Clinical Development in Radiopharma: The 2025 Landscape
Radioligand therapy has moved from niche oncology to a strategic battleground, and the pipeline has grown faster than the infrastructure to run it. This report maps the trial landscape, compares the leading programmes, and sets out where clinical execution actually breaks.
What this report answers
- How large is the radioligand therapy trial pipeline, and where is it concentrated?
- How do the leading development programmes compare on design and positioning?
- What breaks first when an RLT trial scales: sites, imaging, isotope supply, or logistics?
- Which service partners exist for sponsors that cannot build capability in-house?
- What does an RLT clinical leadership team need to look like, and why is it so hard to assemble?
- What did the consolidation wave actually buy?
320+
active clinical trials in the radioligand therapy pipeline at the time of writing - the growth that the report then sets against the infrastructure available to run it.
5 to 1
ProGen Search’s estimate of how far demand for clinical leaders with direct alpha-emitter experience exceeds the available pool. Stated in the report as an estimate, not an observed count.
What the analysis establishes
The trial landscape
The report sizes the active pipeline and shows how it is distributed across targets, isotopes and phases. It tracks the pivot toward alpha emitters and explains why that shift moves the binding constraint from clinical design to isotope supply, making supply control a strategic asset rather than a procurement line.
How the leading programmes compare
A comparative read of the major development programmes, including the prostate cancer head-to-head that reset the benchmark for market entrants. The comparison is on trial design and commercial positioning rather than on data alone, and it explains why one outcome expanded a market while another ended a programme.
Where trial execution breaks
The operational chapters deconstruct the gauntlet an RLT trial runs: site qualification, imaging and dosimetry capability, radiation-safety infrastructure, and delivery against a decaying product. The argument is that these constraints, not patient recruitment, are what set the real pace of a programme.
The clinical support ecosystem
A sponsor-facing guide to the service providers around RLT trials - imaging cores, dosimetry specialists, CROs and logistics partners - covering what each layer does and where the capability is genuinely scarce rather than merely marketed.
The talent gap
The report defines the composite profile an RLT clinical leader needs, spanning oncology, nuclear medicine and drug development, and quantifies how far demand for that profile outruns supply. It also sets out the substitution patterns companies are using when the exact profile cannot be found.
How it was built
A landscape study built from the public trial registry, disclosed transaction data and sector reporting, organised into ten chapters that move from pipeline structure through programme comparison to operational and talent constraints. Where the report gives a view rather than a count, it is labelled as ProGen Search’s own estimate rather than presented as observed data.
Written for sponsors running or planning radioligand therapy trials, the CROs and imaging partners supporting them, and investors underwriting clinical timelines.
Contents
- Executive summary
- The evolving RLT trial landscape
- Comparative analysis of leading RLT development programmes
- The RLT trial execution gauntlet
- The talent crisis: assembling an RLT clinical team
- The clinical support ecosystem: a sponsor’s guide to service partners
- The operational crisis: the infrastructure bottleneck
- The horizon: what is next for RLT clinical development
Organisations covered
Novartis, Eli Lilly, Bristol Myers Squibb, AstraZeneca, Fusion Pharmaceuticals, Actinium Pharmaceuticals, Alpha Tau, Curie Therapeutics, ITM Isotope Technologies, Telix, Clarity, ICON, Fortrea, Ergomed, Clario, Invicro, Image Analysis Group, DOSIsoft, Hermes Medical Solutions, EORTC, FDA, CMS
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The State of Radiopharmaceuticals 2026
The flagship radiopharma report carries the full sector structure behind this landscape, including capacity, isotope supply and the operators positioned against it.
See the full report →