These six radioligand therapy companies to watch are ushering in a new era of precision oncology

Radiopharmaceuticals, once primarily used for diagnostic imaging, are now making significant strides into biopharma, fueling a renaissance in radioligand therapies (RLTs). Pharma’s increased focus on this promising avenue for cancer treatment is driven by rising cancer incidence, advancements in nuclear medicine and increased clinical research. RLTs combine radioisotopes with vectors like peptides, antibodies or small molecules to deliver highly targeted radiation to tumor cells while sparing healthy tissues.

After decades of slow progress since the first FDA-approved radiopharmaceutical in 1951, the past ten years have seen rapid advancements, particularly in theranostics—an approach that integrates imaging and treatment for precise, targeted cancer therapy. Trials like Novartis’ NETTER-2 study highlight the potential of RLTs as first-line treatments, while combining RLTs with immunotherapies opens new possibilities for enhanced efficacy. Innovations in alpha-emitting isotopes such as Ac-225, targeting ligands and manufacturing technologies is addressing long-standing challenges, while evolving regulatory and reimbursement frameworks are shaping the future of this promising field.

Although early targeted radiopharmaceuticals faced commercial hurdles, the emergence of more effective and easy-to-use agents has reignited interest, exemplified by Bayer’s landmark $2.5bn acquisition of Algeta ASA and its global approval of XOFIGO for bone metastases in patients with prostate cancer. Novartis also strengthened its radiopharma portfolio with LUTATHERA, a theranostic for neuroendocrine tumors, following its $3.9bn purchase of Advanced Accelerator Applications, marking a new era of innovation in cancer care.

Numerous companies, including a cohort of pioneering startups, are now committing to developing RLTs to treat underserved, often intractable cancers. The potential of these therapies to deliver on their promise is gaining attention among big pharmas, who have ramped up spending to gain access to assets, platforms and entire companies. Overall, Novartis has been the biggest spender, shelling out approximately $6bn to acquire theranostic expertise and assets, including PLUVICTO, the first targeted RLT containing a radioisotope to make it to market, from Endocyte Inc for $2.1bn.

It can be challenging to stay on top of the growing level of activity from the many biotechs working on different approaches and targets, often at very early stages, as well as the larger ecosystem of investors, partners and research centers supporting their work. To better understand the field and identify some of the promising innovators, Clarivate analysts reviewed data on deal valuations, clinical trials and market approvals in the space to identify six RLT Companies to Watch:

Affibody, a company based in Solna, Sweden, who has pre-clinical and clinical development programs in oncology and immunology based on its proprietary technology platform, Affibody molecules
Alpha-9 Oncology, with headquarters in Boston, Massachusetts, and Vancouver, British Columbia, who uses a bespoke, iterative process to modify peptides, small molecules and small biologics to inform target selection, molecule design, formulation and clinical evaluation
Ariceum Therapeutics, headquartered in Berlin, Germany, who is developing radiopharmaceutical theranostic pairs focusing on aggressive tumors such as small-cell lung cancer (SCLC) and Merkel cell carcinoma (MCC)
Convergent Therapeutics Inc, based in Cambridge, Massachusetts, who is developing radioantibodies, with its lead Ac-225 candidate in phase 2 trials for prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC)
Perspective Therapeutics Inc, a company based in Seattle, Washington, with its proprietary chelator technology platform to target moieties against cancers with therapeutic isotopes of lead (Pb-212) or diagnostic isotopes such as Ga-68 and Pb-203
PRECIRIX, headquartered in Brussels, Belgium, who is designing and developing theranostics using camelid single-domain antibodies (sdAb) labeled with radiometals against multiple targets, with its lead program addressing fibroblast activation protein (FAP)-positive tumors

The RLT marketplace is expanding rapidly, including:

A sharp increase in both deal value and volume over the past year, according to Clarivate data, as pharmas recognize the potential of RLTs to change the treatment paradigm and aim to add the therapeutic modality to their pipelines.
A shift in clinical trials to later phases, with growing evidence being generated for additional targets, novel combinations with other therapies such as immune checkpoint inhibitors and expanded use of alpha emitters.
Maturing regulatory environment for RLTs, as regulators formulate guidance and harmonization efforts are underway by international organizations such as the International Atomic Energy Agency (IAEA).

For more insights into this exciting field of therapeutics and a deeper look at each of the six companies we’re keeping an eye on, please download the report, RLT Companies to Watch.

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