Novartis
Novartis (Switzerland) is the clear global leader and a pioneer in advancing Radioligand Therapy (RLT), operating across the pharmaceutical and diagnostics sectors. The company has played a pivotal role in shaping RLT into a mainstream therapeutic area by developing and commercializing two FDA-approved flagship products. These are **Lutathera** (lutetium Lu 177 dotatate), approved for gastroenteropancreatic neuroendocrine tumors (GEP-NETs), and **Pluvicto** (lutetium Lu 177 vipivotide tetraxetan), indicated for prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC). These established therapies have set new standards for treating hard-to-treat tumors and highlight Novartis’s expertise in theranostics, a strategy that combines diagnostic imaging with targeted therapy. The company is actively reinforcing its market leadership through significant strategic investments and acquisitions, most notably the $1 billion purchase of **Mariana Oncology** in 2024. This move is aimed at enhancing its next-generation RLT pipeline, which is increasingly focusing on more potent alpha-emitting isotopes like Actinium-225 to treat a broader range of solid tumors. Furthermore, Novartis is committing capital to expand its world-class RLT manufacturing and supply chain infrastructure across multiple global sites, including two new US facilities, to ensure a robust and resilient supply of these complex, life-saving precision medicines for patients worldwide.
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Bayer
Bayer AG, a multinational pharmaceutical and life sciences company based in Germany, holds a significant position in the Radioligand Therapy (RLT) market, primarily built on a foundational acquisition. Its presence in the field was solidified with the 2014 acquisition of Algeta, which brought the key asset **Xofigo** (radium-223 dichloride) into its oncology portfolio. Xofigo is notable as the first FDA-approved alpha-emitting radiopharmaceutical, indicated for the treatment of patients with castration-resistant prostate cancer that has spread to the bone (bone metastases). This transaction positioned Bayer as a leader in targeted alpha therapy (TAT), which utilizes high-energy, short-range alpha particles to inflict localized, irreparable damage to cancer cells while sparing surrounding healthy tissue. Bayer continues to build on this legacy by advancing research collaborations and expanding its radiopharmaceutical pipeline to address various additional cancers. The company’s ongoing R&D efforts focus on both monotherapy and combination approaches, leveraging its substantial expertise in oncology and nuclear medicine to enhance clinical outcomes and drive the next generation of targeted treatments in the RLT space.
Eli Lilly & Co.
Eli Lilly & Co., a major U.S.-based pharmaceutical corporation, has rapidly established a strong foothold in the Radioligand Therapy (RLT) market through a significant flurry of strategic deal-making. Lilly officially entered the radiopharma arena in October 2023 with the $1.4 billion acquisition of **Point Biopharma**, a transaction that was completed in December of the same year. This acquisition immediately bolstered Lilly’s oncology pipeline with promising late-stage RLT candidates. The flagship assets gained include **Lu-PNT2002**, a radioligand therapy targeting the prostate-specific membrane antigen (PSMA) for metastatic castration-resistant prostate cancer (mCRPC), and PNT2003 for neuroendocrine tumors. Less than a year later, Lilly doubled down on its commitment by entering into an agreement with **Aktis Oncology** worth up to $1.1 billion. This deal provided Lilly with access to Aktis’ proprietary discovery engine, accelerating the development of novel, next-generation radiotherapeutic assets targeting specific cancer pathways. By strategically acquiring both clinical-stage assets and a cutting-edge discovery platform, Eli Lilly is rapidly positioning itself as a major, integrated player focused on bringing new, targeted precision medicine options to the fight against various challenging cancers.
AstraZeneca
AstraZeneca, a multinational pharmaceutical and biotechnology company based in the UK, has zeroed in on next-generation radioconjugates to make a major impact on the Radioligand Therapy (RLT) market. Its strategic entry was marked by the up to $2.4 billion acquisition of **Fusion Pharmaceuticals** in March 2024. This move brought in new expertise, pioneering R&D, and manufacturing capabilities centered on actinium-based radioconjugates (RCs). The cornerstone of the Fusion acquisition is the radiopharma asset **FPI-2265**, which consists of a small molecule targeting PSMA and carrying the highly potent alpha-emitting radioisotope Actinium-225. FPI-2265 is currently being assessed in the Phase II AlphaBreak study for patients with PSMA-positive metastatic castration-resistant prostate cancer (mCRPC). AstraZeneca is actively expanding its RLT pipeline beyond FPI-2265, including the development of AZD2068, a radioconjugate designed to target cells expressing the EGFR and cMET markers. The company’s overarching goal is not only to develop these novel therapies but also to enhance their delivery and monitoring through advancements in molecular imaging and computational pathology, ensuring it can deliver the most effective treatment to the right patient.
Bristol Myers Squibb (BMS)
Bristol Myers Squibb (BMS), a leading global biopharmaceutical company based in the U.S., made a definitive move into the Radioligand Therapy (RLT) space with the high-profile acquisition of **RayzeBio** in December 2023 for $4.1 billion. This landmark deal provided BMS with immediate access to RayzeBio’s advanced, actinium-225-based radiopharma platform, pipeline, and integrated manufacturing capabilities. BMS is now strategically positioned to develop and commercialize next-generation alpha-emitting radiotherapies, which are considered to have higher potency compared to the beta-emitting isotopes currently dominating the market, such as those used in Lutathera and Pluvicto. The key pipeline assets acquired include **RYZ-101**, a Phase 3-ready asset targeting SSTR2 for gastroenteropancreatic neuroendocrine tumors (GEP-NETs), and RYZ-801, a PSMA-targeting asset. The company’s focus is firmly on leveraging RayzeBio’s expertise in Targeted Alpha Therapies (TAT) to develop highly effective, selective treatments for a range of solid tumors. By making one of the largest acquisitions in the radiopharma sector, BMS signals its intent to become a major leader in the rapidly expanding field of precision oncology.
Curium Pharma
Curium Pharma is a global leader in nuclear medicine, headquartered in France, that has a long and robust history providing diagnostic and therapeutic radiopharmaceuticals. With an extensive global production and distribution infrastructure, Curium is a critical behind-the-scenes player and has recently expanded significantly into the burgeoning Radioligand Therapy (RLT) therapeutics market. The company’s strength lies in its ability to manage the complex manufacturing and supply chain logistics required for these short-lived radioactive medicines. Curium is actively building a promising RLT pipeline, which includes candidates targeting both prostate cancer and neuroendocrine tumors (NETs). A notable emerging asset in its portfolio is **177Lu-PSMA-I\&T**, a Lutetium-177-based radioligand therapy currently being advanced through clinical trials for metastatic castration-resistant prostate cancer (mCRPC). By leveraging its deep roots in diagnostics and its established global manufacturing network, Curium is effectively transitioning to become an integrated theranostics company, aiming to offer both the imaging agents and the therapeutic radioligands necessary to advance precision medicine for cancer patients globally.
Lantheus
Lantheus Holdings, Inc., a U.S.-based company, is a key commercial player in the Radioligand Therapy (RLT) and radiopharmaceutical diagnostics landscape. The company’s strategy centers on partnering and commercializing innovative radiopharmaceuticals. Lantheus holds the exclusive global commercialization rights (excluding specific Asian territories) for **177Lu-PNT2002**, a potential radioligand therapy for metastatic castration-resistant prostate cancer (mCRPC) utilizing a PSMA-targeted ligand paired with the beta-emitting radioisotope no-carrier-added lutetium-177. This asset was acquired as part of the broader deal between Eli Lilly and Point Biopharma, with Lantheus retaining commercial rights. Furthermore, Lantheus strengthened its position in the therapeutic radiopharma space through its prior acquisition of Progenics Pharmaceuticals. Lantheus is also recognized for its successful diagnostic imaging agents, which are foundational to the theranostics approach. By focusing on securing commercial rights for promising late-stage RLT candidates and developing companion diagnostics, Lantheus positions itself as a critical bridge between R&D innovation and global patient access for targeted radiotherapies.
Telix Pharmaceuticals
Telix Pharmaceuticals is an innovative Australian biopharmaceutical company with a global reach, focused on the development and commercialization of diagnostic and therapeutic radiopharmaceuticals, or “theranostics.” The company is a key emerging player in the Radioligand Therapy (RLT) space. Telix’s most significant commercial product is the diagnostic imaging agent **Illuccix** (kit for the preparation of gallium Ga 68 gozetotide injection), which received FDA approval in 2023. Illuccix is used to identify prostate-specific membrane antigen (PSMA)-positive lesions in patients with metastatic prostate cancer, making it a critical tool for selecting patients eligible for PSMA-targeted RLT, such as Pluvicto. In addition to its diagnostic success, Telix is actively developing its own therapeutic RLT pipeline. The lead therapeutic program is **TLX591**, a PSMA-targeting RLT, for which the company is conducting clinical trials in prostate cancer. By successfully commercializing a major diagnostic and advancing a complementary therapeutic, Telix is building a fully integrated theranostics franchise aimed at improving the management and treatment of oncology indications worldwide.
ITM Isotope Technologies Munich SE
ITM Isotope Technologies Munich SE, based in Germany, is a globally active radiopharmaceutical company and a prominent player in the Radioligand Therapy (RLT) market, specializing in the development, production, and supply of novel radioisotopes and radiopharmaceuticals. ITM focuses on creating a new generation of targeted cancer treatments by leveraging its proprietary transport and labeling technologies. The company is vertically integrated, meaning it controls the entire value chain from the production of high-quality radioisotopes, such as no-carrier-added Lutetium-177 (**n.c.a. Lutathera**), to the development of its own therapeutic candidates. ITM actively engages in partnerships to accelerate innovation, such as the exclusive global agreement with Debio for the development and commercialization of the peptide-based theranostic pair, **ITM-91**, which targets the CA IX receptor. By focusing on providing both the essential medical radioisotopes that power RLTs and developing its own differentiated pipeline of radioligands, ITM plays a crucial, dual role in driving the industrialization of radiopharmaceutical production and advancing the next wave of precision cancer treatments globally.
Perspective Therapeutics
Perspective Therapeutics, a U.S.-based company, is an emerging innovator in the Radioligand Therapy (RLT) field, with a distinct focus on advancing targeted alpha therapies (TAT). The company is pioneering the use of the alpha-emitting isotope **Lead-212 (²¹²Pb)**, a powerful radionuclide that delivers high-energy, localized radiation for maximum efficacy against cancer cells while minimizing damage to surrounding healthy tissue. Perspective’s strategy is built around its proprietary VMT-α-GEN generator, which enables the reliable and scalable production of Lead-212. Their pipeline, including the lead asset **VMT-α-NET**, is focused on treating difficult-to-target cancers like neuroendocrine tumors and melanoma. The company’s commitment to TAT is rooted in the belief that alpha emitters represent the next generation of therapeutic radiopharmaceuticals, offering higher potency compared to traditional beta emitters. By actively developing both the proprietary isotope production technology and a deep pipeline of targeted radioligands, Perspective Therapeutics is positioning itself as a leader in next-generation RLT, aiming to provide highly precise and curative options for oncology patients.
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