Bildnachweis: FCF, VentureCapital Magazin.
Nuclear medicine is currently experiencing a dynamic resurgence, fuelled by groundbreaking innovations in theranostics, the rapid development of novel radiotracers, and the emergence of ambitious international start-ups. This momentum is unlocking a wealth of investment opportunities, particularly for stakeholders in the healthcare and life sciences industries.
For decades, clinical nuclear medicine relied heavily on a limited number of radiotracers – specifically fluorodeoxyglucose-18 (FDG), technetium-99m (Tc-99m), and iodine-131 (I-131) – mainly for diagnostics in oncology and cardiology. However, recent advances have transformed the landscape. The convergence of diagnostic imaging and targeted therapy, known as theranostics, is now driving significant growth. This approach harnesses new radiotracers and therapeutic isotopes to deliver highly personalized treatments for cancer and neurodegenerative diseases.
Personalized diagnostics and targeted therapy
Theranostics involves a diagnostic phase followed by a therapeutic phase, using a pair of similar radiotracers. First, a diagnostic tracer with low radioactivity is administered to the patient and binds selectively to diseased cells. The patient is then imaged using PET/CT or SPECT/CT, which provides radioactive signals from the bound diseased cells and a precise anatomical localization. If enough signal is confirmed, a therapeutic radiotracer – chemically similar but linked to a stronger radioactive isotope – is used to deliver a cytotoxic dose directly to the targeted cells. This method, referred to as radioligand therapy (RLT), allows for highly selective treatment of tumours while sparing healthy tissues. RLT is gaining traction due to its dual benefits: personalised diagnostics and targeted therapy. Because the ligand used in the tracer can bind specifically to disease markers present throughout the body, RLT is also effective for treating metastatic tumours that have spread beyond the primary site. The success of treatments such as 177Lu-DOTA-TATE (Lutathera™) for somatostatin receptor-positive neuroendocrine tumours and 177Lu-PSMA-617 (Pluvicto™) for prostate-specific membrane antigen (PSMA)-expressing prostate cancer underscores the expanding clinical and commercial potential of radiotherapeutic agents as viable frontline options. Start-ups including RayzeBio, SOFIE Biosciences, and Telix Pharmaceuticals are proving that innovation in radiopharmaceutical manufacturing and modern imaging technologies can result in significant medical advancements. These companies are spearheading new approaches to diagnose and treat both cancer and neurodegenerative diseases, demonstrating the vast promise of this evolving field for research and commercial development.
Innovations in theranostic radionuclide production
A critical factor accelerating this progress is the advancement in theranostic radionuclide production. Both European research initiatives and private-sector investments have contributed to the creation of increasingly specialized isotopes that expand diagnostic and therapeutic capabilities. One notable example is Pluvicto (177Lu-PSMA-617), approved for the treatment of metastatic prostate cancer. The diagnostic phase employs Locametz (Ga-68) (or others), a short-lived PET tracer that binds to PSMA and reveals tumour burden. Once PSMA-positive lesions are identified, treatment proceeds with Pluvicto, a PSMA-targeting ligand attached to the beta-emitting isotope Lutetium-177. This combination delivers targeted radiation, destroying cancer cells while minimizing damage to surrounding healthy tissue. This precision enables earlier detection of metastases and more effective treatment, improving patient outcomes. Pluvicto is now approved in both the U.S. and Europe for use alongside standard therapies. Clinical trials have shown that this approach can significantly improve outcomes for prostate cancer patients. Meanwhile, studies on neuroendocrine tumours indicate that patients treated with targeted radionuclide therapy may experience notably prolonged survival. Personalized theranostics – by uniting diagnostics with tailored therapies – is opening entirely new clinical pathways.
Start-ups as key innovation drivers
Historically, a few large companies such as Siemens Healthineers, GE, and Philips dominated the nuclear medicine space by providing both imaging hardware (PET/CT and SPECT/CT systems) and radiotracers. However, the landscape is shifting. Innovative start-ups are now essential in translating academic breakthroughs into commercially viable solutions. Alpha9, for instance, focuses on developing novel radiopharmaceuticals aimed at precise oncology treatments and recently secured USD 175 million in an oversubscribed series C funding round. The company’s platform enables synthesis of a wide array of RLT candidates, emphasizing flexibility and precision.
Investing in theranostics
The global radiopharmaceutical market is growing at a remarkable pace. Projections indicate that the market will almost triple between 2024 and 2029, reaching a valuation of USD 12.7 billion, driven by an impressive 24% annual growth rate. These figures reflect the considerable investment potential in this emerging sector. Venture capital and strategic investors are increasingly participating in this space. Major transactions highlight the market’s dynamism, including the USD 3.5 billion acquisition of RayzeBio by Bristol Myers Squibb, the EUR 2 billion acquisition of Fusion Pharmaceuticals by AstraZeneca, the USD 416 million acquisition of SOFIE Biosciences by private equity firm Trilantic, a EUR 188 million investment in ITM Isotope Technologies by Temasek, BlackRock, and the Qatar Investment Authority, and a EUR 134 million series A investment in Belgian theranostics firm PanTera, led by EQT and Kurma Partners.
Future clinical potential and applications
Advancements in radionuclide science are enabling the development of highly specific ligands, fostering a new generation of radiopharmaceuticals that combine diagnostic accuracy with therapeutic power. These compounds are central to personalised medicine, allowing treatments to be tailored to each patient’s biological profile. The growing demand for individualized therapies and highly accurate diagnostics is expected to continue driving the expansion of the theranostics market. In oncology, new tracers and therapeutic agents are poised to improve survival rates and quality of life for cancer patients. Beyond oncology, the impact of radiopharmaceuticals is growing in neurology. Breakthrough PET tracers are enhancing early diagnosis of conditions such as Alzheimer’s disease and other neurodegenerative disorders. As these technologies mature, neurology is expected to become a key focus area for research and investment.
Conclusion
Theranostics and radiopharmaceuticals are entering a phase of accelerated growth, propelled by cutting-edge technologies, forward-thinking start-ups, and clear evidence of clinical benefit. For investors in healthcare and the life sciences, this sector presents compelling opportunities to support groundbreaking innovations while driving medical progress. As capital continues to flow in and scientific momentum builds, the theranostics field is poised to evolve into a cornerstone of 21st-century medicine. Venture capital firms, pharmaceutical companies, and specialized investment funds all stand to benefit from engaging early in this transformative journey.
About the author:
Mathias Klozenbücher joined FCF Fox Corporate Finance in June 2023. As managing director, he is responsible for the life sciences team and supports clients in the preparation, process management, and execution of transactions. Prior to joining FCF, Klozenbücher gained experience at Siemens Healthcare, leading M&A processes in New York and Berkeley, at Speedinvest as well as Böhringer Ingelheim.
