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Radioligand Therapy

About Radioligand Therapy (RLT)

Radioligand therapy (RLT) uses radioactive materials called radioisotopes to target cancer cells. The radioisotope is systematically delivered and collected by tumour cells, where the radiation from the radioisotope kills those cells. If a radioisotope is combined with a substance that helps focus the treatment on the tumour cells, other parts of the body will have less damage from the radiation. This type of therapy does not work for all cancers or clinical situations. A patient may need specialized imaging (for example, PET scans) to find out whether the treatment could be helpful.

Talk to your healthcare team to see if radioligand therapy is right for you.

Radioligand Therapy (RLT) for Prostate Cancer was added in January 2025. Please see the eligibility criteria.

Ontario Health’s Radioligand Therapy Program

Ontario Health currently pays for specific radioligand therapies (RLTs) that have been approved for public funding. Patients do not need to apply for public coverage. Their healthcare team at the hospital will seek funding approval from Ontario Health on their behalf.

What You Need to Know Before You Refer a Patient

To qualify for public funding for radioligand therapies (RLTs):

  • patients must have a valid Ontario health card
  • patient must meet all eligibility criteria for the radioligand therapy (see below for RLT specific criteria)
  • the hospital must have a funding agreement with Ontario Health (see list of participating hospitals)

If your patient does not meet this you may also want to discuss any clinical trials that would be right for them.

Note: Ontario does not pay for RLTs given in private clinics.

Eligibility Criteria

Radioligand Therapy (RLT) for Neuroendocrine Tumours (NETs)

Lutathera for the treatment of NETs is publicly funded when the patient meets all of the following criteria:

Primary Disease

  • Mid-gut neuroendocrine tumour or
  • Pancreatic neuroendocrine tumour

And

  • Tumours that have grown (progressed) and spread (metastasized) after receiving somatostatin analogue therapy
  • Relatively good health (i.e., good performance status)
  • Disease that is somatostatin receptor positive
  • Disease that cannot be removed with surgery or treated with other targeted therapies like focal ablation

Typically, the treatment is 4 intravenous (IV) infusions delivered with an amino acid solution to help protect your kidneys, given every 2 months over 8 months. Each infusion session may take between 3-6 hours.

Radioligand Therapy (RLT) for Prostate Cancer

PLUVICTO for the treatment of prostate cancer is publicly funded when the patient meets all of the following criteria:

  • Metastatic castration resistant prostate cancer (mCRPC)
  • Tumours that have grown (progressed) and spread (metastasized) after receiving at least one androgen receptor pathway inhibitor (ARPI)
  • Tumours that have grown (progressed) and spread (metastasized) or the patient experienced unacceptable toxicity to at least one taxane-based chemotherapy regimen
  • Relatively good health (i.e., good performance status)
    And
  • Disease that is prostate specific membrane antigen (PSMA) positive

Typically, the treatment is up to 6 intravenous (IV) infusions or injections, given every 6 weeks. Each infusion or injection session may take between 30 minutes to 1 hour with additional time for associated care.

Participating Ontario Hospitals

In Ontario, select hospitals are able to offer radioligand therapies (RLTs) for specific types of cancers.

To find out if you would be appropriate for RLT, your oncologist can make a referral to one of these hospitals:

  • Hamilton Health Sciences
  • London Health Sciences Centre
  • Sunnybrook Health Sciences Centre
  • The Ottawa Hospital
  • University Health Network

Public Funding Process for Radioligand Therapies

Ontario has a rigorous process for determining which radioligand therapies (RLTs) that the program will publicly fund. Various expert committees will review the scientific research and assess the RLT’s benefits, risks, and safety, and value for money. Throughout this process, Ontario considers advice from provincial experts on cancer and radioligand therapy (for example, nuclear medicine, radiation and medical oncologists). Outputs from the following organizations inform funding decisions and criteria.

Health Canada: Health Canada provides federal market authorization to sell radioligand therapy products under the Food and Drug Act. Health Canada will evaluate the safety, efficacy, and quality of the product for a given indication.

Canada’s Drug Agency: CDA’s pan-Canadian Oncology Drug Expert Review Committee (pERC) evaluates the clinical- and cost-effectiveness of the radioligand therapy for the specified indication and provides a reimbursement recommendation to provinces and territories.

Pan-Canadian Pharmaceutical Alliance (pCPA): The pCPA uses a pan-Canadian pricing negotiation process with the manufacturer to obtain consistent and lower drug costs (including radioligand therapy products). Ontario is a participant in the process.

Ministry of Health: The Ministry of Health is responsible for the approval of funding for new RLTs and/or indications according to the above process.

Ontario Health (Cancer Care Ontario): Ontario Health’s Radioligand Therapy Program is subsequently responsible for administering the program and reimbursing the hospitals for the delivery of care.

Contact Us

If you have any questions or comments, send us an email.

Please do not send us your medical information – including healthcare number, diagnosis, treatment plans – or other personal information or attachments.