel Williamson: 32:02

A cyclotron on a desk that you've mentioned before in talks. How far away are we from that kind of miniaturisation?

Sam Graf: 32:12

Yeah, sure. So I think um, Cyclotek, uh, cyclotrons that we, we own and operate at the moment, are not miniature. I would say they're maybe, uh, two or three or even four cubic meters in, in size, um, which is still quite large. But if you compare the, the differences in size from the very first computers that Alan Turing developed compared to now, I'm talking to you on a, on a laptop, the, the size, uh, or the shrinkage of, of these cyclotrons and the technology I think is following a similar pathway.

Rachel Williamson: 32:47

That was Cyclotek head of innovation and partnerships, Sam Graf. 

Radiopharmaceuticals are unlike other biotech ideas. 

The drugs and diagnostics begin melting away from the minute to them might and have just hours to be used. There are huge shortages of key ingredients. And biotechs have to behave more like tech companies, being across manufacturing, material sourcing and quality control. Even though quality control is handled by someone else. The newly powerful hospital specialists, who as well as delivering the product to patients, are also in charge of making it. 

It might also be a bit of a biotech bubble right now. Only two therapies have been commercialised since radiopharmaceuticals took off again, versus the 230 odd clinical trials currently running around the world in this space. But one of the predictions in this series was that radiopharmaceuticals will be 60% of the cancer therapy market in a decade. And in many ways, the concept is simpler than using complicated biological mechanisms to fight cancer. 

What we do know is it's going to be fascinating viewing, watching who comes out on top, and how they get there.