A new $10 billion pharmaceutical market is taking shape.
According to a report by Precedence Research, the global radiopharmaceutical market size is projected to grow from $6.74 billion in 2024 to $13.67 billion by 2033, with a compound annual growth rate (CAGR) of 8.2%.
Although many biotech firms have emerged in this field, leveraging innovative technologies and pipelines to expand the application of advanced therapies, the story is unlikely to be dominated by them. Instead, pharmaceutical giants like Novartis and Bayer are circling, ready to strike.
In recent years, capital has increasingly flowed into this blue ocean — not only from venture capital but also from pharmaceutical companies themselves. Multinational corporations (MNCs) have been investing in or acquiring biotech firms and their pipelines, deeply participating in this innovation race. As a result, the industry landscape is gradually taking shape.
The following is an overview of five pharmaceutical giants and their strategies in the radiopharmaceutical space.
Bayer was among the earliest MNCs to bet on radiopharmaceuticals, partnering with Algeta in 2009 to secure global exclusive rights to Xofigo.
Xofigo doesn't include a targeting component. Instead, it uses radium's chemical properties to bind with bone minerals, allowing the drug to localize in areas with high bone turnover.
In 2013, the FDA approved Xofigo as the world’s first alpha particle radiopharmaceutical for treating metastatic castration-resistant prostate cancer (mCRPC) with bone metastases. In 2014, Bayer acquired Algeta for $2.9 billion, fully owning Xofigo.
Hoping to revitalize its pharma division, Bayer had high expectations. Algeta projected global sales of over $1 billion by 2018, but the peak in 2017 was only $408 million.
The decline stemmed from clinical data. In late 2017, Bayer announced Phase III trials of Xofigo combined with Johnson & Johnson’s Zytiga and steroids resulted in deaths and fractures, leading to a sales drop.
Xofigo’s 2024 revenue wasn’t disclosed in Bayer’s financials. GlobalData estimates revenue will be $244 million in 2024, declining to $161 million by 2030.
Still, Bayer is working to regain its footing.
In 2021, it acquired Noria Therapeutics and PSMA Therapeutics, gaining rights to develop a small molecule alpha therapy targeting PSMA. In 2023, Bayer entered a strategic collaboration with Bicycle Therapeutics, paying $45 million upfront and up to $1.7 billion in milestones to develop radiotherapeutics for undisclosed cancer targets.
According to Bayer’s pipeline, at least two clinical-stage radiopharmaceuticals are in development: 225Ac-Pelgifatamab and 225Ac-PSMA-Trillium, both early-stage candidates for advanced prostate cancer.
Among all MNCs in the radiopharmaceutical space, Novartis stands out as the most successful.
Like Bayer, Novartis rapidly built its empire via acquisitions. In 2017, it acquired Advanced Accelerator Applications for $3.9 billion, gaining Lutathera, which saw a 20% YoY revenue increase in 2024 to $724 million. In 2018, it acquired Endocyte for $2.1 billion, gaining Pluvicto, which grew 42% in 2024 to $1.392 billion.
These successes prove that radiopharmaceuticals, despite regulatory and manufacturing complexity, have significant commercial potential.
According to Geoff Towle, VP of Radioligand Therapy for Solid Tumors, Novartis has built a globally leading radioligand R&D and manufacturing infrastructure, accelerating product commercialization.
Novartis continues to invest in the field. In 2024, it acquired Mariana Oncology for $1 billion. Mariana’s pipeline includes MC-339, a promising therapy for small-cell lung cancer. Novartis also launched pivotal trials for AAA817, a next-gen therapy targeting PSMA with an actinium payload.
Another strategy is expanding indications for marketed drugs. In March 2024, the FDA approved Pluvicto for use prior to taxane chemotherapy in PSMA-positive mCRPC, tripling its eligible patient pool. Novartis aims for Pluvicto to hit $5 billion in peak sales with this indication.
Novartis is also exploring other areas like breast and lung cancer, beyond prostate and neuroendocrine tumors.
Oncology has long been a cash cow for AstraZeneca, with 2024 revenue rising 24% to $22.35 billion — 41% of total revenue.
Radiotherapeutics are becoming a strategic focus. AstraZeneca has stated that radionuclide drug conjugates (RDCs) are key to its oncology R&D and will drive growth post-2030.
In 2024, AstraZeneca acquired Fusion Pharmaceuticals for up to $2.4 billion, entering the radiopharmaceutical market. Fusion’s lead candidate, FPI-2265, is in a Phase II/III trial for PSMA-positive mCRPC, with data expected in late 2025.
GlobalData estimates potential commercialization in 2028, with $182 million in sales by 2030. AstraZeneca is also studying AZD2068, another RDC from Fusion targeting EGFR and cMET in solid tumors, now in Phase I with data expected in 2026.
Beyond drug development, AstraZeneca is investing in molecular imaging and computational pathology to enhance delivery and monitoring of radiopharmaceuticals.
Despite Novartis’s dominance, there are weaknesses. Its lead products use lutetium-177 (a beta emitter), while alpha emitters like actinium-225 offer 400x stronger DNA-damaging power.
BMS is betting big on actinium. In 2023, it acquired RayzeBio for $4.1 billion, gaining a platform focused on actinium-225-based therapies, including several potential first-in-class and best-in-class candidates.
Lead drug RYZ-101 targets somatostatin receptor 2 (SSTR) and is being tested in three trials: a Phase III for GEP-NET, and Phase I trials for metastatic breast cancer and extensive-stage SCLC. Results are expected in 2025 and 2026, respectively.
RYZ-801, targeting GPC3, began clinical trials in late 2024 for liver cancer. BMS also gained RayzeBio’s “IND engine,” expected to generate multiple candidates in coming years.
Its manufacturing facility in Indianapolis is operational, and BMS plans to expand it for commercial-scale production.
Eli Lilly is a newcomer. In October 2023, it officially entered the field with a $1.4 billion acquisition of Point Biopharma.
Jacob Van Naarden, head of oncology, called it the beginning of Lilly’s radiopharmaceutical development journey. The deal brought two Phase III drugs (PNT2002, PNT2003) and earlier-stage assets — though both overlap with Novartis products, complicating commercialization.
PNT2002’s Phase III results in December 2023 showed a 29% risk reduction in death or disease progression — statistically significant but below expectations.
The greater value may lie in Point’s manufacturing platform — one of the world’s largest radiopharmaceutical factories (180,000 sq ft), with excellent logistic access to North America and Europe.
Lilly plans to diversify and increase its success odds through multiple bets. In 2024, it licensed a novel protein platform from Aktis Oncology and signed an investment agreement with Radionetics Oncology with an option to acquire for $1 billion.
It’s also securing radionuclide supply. Point signed and expanded a Lu-177 supply deal with Germany’s ITM. In August 2024, Lilly invested $10 million in Ionetix, a U.S. isotope supplier producing actinium-225 via cyclotron technology.
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