Scaling radiotherapy: 3 basic strategies within the ecosystem

Radiotherapy has become mainstream. Eli Lilly’s $1.4 billion acquisition of Point Biopharma and Novartis’ $23 billion infrastructure investment signal, Big Pharma sees this as the next major oncology opportunity.

But our collaboration with industry leaders and analysis of the radionuclide ecosystem reveals a disturbing pattern: Most organizations still have a complete understanding of the ways in which these therapies are needed to successfully sell.

Success requires coordination of an end-to-end experience that connects manufacturing, logistics, clinical sites, payers and patients. Think of this orchestration as a company that is strategically capable rather than just operating logistics, it is best to position it as an extension.

In an hour-long decayed radiopharmaceutical and treatment coordination spans multiple experts, operational and service excellence is not only important, but also exists.

Among the companies that are most suitable for the size, three strategic approaches are emerging.

Strategy 1: Choose your battle carefully

Since 2013, Landscape: Lutetium-177 has dominated clinical trials in over 30 sponsors and over 20 disease types, mainly because companies like ITM have built a reliable supply network, which has led to Novatis' Pluvicto success. But in the Alpha Emitter competition, Actinium-225 leads early development (more than 20 phase 1 trials), while Lead-212 (PB-212) improves momentum (4 trials), with a key advantage: 99% dose delivery within 72 hours.

Why this matters: The tight schedule of PB-212 creates operational requirements that can only be solved by design. Companies that choose this path must specify production plans, patient preparation and clinical management with military accuracy. A missed connection killed the dose.

Leaders’ response: Artbio’s Series B funding is specifically targeted at integrated supply chain infrastructure, as the company recognizes that the complex operational needs of PB-212 can become competitive advantages. Meanwhile, Novartis, Telix, Lantheus and ITM are building multi-phase platforms that can adapt to different solutions, which are hedging against technical risks but require broader operational capabilities.

Investors should ask: Can management express their operational strategies as clearly as their clinical strategies? Companies that consider isotope selection as purely scientific lack half of the equation.

Strategy 2: Build a platform, not just a pipeline

The data show obvious market concentration:

PSMA: More than 100 trials, 38 companies
SSTR: 38 trials of 14 diseases
FAP: 16 trials, 6 disease types, 10 companies
GRPR: 12 trials, 6 diseases, 4 companies
CAIX: 10 trials, 5 diseases, 4 companies

Strategic Reality: Companies targeting PSMA and SSTR are not only pursuing biological goals, but also leveraging existing clinical infrastructure and physician familiarity to reduce operational friction. When doctors already understand the treatment pathways, companies can focus their resources on delivery optimization rather than education.

Platform leader to watch: Novartis has built the largest platform (35 trials in 16 disease types), while ITM, Clarity, Telix and Lantheus are expanding to traditional indications to expand to breast, pancreatic and brain cancer. It’s not just portfolio diversification; it’s infrastructure optimization that creates economies of scale in manufacturing and patient use.

Execution Challenge: New goals like Caix often require the creation of new development and delivery pathways. Companies must also educate doctors, design patient identification programs, and manage unfamiliar safety profiles. Telix and ITM (via Debiopharm) are advancing multi-center clinical programs to test therapeutic efficacy and operational scalability.

Executives should prioritize: Effective platform approaches require shared infrastructure and shared chemistry. Can your operating system and processes support multiple instructions without rebuilding from scratch?

Strategy 3: Have the last mile or take risks

Basic Decision: As the pipeline matures, delivery complexity becomes the main limit on growth. Companies must choose between establishing integrated functions internally and coordinating through partners. Both models work, but only when designing from day one is around the patient and provider needs.

Vertical integration advantages: Companies such as Novartis, Telix and Artbio control contact points go from isotope procurement to patient treatment. Trends are accelerating, with both ITM and Orano Med moving from pure isotope supply centers to developing their own therapies, recognizing that value chain control will bring competitive advantages.

Partnership model success factors: clear information flow and decision points that can be processed regardless of the partner’s step. The difference between success and failure usually depends on the details of what appears to be operational: ease of recommendations by physicians, efficiency of treatment planning, consistency of patient information, and visibility of real-time supply.

The core challenge is: “If you have amazing products, but you have no way to make them make and ship them, you have nothing,” said Emanuele Ostuni, CEO of Artbio. “The whole is greater than the sum of the various parts.”

What this means for different stakeholders:

• Investors – Due diligence should focus more on operational preparation assessment
• Large Pharmaceuticals – Acquisition targets should be evaluated in terms of delivery capacity, not just pipeline assets
• Emerging Biotechnology – The core elements of your clinical infrastructure (order management, research management, quality control) should be designed as a scalable foundation for commercial services, not a temporary system.

When clinical success fits business reality

Radiopharmaceuticals succeed when companies design companies that connect isotope supply, clinical delivery, and patient experience to a seamless whole. Patients and physicians have been navigating in complex treatment processes involving scheduling, approval, preparation and follow-up coordination. When these processes are broken down, regardless of supply stability.

Opportunity: Design companies at each touchpoint during the treatment process, ensuring patients have consistent information, easy access to resources, and the nursing team has clear and complex logistics solutions that will occupy a disproportionate market share.

Now, which companies should ask themselves:

• Can we express our customer service strategy as clearly as our clinical strategy?
• Can our systems and processes adapt to multiple indicators/isotopes without reconstruction?
• Are we designing customer and patient experiences, or are we just managing supply chains?

What investors should look for:

• Management teams with operations background and understand the importance of customer experience
• A clear infrastructure investment plan, not just a R&D budget
• Customer experience metrics, not just manufacturing capabilities

Companies that view delivery infrastructure as their primary competitive advantage are most successful. In areas where product differentiation may be limited, operations and excellent service will determine the market winners.

Editor's Note: Neither the author nor the company has any relationship with the mentioned company/product.

Photo: Flickr user Stefan rschwendner

This article passed Mixed Influencer program. Anyone can post a view on MedCity News' healthcare business and innovation through MedCity Remacence. Click here to learn how.