Radiopharmaceuticals (RPTs) have moved rapidly from a niche area of oncology research to one of the most closely watched modalities in global biopharma development. As highlighted in the Global R&D Trends 2026 Report from the IQVIA Institute, these therapies are now attracting sustained investment, growing pipeline activity, and increased strategic attention from both emerging biopharma and large pharmaceutical companies.

As oncology pipelines become more competitive and precision medicine expectations continue to rise, radiopharmaceuticals are increasingly viewed as a differentiated path to targeted efficacy in hard-to-treat cancers.

What are radiopharmaceuticals and why now?

Radiopharmaceuticals are therapies that combine a targeting component, often an antibody or peptide, with a radioactive payload. This design allows radiation to be delivered directly to tumor cells while limiting exposure to surrounding healthy tissue. The approach builds on decades of nuclear medicine experience but applies it in more targeted, therapeutic contexts.

The renewed momentum behind RPTs reflects several converging forces. Advances in targeting biology, improvements in radioisotope chemistry, and growing clinical evidence have improved confidence in their therapeutic potential. At the same time, sponsors are actively seeking modalities that can deliver clear differentiation in increasingly crowded oncology landscapes.

Accelerating deal activity signals long term confidence

One of the strongest signals of radiopharmaceutical momentum is the sharp increase in deal activity since 2019. The 2026 report identifies RPTs as one of the modalities with the most notable growth in partnerships, licensing agreements, and acquisitions, alongside antibody drug conjugates (ADCs) and oligonucleotides.

Deal volume for radiopharmaceutical assets has more than doubled over the past six years, indicating sustained investor and sponsor confidence rather than short term experimentation. These transactions frequently involve collaborations between emerging biopharma companies with specialized platforms and large pharmaceutical organizations seeking to expand or diversify their oncology portfolios.

This pattern mirrors earlier waves of investment seen with ADCs and cell and gene therapies, where deal activity accelerated well ahead of widespread late-stage approvals.

Oncology remains the primary driver

Radiopharmaceutical development is overwhelmingly concentrated in oncology, where unmet need and biological targeting opportunities align closely with the modality’s strengths. According to the report, oncology continues to account for the largest share of clinical trial starts globally, and novel modalities are playing an increasingly central role.

In 2025, one third of oncology trial starts involved novel therapeutic modalities, including RPTs, ADCs, cell and gene therapies, and multi-specific antibodies. This represents a threefold increase compared with a decade earlier. RPTs are therefore part of a broader shift toward more complex, targeted treatment approaches rather than standalone innovations.

Many development programs focus on solid tumors with known or emerging biomarkers, where precision targeting can translate into meaningful clinical differentiation. In these settings, RPTs are often positioned as complementary to existing systemic therapies or as options for patients with limited treatment alternatives.

Part of a broader modality transition

While small molecules continue to dominate biopharma deal activity in absolute terms, the most important changes in R&D strategy are happening at the modality level. The report highlights RNA based therapies, ADCs, and RPTs as the areas with the most pronounced growth since 2019.

This shift reflects intentional portfolio diversification. Sponsors are balancing the scalability and familiarity of small molecules with investments in platform driven, high value modalities that may offer more durable competitive advantage. Radiopharmaceuticals fit squarely within this strategy, particularly for companies seeking to differentiate within oncology.

The rise of these modalities also underscores a growing willingness among sponsors to engage with higher scientific and operational complexity if the potential clinical value is compelling.

Development brings unique execution challenges

Despite their promise, RPTs introduce distinct development and operational considerations that differ meaningfully from traditional small molecule or biologic programs.

Key challenges include reliable access to radioisotopes, specialized manufacturing and handling requirements, and integration of imaging, diagnostics, and therapeutic delivery. Clinical trial execution also depends heavily on-site readiness, regulatory coordination, and careful logistics planning to account for isotope half-life and transport constraints.

These factors raise the bar for planning and execution and have contributed to greater reliance on experienced development partners, specialized site networks, and integrated clinical and operational strategies. Sponsors that underestimate this complexity risk downstream delays, even with strong clinical data.

Strategic implications for sponsors

Radiopharmaceuticals are no longer experimental side bets. They are becoming core components of modern oncology portfolios, with increasing expectations for performance, scalability, and commercialization.

Competition for differentiated assets is intensifying, placing greater emphasis on target selection, isotope strategy, and platform reproducibility. Execution excellence is also becoming a major differentiator, particularly as programs advance into later stage development and global trials.

Importantly, RPT development is often guided by a theragnostic rationale, with biomarkers and companion diagnostics emerging as a downstream consequence of target biology. In addition, combination strategies with other modalities are an emerging opportunity, with potential implications for future lifecycle expansion.

Looking ahead

The 2026 outlook positions radiopharmaceuticals as one of the most dynamic areas in oncology R&D. Strong deal activity, expanding clinical pipelines, and increasing sponsor sophistication all point to continued growth over the coming years.

For sponsors, success will depend not only on scientific innovation but also on the ability to manage complexity across clinical development, manufacturing, and operations. For development partners, the rise of radiopharmaceuticals underscores the need for specialized capabilities and integrated execution models.

What is clear is that radiopharmaceuticals are no longer emerging at the margins of oncology innovation. They are moving decisively into the center of the global R&D conversation.

This blog is based on insights from The IQVIA Institute’s Global R&D Trends 2026 Report: Advancing Innovation in a Changing Landscape. For more report information, please visit https://www.iqvia.com/insights/the-iqvia-institute/reports-and-publications/reports/global-r-and-d-trends-2026.