Radiopharmaceutical & Radioligand Therapy Markets

Radiopharmaceutical & Radioligand Therapy: Market Forecast, Competitive Landscape and Strategic Opportunities, 2027–2031

Global forecasts by indication, isotope, target, targeting vector and treatment setting, with country and regional breakouts and 20 company profiles.

Our Take

Radioligand therapy is moving earlier. The market grows from $3,910.0 million in 2026 to $10,800.0 million in 2031, at 22.5% a year. Pluvicto's approval in hormone-sensitive prostate cancer on 31 July 2026 lifts Earlier-Line Metastatic use from $879.8 million to $5,130.0 million, overtaking late-line use, while alpha emitters rise from about 10% to 22% of the market after the first positive Phase 3 trial of an actinium-225 drug.

Situation Analysis: what is really happening

• Pluvicto moves earlier. The FDA approved Pluvicto in PSMA-positive hormone-sensitive prostate cancer on 31 July 2026. Pluvicto sold $1,994 million in 2025 and $1,967 million in the first nine months of 2026, up 42%. Prostate Cancer grows from $2,866.0 million to $6,696.0 million.
• Actinium arrives. Bristol Myers Squibb's RYZ101 met its Phase 3 endpoint in neuroendocrine tumours in October 2026, the first pivotal win for an actinium product. Actinium-225 grows from $3.9 million to $1,134.0 million.
• Lutathera faces copies. Curium's Bexlutry and Lantheus's Bravnetsa were approved in September 2026, and Curium agreed to buy Lantheus for up to $8.0 billion. Neuroendocrine Tumours still grow 20.5% a year, from $957.9 million to $2,430.0 million.
• Manufacturing decides approvals. ITM received a complete response letter for ITM-11 in August 2026 for manufacturing reasons alone, and Orano Med and Sanofi reset the lead-212 programme AlphaMedix after delayed side effects.
• The US leads, China grows fastest. The United States accounts for 65.1% of revenue in 2026, while China grows from $209.2 million to $697.2 million, at 27.2% a year.

Company Analysis: who is positioned, who is exposed

• Novartis: Pluvicto and Lutathera earn about nine dollars in every ten spent on therapeutic radiopharmaceuticals in 2026. Novartis must move Pluvicto earlier and bring actinium forward before copies and challengers erode its franchise.
• Bristol Myers Squibb: RYZ101 (Ac-225-DOTATATE), acquired with RayzeBio, met its endpoint in the Phase 3 ACTION-1 trial after lutetium therapy, putting BMS first among the alpha challengers.
• AstraZeneca: AZD2265, an actinium-225 PSMA drug, is in the Phase 3 VECTRA-01 trial in prostate cancer after lutetium PSMA therapy.
• Curium: Bexlutry, the first approved copy of Lutathera, and the planned acquisition of Lantheus give it isotope production, two radioligand equivalents and a Lu-177 PSMA candidate.
• Bayer: Xofigo is in long-term decline, and 225Ac-PSMA-Trillium is not expected to launch before the end of the decade.
• ITM: One of the largest suppliers of non-carrier-added Lu-177; its first therapy, ITM-11, was delayed by a complete response letter, and ITM plans to resubmit.

Plus 14 more company profiles covering Eli Lilly, Sanofi, Lantheus, Telix, Orano Med and clinical-stage developers.

Questions this report answers

• How fast will Pluvicto move into hormone-sensitive prostate cancer?
• Which actinium-225 and lead-212 products will reach the market by 2031?
• How quickly will copies of Lutathera erode prices in neuroendocrine tumours?
• Can isotope supply and manufacturing keep up with demand?
• Which new targets, such as FAP and Nectin-4, will open breast, lung and other cancers?
• How large will China become, and who will lead there?

What’s inside

• 193 pages, 23 chapters, 53 tables and 50 figures
• 20 company profiles with technology, pipeline, strategy and risks
• Forecasts 2027–2031 from a 2026 base (actual) year, by indication, isotope, target, targeting vector and treatment setting, for 14 countries and regions
• Approved product benchmarks, Pluvicto and Lutathera sales, and ten market-moving developments from 2026
• Clinical pipeline, combinations, isotope supply and manufacturing, regulation and reimbursement, the Lutathera patent cliff, and a China ecosystem chapter
• Delivered as 3 files: full report PDF, Situation Analysis PDF, and Excel workbook of all charts and tables
• Download the Table of Contents (PDF)

Who buys this report

• Business development teams: track which isotopes, targets and vectors are winning, and who leads each.
• Investors and equity analysts: model Pluvicto's earlier-line growth, the arrival of actinium-225 and the Curium–Lantheus deal.
• Radioligand developers: choose the targets, isotopes and treatment settings with the most room to grow.
• Isotope producers and manufacturers: size demand for lutetium-177, actinium-225 and lead-212 and the capacity being built.

Licences and support

Your order is delivered to your inbox immediately. Every licence includes unlimited questions to the analyst and custom data breakouts, including any country not shown. Single User, Five User and Enterprise licences contain the same report; they differ only in how many people may use it.

About the author

Greg Powell, B.Sc., M.B.A., has worked in laboratory testing and management for more than 20 years, with executive training at Harvard Business School and the Burke Institute.