[Exclusive] Latest Cancer Treatment Costs Rise by 40 Million Won... War Disrupts Raw Material Supply, Domestic Production Stalled Without Budget

Raw Isotope Actinium Price Surge Drives 30% Rise in Treatment Costs
Russian Supply Chain Cutoff and Payment Barriers Disrupt Procurement
Ministry of Science and ICT's Localization Project Halted for a Year Due to Lack of Budget Allocation

Due to disruptions in the supply of raw materials for radiopharmaceuticals caused by the prolonged Russia-Ukraine war, the cost of the latest cancer treatments in Korea has risen significantly. Efforts to establish domestic production facilities to reduce reliance on foreign sources have been stalled for a year, as the 2 billion won construction cost required for facility approval was not included in the government budget.

According to the Korea Institute of Radiological & Medical Sciences on April 21, the cost of raw materials for four sessions of domestic alpha-emitting targeted therapy, which was 120 million won as of July last year, has now surged to 160 million won, an increase of about 30%. This therapy is used for patients who do not respond to conventional chemotherapy or radiation treatments, and the price of the required radioisotope per session has soared by about 10 million won, from 30 million won to 40 million won.

Alpha-emitting targeted therapy is a next-generation radiopharmaceutical treatment that destroys cancer cells by binding the alpha-emitting radioisotope Actinium-225 to them. For patients with castration-resistant prostate cancer and advanced neuroendocrine tumors, it is the only available treatment option. In Korea, this treatment is carried out in the form of compassionate use, in which the attending physician obtains approval from the Ministry of Food and Drug Safety and the patient bears the cost.

A special glove box installed at the Actinium-225 production facility of the Korea Institute of Radiological and Medical Sciences. It is a device designed to safely handle the radioactive material Radium-226 while separating and purifying Actinium, allowing simultaneous work from both sides. Photo by Jungyeon Park

The surge in prices is primarily attributed to the Russia-Ukraine war. The international price of actinium was 680 euros (about 1.17 million won) per megabecquerel (MBq) in the first half of 2025, but with the war dragging on, it rose to 840 euros (about 1.45 million won) in the second half of last year. Since highly advanced nuclear facilities are required to refine and produce Actinium-225, Russia has effectively served as the world's largest supplier. However, with intensified Western sanctions against Russia following the outbreak of war, supply routes have been virtually cut off.

Another major factor is the difficulty in making payments, as some Russian financial institutions have been excluded from the Society for Worldwide Interbank Financial Telecommunication (SWIFT) payment network. Kang Keonwook, professor of nuclear medicine at Seoul National University Hospital, said, "Although Russia says it can supply, there is no way to settle transactions in dollars, so deals are extremely difficult." The price of Nickel-64, which is also used in actinium production, has risen from about 60 million won per gram before the war to over 100 million won now.

The instability in raw material supply is causing patients to miss optimal treatment windows. Actinium-225 has a short half-life of about 10 days and must be administered immediately after production, but repeated last-minute notifications from suppliers about shortages have led to delays in treatment schedules. Most candidates for alpha-emitting targeted therapy are already in advanced stages of illness, and any treatment gap can be fatal. There have even been cases where patients' conditions worsened while waiting for treatment, resulting in lost treatment opportunities.

The domestic actinium production facility, established to reduce dependence on overseas sources, has been unable to operate for a year because it has not received facility approval despite having received production approval. In May of last year, the Ministry of Science and ICT granted Actinium-225 production approval to the Korea Institute of Radiological & Medical Sciences, but around the same time, the Korea Institute of Nuclear Safety (KINS) withheld facility approval due to insufficient radiation shielding.

The institute's production method involves irradiating radium-226 with a proton beam to generate actinium. Including the construction of about 70 tons of lead shielding for radiation protection, exhaust facilities to prevent the release of radioactive gases during radium handling, and environmental monitoring equipment, an additional 2 billion won is required.

Lee Kyocheol, Director of the RI Application Department at the Korea Institute of Radiological & Medical Sciences, said, "We have received production approval but not facility approval, so in reality, we cannot do anything—it's only a partial approval." He added, "The separation and purification equipment we have installed has not been operated for three years, and as a result, some equipment is developing problems." The shielding construction costs requested by the institute were not included in this year's government budget.

Once the domestic production facility is completed, it will be possible to supply treatment raw materials for dozens of patients each month. When operational, each production cycle can yield 1 to 3 millicuries (mCi)—enough for a single treatment for 2 to 3 adult patients. If the process is later transitioned to solid target technology, large-scale production in the tens of millicuries will also become possible.

The stability of isotope supply is also considered a key factor from an industrial perspective for the development of next-generation radiopharmaceuticals. Seonkwan Hwang, Vice President of SK Biopharmaceuticals, said at last year's "On-Site Meeting for Isotope Self-Sufficiency and Radiopharmaceutical Development Promotion," "Even in basic research and development, the lack of actinium hinders active research. Since the short half-life means we must compete under unfavorable conditions with major pharmaceutical companies when importing from abroad, a stable domestic supply system would be a great help."

This content was produced with the assistance of AI translation services.