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In radiopharma, the supply chain is part of the product
Every radioligand therapy (RLT) dose decays on a radioactive clock between isotope production and infusion, so the supply chain is not a back-office function, and most disclosed radiopharma deal value in 2025 and 2026 went to securing it rather than to drug assets. Sleuth’s August 2026 analysis counts about 2,300 active radiopharmaceutical programs, about a quarter of them therapeutic and the rest diagnostic imaging agents. Disclosed 2026 deal value is on an annualized pace of about $13.5 billion, which would be a record. Scaled players that have invested in isotope procurement, redundant manufacturing and nuclear-medicine relationships can spread the cost across a portfolio, which gives them more cash flow from the same asset, lets them pay more for new assets and makes further dealmaking likely.
First-generation RLT is already a multibillion-dollar market, and as of August 2026 Novartis owned the only two approved RLTs, Lutathera and Pluvicto. In September 2026, the FDA approved Curium’s Bexlutry, a lutetium-177 dotatate equivalent to Lutathera.
The binding constraint has moved from isotope supply to delivery: treatment chairs, trained staff and reimbursement. Assets that use less of that scarce capacity per course will be worth more, and the isotopes behave differently. Actinium-225’s half-life is about 10 days, while lead-212’s is measured in hours. For biotechs, new isotopes are the ground where incumbent advantages matter less, and infrastructure that shortens a buyer’s path to scale is its own asset. September 2026 underlined the point when Telix agreed to buy ITM for $1.65 billion upfront to own lutetium-177 production.
About 2,300 programs, with China the largest originator
The next wave of targets and alpha emitters is still early
Of the roughly 2,300 active programs, about 1,300 are preclinical, 725 in Phase 1, 155 in Phase 2, 65 in Phase 3 or filed and 95 approved. Chinese developers originate about 1,000, making China the largest source, but their programs skew early and resemble the West’s in targets, modality mix and isotopes. China accounts for 47% of preclinical and 50% of Phase 1 programs, against 24% of Phase 2, 32% of Phase 3 and 13% of approved products.
Gen-1 RLT is commercial, but new targets and alpha emitters are mostly at the start of development, and China will supply much of that early pipeline.
Approved RLTs all use lutetium-177, while actinium-225 and lead-212 lead the alpha emitters
Every approved radioligand therapy uses the beta emitter lutetium-177. Actinium-225 and lead-212 lead the alpha emitters in development, while an approved alpha emitter, Bayer’s radium-223 (Xofigo), is an older bone-seeking agent. Terbium-161, astatine-211 and copper-67 programs are early.
Beyond PSMA and SSTR, targets sort into crowded, contested and open bets
FAP and CAIX are crowded, with validated leaders in Novartis’s FAP-2286 (Phase 1/2) and Telix’s TLX250 (Phase 2). DLL3 is contested, with Abdera’s ABD147 in early trials, and GRPR opened up when Novartis discontinued its NeoB program in July 2026. GPC3 in liver cancer and MC1R in melanoma are the open alpha bets, led by RayzeBio and BMS’s actinium-225 RYZ801 and Perspective Therapeutics’ lead-212 VMT01. HER2 and B7-H3 are re-entry plays after their iodine-131 leads were discontinued.
Deal value is on pace for a record, and more of it buys the supply chain
2026 deals are running at about $13.5 billion a year
Radiopharma deal count rose from 3 in 2021 to a peak of 21 in 2024, followed by 12 in 2025 and 10 through August 2026. The 2026 deals carried $9.0 billion in disclosed value, an annualized pace of about $13.5 billion that would top 2024’s $11.1 billion, after $10.3 billion in 2023 and $9.9 billion in 2025. Most of the 2025 and 2026 value went to supply-chain deals rather than drug assets. The set includes M&A, licensing, minority financings and long-term supply agreements, and about 92% of deals are between Western companies.
Because the radioactive supply chain has to stay close to patients, radiopharma dealmaking stays largely domestic, unlike ADCs.
Every buyer type is consolidating a different link
Novartis built its franchise through more than $7.5 billion of asset acquisitions, including Advanced Accelerator Applications ($3.9 billion, 2017), Endocyte ($2.1 billion, 2018) and Mariana Oncology ($1.75 billion, 2024), then secured its own actinium-225 supply, manufacturing and radiopharmacy. Three buyouts above $1 billion came between October 2023 and March 2024: BMS bought RayzeBio for $4.1 billion, AstraZeneca bought Fusion for about $2.4 billion and Lilly bought POINT Biopharma for $1.4 billion, and POINT and RayzeBio each brought manufacturing infrastructure into their buyers’ RLT businesses. Independent specialists such as Lantheus, Curium, Telix and ITM also own parts of the chain, and private equity is buying infrastructure, as Nordic Capital did when it agreed in August 2026 to buy BWXT’s medical isotope business for up to $800 million. In September 2026, Telix agreed to acquire ITM for $1.65 billion upfront plus up to $700 million tied to ITM-11, weeks after the FDA issued a complete response letter for that drug over manufacturing issues.
Securing isotope supply and manufacturing early supports independent growth and makes a developer more attractive to buyers, a pattern Sleuth maps in the T15 pharma buyout map.
Delivery infrastructure, not molecules, is the near-term ceiling
Five stages run on a radioactive clock
An RLT dose moves through isotope production, drug manufacturing and radiolabeling, specialized logistics, radiopharmacies and nuclear medicine clinics, and finally infusion, which takes two to four hours of chair time. Each stage is time-boxed by the isotope’s half-life, and the pressure increases downstream: actinium-225 lasts days, while lead-212 lasts only hours. Pluvicto is administered at more than 400 US sites.
The constraint moved from supply to sites and staff
In 2022, Pluvicto’s supply was paused, and in 2023 doses shipped from Italy to the US on a five-day window. By 2024, lutetium-177 supply was unconstrained and production had doubled, pushing friction downstream. A 2025 CMS rule began paying separately for diagnostic radiopharmaceuticals above $630 per day. By 2026, nuclear medicine chairs and staff were the limit, with two- to six-week treatment waits.
No molecule can fix a shortage of treatment slots. Chair availability, radiopharmacy staffing and reimbursement will set the near-term growth rate, which rewards assets that need less staff time per course.
The move to alpha emitters runs into actinium-225 supply
Actinium-225 deposits far more energy over a shorter range than lutetium-177, sparing nearby tissue, and its chain of alpha decays and roughly 10-day half-life make it the practical frontier, although alpha superiority is not yet clinically proven. Legacy actinium output supports only a few hundred patients a year, and the largest players have moved to lock up capacity. AstraZeneca signed a 10-year actinium-225 offtake with Niowave in December 2025, Novartis a global supply agreement with Niowave in February 2026, TerraPower committed $450 million to an actinium-225 plant in March 2026, and Nordic Capital agreed to buy BWXT’s isotope platform in August 2026.
New capacity should ease scarcity around 2027, but developers that plan to use actinium-225 need to secure supply now or risk being locked out.
China originates the pipeline, but only the molecule travels
About 45% of active radiopharma programs, including diagnostics, are China-origin. Unlike ADCs, where China is a major deal source, radiopharma has seen few cross-border deals: Full-Life licensed an asset to Korea’s SK Biopharmaceuticals in 2024, and Zonsen PepLib licensed one to Novartis in January 2026. In September 2026, after the report’s snapshot, Novartis licensed a preclinical radioligand therapy from BoomRay for up to $900 million. Western buyers can in-license the molecule, but the rapid decay of the product means manufacturing must stay local or regional.
The value of China’s pipeline accrues to whoever in the West owns the RLT infrastructure. Once that chain is running, in-licensed assets, China’s included, drop onto it much more easily, a dynamic Sleuth also tracks in its China biopharma landscape.
What the radiopharma findings mean for developers and buyers
These implications are Sleuth’s interpretation of the data above.
For developers, pair the asset with a path to scale. A differentiated molecule is necessary but not sufficient. Developers that lock isotope supply and manufacturing access early keep the option to stay independent, and those without it are more likely to end as partners or acquisition targets. A new isotope or a design that needs less chair and staff time can sidestep incumbent advantages.
For buyers, build or buy the chain before the asset. Supply-chain ownership turns each new asset into more cash flow and justifies higher prices in M&A. Diligence should cover isotope security, manufacturing redundancy and site capacity alongside the clinical data, and China-origin assets are worth most to buyers that already own Western infrastructure.
What Sleuth expects in radiopharma
These predictions are Sleuth’s analytical interpretation, looking beyond what the data shows today.
- Supply-chain control will decide who stays independent, alpha emitters included. The independent RLT leaders of 2028 will pair a differentiated asset with locked isotope supply and manufacturing, while asset-only developers still win but as partners or acquisition targets, as RayzeBio did at $4.1 billion.
- Western in-licensing of Chinese-origin RLT assets will step up clearly by 2027. Novartis’s up-to-$900 million BoomRay license in September 2026 is an early sign.
- The next franchise is still unclaimed. The first winner beyond PSMA and SSTR will come from FAP or the less crowded DLL3, GRPR and GPC3 bets, not the long Phase 1 tail, and early Phase 2 readouts will settle it.
How Sleuth built this analysis
Pipeline scope
The pipeline covers about 2,300 active radiopharmaceutical programs as of August 2026, both therapeutic and diagnostic, by highest development phase and originator region. The isotope and target maps cover confirmed therapeutic assets only and exclude diagnostic tracers, with acquired companies rolled up to their parent.
Deals
The deal set is a radiopharma consolidation set from 2016 to 2026 covering M&A, licensing and collaboration, minority financings and long-term supply agreements. Values are disclosed only, and the 2026 figure runs through August with an annualized run rate. Supply-chain deals and players shown are representative, not exhaustive.
Delivery and supply
US site counts are as of 2026. Actinium-225 supply and capacity deals cover December 2025 to August 2026.
Interpretation
Target groupings are directional. The implications and predictions are Sleuth’s analytical interpretation rather than direct findings from the data.
Pipeline and deal figures are as of August 2026 unless otherwise noted. Deals, approvals and program news after the snapshot are current as of September 2026.
Frequently asked questions about radiopharmaceuticals
How many radiopharmaceuticals are in development?
Sleuth tracked about 2,300 active radiopharmaceutical programs as of August 2026. About 25% are therapeutic and 75% diagnostic imaging agents, and about 1,300 are preclinical, 65 in Phase 3 or filed and 95 approved.
What are radioligand therapies?
Radioligand therapies attach a radioactive isotope to a molecule that binds a target on cancer cells, delivering radiation directly to the tumor. Novartis’s Pluvicto (PSMA) and Lutathera (SSTR), both using lutetium-177, were the only approved radioligand therapies as of August 2026. In September 2026, the FDA approved Curium’s Bexlutry, a lutetium-177 dotatate equivalent to Lutathera.
Why are alpha emitters like actinium-225 important?
Alpha emitters deposit more energy over a shorter range than beta emitters such as lutetium-177, which can kill tumor cells while sparing nearby tissue. Actinium-225 and lead-212 lead alpha development, but alpha superiority is not yet clinically proven and actinium-225 supply is scarce.
What limits radiopharma growth today?
Delivery infrastructure. Isotope supply has eased, but nuclear medicine chairs, trained staff and reimbursement now limit capacity, with two- to six-week treatment waits in 2026. Each dose also decays on a clock, so every step from production to infusion is time-boxed.
How much radiopharma dealmaking is there?
Radiopharma deals, including M&A, licensing, financings and supply agreements, reached $9.0 billion in disclosed value through August 2026, an annualized pace of about $13.5 billion that would set a record. Major buyouts include BMS–RayzeBio ($4.1 billion), AstraZeneca–Fusion (about $2.4 billion) and Lilly–POINT ($1.4 billion).
What role does China play in radiopharma?
China originates about 45% of active radiopharma programs, the largest share of any country, but few assets have been licensed to the West. Because radioactive products decay quickly, only the molecule can travel, and manufacturing must stay local.
