Targets and Tollbooths: Where SNMMI 2026 Told You Radiopharma Capital Goes Next

The signal

SNMMI 2026 in Los Angeles produced nearly 1,500 abstracts, a 25% increase on last year. The headlines went to Novartis's Pluvicto data, the Curium approach for Lantheus, and the Image of the Year award.

But the most useful signal for anyone allocating capital came from three smaller companies. Specifically, from the gap between what they presented and what they lacked.

That gap tells you where the next wave of M&A is heading.

The pattern is already set

Since late 2023, Big Pharma has spent more than $9 billion acquiring radiopharma companies:

• BMS acquired RayzeBio (~$4.1B) for its Ac-225 radioligand therapy platform and pipeline
• Lilly acquired POINT Biopharma (~$1.4B), including its Indianapolis manufacturing footprint
• AstraZeneca acquired Fusion (~$2.4B), including actinium-based radioconjugates and manufacturing capability

Clinical data mattered in every deal. But every acquirer also paid for physical infrastructure. Active GMP manufacturing. Isotope supply contracts. Operational capability.

In radiopharma, clinical data without supply chain credibility now carries a valuation discount.

The question SNMMI helped answer is: who is next?

Three companies that look like targets

Actinium Pharmaceuticals

Actinium presented three posters at SNMMI around ATNM-400, its Ac-225 antibody radioconjugate. The work spans prostate cancer (including PSMA-high, PSMA-low, and PSMA-negative models), KRAS-mutated NSCLC, and chelator-to-antibody ratio optimisation.

This is preclinical work. Not a late-stage pipeline.

But the positioning matters. ATNM-400 is PSMA-independent. That addresses the problem everyone in PSMA-targeted therapy already knows is coming: lineage plasticity, PSMA downregulation, and disease that evolves beyond PSMA expression.

The timing is important. Every Big Pharma player that has invested in Ac-225 manufacturing infrastructure now needs therapeutic pipelines to fill that capacity. A broad solid-tumour alpha platform, even at an early stage, becomes strategically interesting when the infrastructure it would run on already exists.

Actinium does not have the CDMO capability required to commercialise globally. That gap is what makes it an acquisition target rather than a standalone builder.

MTTI (EBTATE)

For my money, MTTI presented the most commercially significant dataset at SNMMI 2026.

EBTATE is a Lu-177 conjugate that uses Evans Blue albumin-binding technology to extend circulatory half-life. The reported Phase 1 data in 81 GEP-NET patients:

• ~8x higher tumour uptake than conventional Lu-177 DOTATATE
• Tumour responses using ~12.5% of the cumulative radioactivity of standard PRRT
• Two-cycle treatment potential vs the standard six cycles
• No observed kidney toxicity at one-year follow-up

This is not just a clinical improvement. It is a potential economic inversion.

If EBTATE's pharmacokinetics replicate, the same Lu-177 supply could treat dramatically more patients in specific indications. The effective manufacturing capacity of existing production lines expands without building a single new facility.

This makes MTTI an attractive bolt-on for any company that wants to extend its Lu-177 franchise. Novartis, which markets Lutathera (the current standard Lu-177 PRRT for GEP-NETs), faces a strategic problem if a competitor brings a two-cycle, low-toxicity alternative to market. Acquiring EBTATE would allow controlled cannibalisation of a first-generation product with a superior, dose-sparing successor.

MTTI is a tiny company with a single transformative pharmacokinetic technology. That is the profile of a bolt-on target.

Serac Healthcare

Serac received FDA Fast Track designation for 99mTc-maraciclatide SPECT/CT in interstitial lung disease in February 2026. At SNMMI, early Phase 2 data (15 participants) showed distinct uptake in ILD patients compared to healthy controls, with potential to distinguish inflammation from fibrosis.

This is not oncology. That is exactly why it is interesting.

ILD is a massive, underserved indication where better diagnostic imaging could directly influence treatment decisions. Maraciclatide uses standard Tc-99m, running through existing SPECT/CT infrastructure in every nuclear medicine department.

Serac has no commercial sales force. No standalone distribution. This is the kind of asset that makes sense as a tuck-in for a larger imaging company (GE HealthCare, Bracco) that already has the pulmonology channel.

The PE signal

While Big Pharma buys pipelines, private equity is buying something different.

Curium's reported approach for Lantheus at approximately $7 billion tells you where PE sees permanent value:

• Not the molecule
• The rails
• The diagnostic gateway and last-mile distribution network

Lantheus controls PYLARIFY, which holds approximately 60% of the US PSMA PET market across more than 1,500 imaging centres. In theranostics, the scan is the front door. A patient cannot receive a PSMA-targeted therapy until a PSMA scan has identified them.

Curium is advancing its own PSMA therapeutic (177Lu-PSMA-I&T). Buying the diagnostic gateway means owning the funnel that feeds its own therapeutic pipeline.

This is the data centre playbook applied to radiopharma. PE is buying tollbooths.

Telix posted a 64% gross margin in 2025. Regeneron, one of the most capable antibody engineering platforms in the world, chose to rent that manufacturing and distribution access through a 50/50 partnership rather than build it.

That margin is the rent Big Pharma will pay to infrastructure specialists.

The inversion nobody is modelling

The conventional thesis is straightforward. Radiopharma is supply-constrained. Owning more supply creates a durable moat.

MTTI's EBTATE data introduces an uncomfortable question.

If better pharmacokinetics allow patients to be treated with materially less radioactivity per course, the effective capacity of existing manufacturing expands without additional capital expenditure.

The stack can be attacked from two directions:

• By owning more of it (the Curium/Lantheus approach)
• By making it less scarce through superior biology (the EBTATE approach)

That second route is under-modelled in most investment theses.

This does not mean infrastructure investment is wrong. Alpha therapy in particular still faces a genuine supply deficit. But the biggest long-term threat to a radiopharma CDMO roll-up thesis may not be another CDMO.

It may be a better drug.

Where capital goes next

The logic splits into two tracks:

Big Pharma buys the pipelines that fill existing Ac-225 and Lu-177 infrastructure. They want therapeutic payloads, especially PSMA-independent and alpha-emitting, that run through the manufacturing and supply chains they have already acquired.

PE buys the infrastructure that everyone else has to rent. Diagnostic gateways, radiopharmacy networks, CDMO capacity, and last-mile distribution generate recurring, high-margin revenue regardless of which molecule wins.

The companies that presented at SNMMI 2026 without manufacturing scale, without commercial infrastructure, or without sales forces were not showing weakness.

They were showing exactly what makes them acquirable.

The signal was there for anyone reading the programme carefully enough.

ProGen Search runs retained executive search and market intelligence across radiopharma, CDMO, ADC and advanced modalities. This article is provided for information only and is not investment, legal or regulatory advice. Deal values, market positions and clinical data reflect the state of play as of Q2 2026 and may have changed since publication.