While much of the discussion in San Francisco focuses on identifying the next wave of innovation, the industry is increasingly concerned with the clinical and operational implications of these technologies as they mature. A primary example of this transition is radiopharmaceuticals (RPTs), which have moved beyond their status as an emerging modality to become a tangible, scalable reality.
At a McKinsey-hosted panel, “Radiopharmaceuticals are the next horizon,” leaders from RayzeBio (a Bristol Myers Squibb company), NorthStar Medical Radioisotopes, and Advanto discussed how this field is rapidly maturing from a diagnostic niche into a central pillar of cancer treatment.
From trailblazing to multibillion-dollar markets
The radiopharmaceutical landscape has shifted dramatically over the past five years. What was historically a market dominated by imaging and diagnostics has evolved into a robust therapeutic pipeline. Although 88 percent of current assets remain in early development, the richness of this pipeline is driving a surge in capital market activity.
Strategic players such as Bristol Myers Squibb now view radiopharmaceutical therapy (RPT) as a foundational modality—a vertical pillar on par with cell therapy, targeted therapy, and immuno-oncology. The recent billion-dollar market valuation from ACS’s IPO further underscores the investor base’s intense optimism. As one panelist noted, the goal is no longer just to participate but to be a leader in a market that will soon be measured in the multiple billions.
It’s not just about the next one or two or three years; we are planning for the next decade.
The logistical challenges of radioactive decay
Unlike traditional small molecules or monoclonal antibodies, radiopharmaceuticals pose a unique physical challenge: they begin to decay the moment they are created. Depending on the isotope, half-lives range from hours to days, necessitating a flawless, high-speed supply chain. This requires a shift in manufacturing strategy, balancing central hubs with distributed networks across the country to ensure the medicine reaches the patient before it loses potency.
This just-in-time manufacturing model requires significant capital investment. High entry barriers stem from long lead times for specialized equipment—accelerators, cyclotrons, and hot cells currently have lead times of two to three years. Furthermore, the industry operates under the dual scrutiny of the FDA and nuclear regulators, such as the Nuclear Regulatory Commission (NRC), adding layers of complexity to safety and waste management.
We actually have to relearn some things. It’s not a simple transfer of a small-molecule operator into a radiopharmaceutical plant.
While NorthStar predicts it will be able to support global demand by late 2026, the industry remains focused on debottlenecking the entire value chain, from isotope production to the treatment center.
Innovation through alpha emitters and AI
A major focus of the discussion was the emergence of next-generation alpha emitters, specifically actinium-225. Unlike beta particles (electrons and positrons), alpha particles are heavy clusters of two neutrons and two protons that deliver high-energy double-strand DNA breaks over very short distances, significantly limiting exposure to healthy tissue.
The radiopharmaceutical does very well at rapidly debulking a tumor... we can start dreaming about cures and transforming outcomes.
RPTs also offer a unique development advantage: rapid iteration. Because they are inherently theranostic, researchers can image a patient’s human biodistribution to get an early read on safety and efficacy before committing to the massive capital required for Phase III trials. This allows developers to shift attrition earlier—identifying and stopping unsuccessful programs much earlier in the timeline than other modalities allow. This real-time feedback loop is further accelerated by AI, which companies are leveraging to optimize manufacturing workflows, target identification, and clinical protocol design.
The 2026 roadmap
This upcoming year is set to be a milestone-heavy chapter for the modality. The industry is eagerly awaiting data readouts for the first pivotal actinium-225 registrational studies, which could set the stage for a new standard of care in the postlutetium setting.
However, the crystal ball for the next decade points toward combinatorial strategies. The true potential of RPT may lie in its ability to rapidly debulk solid tumors, creating an immunogenic environment that allows other therapies, such as immuno-oncology agents, to work more effectively.
By moving from monotherapy into earlier lines of treatment and expanding from prostate cancer into liver, lung, and breast cancer, the industry is aiming for more than just incremental gains—it is pursuing cures.
As the panel concluded, the sentiment was clear: the infrastructure being built in 2026 is not just for the next few quarters, but for the next decade of oncology. With a maturing ecosystem of CDMOs, increasing site readiness, and a surge in novel chemistries, radiopharmaceuticals have officially arrived as a permanent fixture in the modern therapeutic toolkit.
Ben Hickey is the president of RayzeBio; Frank Scholz is the president and CEO of NorthStar Medical Radioisotopes; and Anna Karmann is the chief medical officer of Advanto.
Comments and opinions expressed by interviewees are their own and do not represent or reflect the opinions, policies, or positions of McKinsey & Company or have its endorsement.