Radioligand therapy has stopped being a niche of nuclear medicine and become a funded priority of the largest balance sheets in pharma. Novartis pushed Pluvicto into earlier lines of prostate cancer, and between 2023 and 2025 Eli Lilly, Bristol Myers Squibb, AstraZeneca and Novartis each bought a radiopharmaceutical developer outright. The pipeline that follows is not a handful of trials but dozens of programmes aimed at prostate, neuroendocrine, kidney and lung tumours, all of which converge on the same physical infrastructure.
Here is the part the market keeps mispricing. A radiopharmaceutical is the only drug class where inventory is physically impossible. Lutetium-177 loses half its activity in 6.6 days, actinium-225 in about 10 days, gallium-68 in 68 minutes and fluorine-18 in under two hours. There is no safety stock, no warehouse, no rebuilding of a supply buffer after a bad quarter. The dose is made to order for a named patient on a named day, and if the courier is late the product is simply weaker than the prescription. Every other pharmaceutical bottleneck in the last decade, from GLP-1 pens to sterile vials, could in principle be solved by running the line longer. This one cannot.