Will radioligand therapies keep the momentum going in 2026? 

Radioligand therapy has been around for a long time, but 2025 was the year it started to look less like a niche tool and more like something oncology teams have to actively plan for. In March 2025, the U.S. Food and Drug Administration (FDA) expanded the label of Novartis’ Pluvicto so it could be used in PSMA-positive metastatic castration-resistant prostate cancer before chemotherapy, giving clinicians an option to delay taxanes in eligible patients. 

What is radioligand therapy? 

Radioligand therapy pairs a targeting molecule, a small ligand, peptide, or antibody, with a radioactive isotope, aiming to deliver radiation to tumor sites while limiting exposure elsewhere. Many programs follow a theranostic approach, meaning imaging the target first to confirm uptake, then treating the patients whose disease actually lights up. 

The idea itself isn’t new, as internal radiation therapies go back to radioiodine being used against thyroid disease in the early 1940s. What changed in oncology came decades later, with the development of peptide receptor radionuclide therapy (PRRT) in neuroendocrine tumors. In that setting, radiolabeled somatostatin analogues were used to target tumors expressing somatostatin receptors, culminating in the U.S. approval of lutetium-177 dotatate (Lutathera) in 2018. Prostate cancer followed with therapies directed at prostate-specific membrane antigen, better known as PSMA, a protein highly expressed on many prostate tumors.  

That’s why 2025 felt like a consolidation year for the field, and the market is already showing its appetite in 2026. 

2025 consolidated the radioligand therapy field 

Radioligand therapy moved into treatment sequencing 

The biggest structural shift in 2025 was not that radioligand therapy worked, but that it started to move forward in the treatment pathway. In March, the FDA expanded the label of Pluvicto so it could be used in PSMA-positive metastatic castration-resistant prostate cancer before chemotherapy, for patients who had received an androgen receptor pathway inhibitor and were considered appropriate to delay taxanes. 

That is no narrow label tweak; it changes how the modality is judged. Earlier-line use means the treatment is no longer competing in a heavily pretreated population where any signal can be framed as meaningful. It means competing against established standards, in patients who are generally fitter, with higher expectations around tolerability, logistics, and durability. In other words, it forces radioligand therapy to behave like a mainstream oncology tool, which it is becoming. 

That earlier-stage push also showed up in the PSMAddition trial, which tested adding Pluvicto to standard hormone therapy in metastatic hormone-sensitive prostate cancer (mHSPC). Novartis reported a statistically significant, clinically meaningful improvement in radiographic progression-free survival at a pre-specified interim analysis.  

Moving into metastatic hormone-sensitive disease would place radioligand therapy alongside first-line hormonal strategies rather than after their failure. The field is aiming upstream, and Novartis’ therapy could open the way for other therapies. 

Capital began funding industrialisation of radioligand therapies, not just molecules 

If 2025 showed that radioligand therapy could move earlier in treatment sequencing, it also showed that investors were preparing for something larger than a handful of promising assets. Several of the year’s sizeable private financings were explicitly tied not only to advancing lead candidates, but to expanding isotope access, manufacturing networks, and platform capabilities. 

Swiss radiopharma developer Nuclidium closed a CHF 79 million ($98 million) series B in July to advance its copper-based theranostic programs and scale up production infrastructure across Europe and the U.S. The raise was framed as much around building out a supply footprint as around any single clinical asset. Just a day before Nuclidium’s series B round, Actithera secured $75.5 million in an oversubscribed series A to advance a fibroblast activation protein (FAP)-targeting radioligand while expanding its discovery platform. 

The theme continued with ARTBIO, which closed a $132 million series B round to push forward its alpha radioligand pipeline while explicitly investing in isotope supply and manufacturing capacity. Earlier in 2025, AdvanCell also raised big with a $112 million series C, pairing clinical acceleration with plans to scale its targeted alpha manufacturing capabilities. 

These different rounds acknowledge a structural constraint of the modality: radioligand therapies are built on isotopes with limited half-lives, requiring tightly coordinated production, rapid distribution, and specialized handling. Unlike small molecules or antibodies, they cannot be stockpiled or manufactured in distant bulk facilities without careful logistics. That logistics becomes critical for the programs to actually scale. 

The fact that companies are raising capital to address supply chains and manufacturing at the same time as they advance the science is a sign of a field maturing. In 2025, money did not just chase novel targets; it aimed to address the industrial layer that will determine whether radioligand therapy can operate at scale. 

What to watch in 2026 

One of the clearest regulatory markers is ITM’s Lu-edotreotide-177 (ITM-11) in gastroenteropancreatic neuroendocrine tumors (NETs). The FDA has set a decision goal on August 28, 2026. If approved, ITM-11 would expand the PRRT options in neuroendocrine tumors, where lutetium-177 dotatate (Lutathera) has been part of standard care since 2018. 

Prostate cancer remains another focal point. Following the earlier-line expansion of Pluvicto, attention is turning to how upstream data matures. In 2025, Novartis reported a significant radiographic progression-free survival benefit in the phase 3 PSMAddition study in metastatic hormone-sensitive prostate cancer, with overall survival still immature at the time of reporting. Further updates in 2026 may help clarify how durable that benefit is and how the therapy fits within first-line treatment strategies. 

Beyond regulatory dates, alpha-emitting radioligands are also bound to draw attention. Bristol Myers Squibb’s acquisition of RayzeBio and AstraZeneca’s purchase of Fusion signaled strong pharma belief in the approach. Programs such as RayzeBio’s RYZ101 and Fusion’s FPI-2265 are already in late clinical development. What would meaningfully move the field forward in 2026 is not simply early response rates, but clearer evidence around tolerability, repeat dosing feasibility, and the practicality of isotope supply at scale, not only for these programs, but for the broader wave of alpha-emitting candidates in development. 

Another area to monitor is whether radioligand therapy can extend beyond its two most established target classes, prostate-specific membrane antigen in prostate cancer and somatostatin receptors in neuroendocrine tumors. We’ll keep an eye on whether new targets can demonstrate reliable imaging-based selection, consistent tumor uptake, and manageable safety profiles in larger trials. 

Finally, infrastructure remains part of the equation. Radioligand therapies depend on isotopes with limited half-lives and coordinated manufacturing and distribution networks. As more programs move into later-stage development and potentially earlier lines of care, the ability to deliver treatment reliably across centers may become increasingly visible as a practical consideration. It is likely to see more infrastructure and manufacturing deals in the coming year. 

Capital markets: a radiopharma IPO to start the year 

Radiopharma entered 2026 with a notable capital markets event in January as Aktis Oncology raised roughly $318 million in an upsized initial public offering priced at $18 per share, with Eli Lilly committing around $100 million as an anchor investor. That makes it one of the first sizeable biotech IPOs of the year and a clear vote of confidence in the radiopharmaceutical space. 

Aktis is developing targeted radioconjugates built around precision targeting molecules and alpha-emitting isotopes, with its lead proprietary program focused on Nectin-4, a tumor-associated antigen expressed across several solid tumors. The company’s approach combines target validation through imaging with the subsequent therapeutic use of the same targeting scaffold, consistent with the theranostic logic.  

In documents filed with U.S. finance regulators ahead of its IPO, Aktis also emphasized isotope supply agreements, including access to actinium-225, a reminder that manufacturing and material access are essential to the development strategy. 

The company also maintains a collaboration with Eli Lilly under which Lilly can take partnered candidates into later-stage development and commercialization. This enables Aktis to position itself as both a pipeline company and a radiopharma platform supplying a large pharmaceutical partner. 

It would be premature to read one IPO as evidence of a fully reopened biotech market. But the scale of the raise and the presence of a major pharma anchor, show that radiopharmaceutical programs keep attracting substantial capital. Whether other public or private investments follow in 2026 will provide a clearer sense of how enduring that appetite is.