Radioligand Therapy: What Pluvicto's USD 2 Billion Year Means for Nuclear Medicine
Updated: 4 days ago
Executive summary. For decades nuclear medicine was mostly about imaging: a radioactive tracer showed doctors where a tumour was, and other therapies did the treating. Radioligand therapy changes that. A targeting molecule carries a radioactive isotope directly to cancer cells and delivers radiation from the inside, and the same target can be used first to image and select patients, then to treat them. In 2025 the approach crossed into blockbuster territory. Strategic Revenue Insights estimates the global radioligand therapy market at USD 3.20 billion in 2025, rising to USD 18.22 billion by 2035 at a 19.0 percent compound annual growth rate. PSMA-targeted prostate cancer uptake, the alpha-emitter pipeline, theranostic patient selection and big pharma investment are driving it. This article sets out five lessons from the drug developers, isotope suppliers and treatment centres moving first, with takeaways for strategy, supply chain, clinical operations, pipeline and revenue.
The structure of the market explains where value is concentrating. Strategic Revenue Insights' Radioligand Therapy Market research finds that lutetium-177 is the largest isotope at 52.00 percent of 2025 revenue while actinium-225 is the fastest growing, that neuroendocrine tumours are the largest indication at 38.00 percent while prostate cancer is the fastest growing major indication, that PSMA is both the largest and the fastest growing target, and that hospitals are the largest end user while specialty clinics are the fastest growing. North America is the largest region at 46.88 percent of 2025 revenue, and Asia Pacific is the fastest growing. The research names isotope supply limits and treatment site capacity as restraints, and lists Novartis, Bayer, Lantheus, Telix Pharmaceuticals, Curium, Eli Lilly, Fusion Pharmaceuticals, ITM Isotope Technologies, Clarity Pharmaceuticals and Perspective Therapeutics among the leading companies.
One product shows how fast the market is moving. Novartis reported full-year 2025 sales of its PSMA-targeted therapy Pluvicto of USD 2.0 billion, up 43 percent, and attributed US growth to strong demand following approval in the pre-taxane metastatic castration-resistant prostate cancer setting in the first quarter of 2025, according to its fourth-quarter 2025 report. An earlier approval opened a larger patient population, and demand followed. The challenge for the whole field is now less about whether radioligand therapy works and more about whether isotopes, manufacturing and treatment capacity can keep up.
Why the Radioligand Therapy Market Is Entering a New Phase
Three structural forces are converging.
Therapies are moving earlier in treatment. SRI's research names PSMA prostate cancer uptake as the largest driver of growth and lists earlier-line prostate and neuroendocrine use as an opportunity. Each move into an earlier treatment setting expands the eligible patient population many times over, as Pluvicto's 2025 growth illustrates.
Alpha emitters are the next generation. Beta-emitting lutetium-177 dominates today. Alpha emitters such as actinium-225 deliver more energy over a shorter distance, potentially killing cancer cells more effectively with less damage to surrounding tissue. SRI's research identifies actinium-225 as the fastest growing isotope and the alpha-emitter pipeline as a major driver.
Big pharma has committed. Large pharmaceutical companies have acquired radiopharmaceutical specialists and invested in manufacturing and isotope supply. SRI's research names big pharma investment as a driver. That capital is funding the infrastructure the field needs to scale.
These forces explain SRI's forecast of rapid growth to 2035, with value concentrating in PSMA, alpha emitters and outpatient delivery.
Five Lessons From the Companies Moving First
The developers, suppliers and treatment centres turning these forces into advantage share a recognisable pattern. We have distilled it into five lessons, each followed by a takeaway for a specific leadership function.
Lesson 1: Isotope Supply Is the Strategy
A radioligand dose has a short life. Isotopes decay within days, so every dose must be produced, shipped and given on a tight schedule. SRI's research names isotope supply limits as the largest restraint and isotope shortages and logistics delays as a challenge. A therapy that cannot be supplied cannot be sold.
The companies moving first treat isotope supply as a core strategic capability: long-term contracts with reactor and cyclotron operators, investment in new production routes, dedicated manufacturing sites close to major markets and redundant supply chains. SRI's research lists dedicated actinium-225 production facilities as an opportunity, because alpha-emitter supply is even scarcer than lutetium-177.
The time-critical delivery challenge resembles the one described in why pharma, automation and utilisation now decide cold chain logistics, where the network, not the product, determines what reaches the patient.
"In radioligand therapy, the isotope is the bottleneck and the clock is always running. Whoever controls reliable supply controls the market."
Takeaway on supply chain. Secure long-term isotope supply, invest in new production routes and regional manufacturing, and build redundant, time-critical logistics. Treat actinium-225 capacity as a strategic asset ahead of alpha-emitter approvals.
Lesson 2: Treatment Capacity Must Grow With Demand
SRI's research names treatment site capacity as a restraint and radioactive waste and licensing rules as a challenge. Giving a radioligand therapy requires licensed facilities, nuclear medicine specialists, shielded rooms and waste handling, and many hospitals have limited capacity.
The companies moving first help build capacity: training programmes for nuclear medicine staff, support for new treatment centres, scheduling and logistics tools, and expansion into outpatient settings. SRI's research identifies specialty clinics as the fastest growing end user and lists expanded outpatient radioligand administration as an opportunity.
The shift of complex therapies out of the hospital follows the same pattern described in how the site-of-care shift is rebuilding specialty drug delivery.
Takeaway on clinical operations. Invest in treatment capacity alongside drug supply: staff training, centre development, scheduling tools and outpatient models. Work with regulators on licensing and waste rules that allow safe expansion.
Lesson 3: Theranostics Turns Diagnosis Into a Funnel
Radioligand therapy uses the same target for imaging and treatment. A PSMA PET scan shows whether a patient's tumours express the target, and those patients become candidates for PSMA-targeted therapy. SRI's research names theranostic patient selection as a driver.
The companies moving first own both sides: diagnostic imaging agents and therapeutic radioligands for the same target. That builds a patient pathway from scan to treatment, improves response rates by treating the right patients and gives companies visibility into future demand.
"In theranostics, every scan is the beginning of a treatment decision. The company that owns the imaging agent sees the therapy market before anyone else."
Takeaway on strategy. Pair imaging agents and therapies for each target, build referral pathways from imaging to treatment and use imaging data to forecast therapy demand and site capacity.
Lesson 4: Go Beyond PSMA and SSTR
PSMA in prostate cancer and SSTR in neuroendocrine tumours dominate today, with neuroendocrine tumours the largest indication and PSMA the largest target in SRI's research. The long-term growth of the field depends on new targets. SRI's research lists new targets beyond PSMA and SSTR as an opportunity.
The companies moving first build pipelines across new targets and tumour types, combine radioligands with other cancer drugs and explore alpha emitters for resistant disease. Partnerships between large pharmaceutical companies and specialist biotechs spread the risk of early-stage research.
Takeaway on pipeline. Build a portfolio across new targets and tumour types, test combinations with other oncology drugs and prioritise alpha-emitter programmes where beta therapies fall short.
Lesson 5: Prove Value to Payers and Grow in Asia Pacific
Radioligand therapies are expensive, and SRI's research names reimbursement pressure on high-cost therapies as a challenge. Payers want evidence that earlier use extends life, delays costlier treatments and improves quality of life. The companies moving first generate real-world evidence, design outcomes-based agreements and show the total cost of care, not just the drug price.
Geographically, SRI's research identifies North America as the largest region and Asia Pacific as the fastest growing. Rising cancer incidence, growing nuclear medicine infrastructure and regulatory approvals are opening markets across China, Japan, Australia and India. The value-based care logic that shapes reimbursement is discussed in why value-based care has become a software business.
The capabilities that decide who captures this demand are specific:
Secure, redundant isotope supply including actinium-225.
Treatment capacity, training and outpatient models.
Paired imaging and therapy for each target.
Pipelines beyond PSMA and SSTR.
Real-world evidence and value-based agreements for payers.
Companies evaluating these competitive dynamics in greater detail can use SRI's Radioligand Therapy Market analysis to assess isotope, indication, target and end-user segments and the positioning of the leading developers.
Takeaway on market development. Build value evidence and outcomes-based agreements for payers in North America and Europe, and enter Asia Pacific through local manufacturing, isotope partnerships and regulatory filings.
Where the Opportunity Is Concentrating
Value is moving toward PSMA, alpha emitters and outpatient delivery.
By isotope, lutetium-177 is the largest segment while actinium-225 is the fastest growing.
By indication, neuroendocrine tumours are the largest segment while prostate cancer is the fastest growing major indication.
By target, PSMA is both the largest and the fastest growing, with new targets emerging.
By end user, hospitals are the largest segment while specialty clinics are the fastest growing, and by geography North America is the largest region while Asia Pacific grows fastest.
At the Horizon: What to Watch Over the Next Three Years
Earlier-line approvals. Further approvals in earlier treatment settings will expand eligible patient numbers far faster than new indications alone.
Actinium-225 supply. New production capacity for alpha emitters will decide how quickly next-generation therapies reach patients.
Treatment capacity. The number of licensed sites and trained staff will show whether delivery can keep pace with demand.
"The next phase of radioligand therapy will not be limited by science. It will be limited by isotopes, treatment rooms and trained hands, and the companies that build them will lead."
The Strategic Revenue Opportunity
For drug developers, the task is to secure supply, build capacity and extend pipelines beyond today's targets. For isotope producers, the opportunity is long-term contracts and new production routes. For hospitals and clinics, the priority is to build nuclear medicine capacity and outpatient pathways. For investors, the signal is supply capacity, earlier-line approvals and treatment site growth.
Market intelligence turns these questions into decisions. Segment-level sizing shows where isotope, indication and target demand is concentrating, competitive analysis shows how developers and suppliers are positioned, and regional analysis shows where approvals and infrastructure will pull demand first. This is the path from market signals to strategic insight to revenue impact.
Takeaway on revenue. Treat the radioligand therapy market as four revenue pools: therapies sold on outcomes, imaging agents sold as the entry point to treatment, isotopes sold through long-term supply contracts, and treatment services sold through hospitals and clinics. Each needs its own pricing model.
The Next Leg: Preparing for the Journey Ahead
The defining shift in nuclear medicine is that radioligand therapy has moved from a niche to a mainstream oncology modality. That changes the constraint from proving the science to building supply, capacity and evidence. The companies moving first are not the ones with the longest pipelines alone; they are the ones securing isotopes, growing treatment capacity, pairing imaging with therapy, expanding targets and proving value to payers.
The next three years will decide which companies control the infrastructure of radioligand therapy. Decision-makers should invest in isotope supply and treatment capacity, build theranostic pathways and track earlier-line approvals, actinium-225 production and site growth. Companies evaluating growth opportunities in this market can use Strategic Revenue Insights' Radioligand Therapy Market report to assess market size, competitive dynamics, regional opportunities and strategic growth priorities.
Sources: Strategic Revenue Insights, Radioligand Therapy Market report (2026); Novartis Q4 and full year 2025 report.
Frequently Asked Questions
How big is the radioligand therapy market?
Strategic Revenue Insights estimates the global radioligand therapy market at USD 3.20 billion in 2025, rising to USD 18.22 billion by 2035 at a 19.0 percent compound annual growth rate. North America is the largest region at 46.88 percent of 2025 revenue, while Asia Pacific is the fastest growing.
What is driving growth in radioligand therapy?
Uptake of PSMA-targeted therapy in prostate cancer, the pipeline of alpha-emitting therapies, theranostic patient selection and investment by large pharmaceutical companies are the main drivers. Novartis reported 2025 Pluvicto sales of USD 2.0 billion, up 43 percent.
Which radioligand therapy segments lead?
Lutetium-177 is the largest isotope at 52.00 percent of 2025 revenue, neuroendocrine tumours are the largest indication, PSMA is the largest target and hospitals are the largest end user. Actinium-225, prostate cancer and specialty clinics are growing fastest, according to Strategic Revenue Insights.
What limits the growth of radioligand therapy?
Limited isotope supply and treatment site capacity are the main restraints. Isotopes decay within days, so doses must be produced and delivered on tight schedules, and administering therapy requires licensed facilities, trained staff and radioactive waste handling.
About the authors: This article was prepared by the Strategic Revenue Insights research team, which combines market intelligence, competitive analysis and strategic advisory for growth-stage, mid-market and enterprise organisations across the healthcare sector. Sector analyst: Kamrul Hasan, Research Manager. Our market estimates combine primary research (interviews, surveys and expert panels) with secondary data (industry reports, databases and public disclosures); read more about how Strategic Revenue Insights works. To discuss this market with our analysts, contact our team.
Comments