Session 2 of Bracken's Radiopharma Roundtable paired a teaching talk from Ben Larimer with an open panel: Anna Pokorska-Bocci and Deepak Behera working through the strategic calls that decide whether an early radiopharmaceutical program succeeds, long before the isotope's clock starts ticking. Recorded September 16, 2026.
Most teams open with therapeutic vs. theranostic. Ben Larimer argues that's the wrong end. Because the FDA treats many imaging agents differently than therapeutics, a good targeting molecule can reach a Phase 0 or Phase 1 imaging study with minimal investment — and answer whether the drug hits its target before a single therapeutic dose is given.
Dose isn't one number. It's four dials: activity, mass, schedule, and cycles. The mistake, per Deepak Behera, is treating dosimetry as a post-hoc analysis instead of a design input. Use imaging to design for dosimetry up front, and the odds improve exactly where failure gets expensive — Phase 2 and Phase 3.
The classic mistake is defaulting to DOTA because it's familiar and royalty-free. The panel's case: match the imaging isotope to the therapeutic isotope's chemistry first, even if that means moving past a familiar chelator to a better-matched pair. The isotope choice also decides your supply chain — centralized manufacturing versus site-by-site.
Sites need more than equipment: radiochemistry, scanner time, and dosimetry expertise, all producing repeatable measurements. Vendors split the same way — physical supply versus CRO and data management. Anna Pokorska-Bocci's fix: one CRO, one point of contact, spanning imaging, dosimetry, and clinical operations.
"The half-life is the easy part. It's fixed physics. The hard part is everything you have to do before the half-life clock even starts ticking."
"It's not simply how many sites are open, but how reliably can we treat patients safely and obtain the complete data that we need for the next decision."
"It's an important thing to discuss before you see the images, because then a decision has to be made."
Larimer, Pokorska-Bocci, and Behera walked through the strategic calls that decide an early radiopharmaceutical program: why a diagnostic, which isotope, what supply chain, and how to design for dosimetry before you need it. New panel, same candid format. Seats are open.
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