Many tumors express one or more proteins that are either absent or hardly present in normal tissues, and which can be targeted
by radiopharmaceuticals for either visualization of tumor cells or for targeted therapy. Radiopharmaceuticals can consist of a radionuclide
and a carrier molecule that interacts with the tumor target and as such guides the attached radionuclide to the right spot. Radiopharmaceuticals
hold great promise for the future of oncology by providing early, precise diagnosis and better, personalized treatment. Most advanced
developments with marketed products are based on whole antibodies or antibody fragments as carrier molecules. However, a substantial
number of (pre)clinical studies indicate that radiopharmaceuticals based on other carrier molecules, such as peptides, nonimmunoglobulin
scaffolds, or nucleic acids may be valuable alternatives. In this review, we discuss the biological molecules that can deliver
radionuclide payloads to tumor cells in terms of their structure, the selection procedure, their (pre)clinical status, and advantages or
obstacles to their use in a radiopharmaceutical design. We also consider the plethora of molecular targets existing on cancer cells that can
be targeted by radiopharmaceuticals, as well as how to select a radionuclide for a given diagnostic or therapeutic product.
Keywords: Radiopharmaceuticals, molecular imaging, targeted therapy, antibody, peptides, non-immunoglobulin scaffolds, nucleic acids.
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