Radiopharmaceutical therapy has rapidly become a breakthrough strategy in cancer treatment. Unlike external beam radiation, which affects large areas, or chemotherapy, which indiscriminately targets rapidly dividing cells, this method delivers radiation directly to cancer cells while sparing most surrounding healthy tissue. With thousands of patients treated worldwide, it has become one of the fastest‑growing fields in oncology.
European companies, notably Novartis, currently lead the field, with US and Chinese players close behind.
The global radiopharmaceutical therapy market was valued at around $3.2 billion in 2025 and is expected to grow to $30 billion by 2034.
But global tensions are making an already complex therapy even more difficult. The production of lutetium‑177 – used in Pluvicto and Lutathera – requires the rare earth isotope ytterbium, mined in countries such as China, Australia, Russia and the United States. Until recently, nearly all ytterbium‑176, the preferred isotope for nuclear medicine, came from Russia. Now, supplies have shifted toward North American producers, whose reserves are not unlimited.
Access to nuclear reactors is also a challenge: enriched ytterbium-176 must be bombarded with neutrons in a nuclear reactor to make it radioactive and transform it into lutetium‑177. As Russian nuclear centres become a less attractive option, European drugmakers now rely on ageing research reactors that are subject to maintenance shutdowns.
One such reactor in the Dutch village of Petten was temporarily shut down in 2024, leading to the cancellation of thousands of patient appointments in hospitals.
Dependence on air freight has also become a critical issue, especially during the Middle East conflict when airspace was closed and airports were damaged. Shipping radioactive drugs by sea is not always feasible due to their limited shelf life.
Despite these challenges, companies are pressing ahead with radiopharmaceutical development.
Swiss drug giant Novartis currently dominates the market, with two FDA-approved radiopharmaceuticals – Pluvicto for prostate cancer and Lutathera for neuroendocrine tumours – generating a combined $2.8 billion in net revenue last year. Novartis now allocates 40% of its oncology R&D budget to radiopharmaceuticals and expects Pluvicto alone to deliver $5 billion in revenue by 2030.
German private company ITM Isotope Technologies Munich is hoping to secure US regulatory approval for its experimental drug, a competitor to Lutathera. A decision is expected this summer.
Other companies, including Bristol‑Myers Squibb, AstraZeneca and Eli Lilly, are also trying to enter the market.
