There’s been a lot of attention lately on a corner of the oncology market called radiopharmaceuticals. The therapy seeks to destroy cancer cells by binding a radioactive particle to a targeted molecule and then dispatching it directly into the tumor. There are currently two products on the market from Novartis and a slew of clinical trials underway. Interest is so high that within the past year it has been at the center of a flurry of acquisition announcements by big pharma. The latest came from Novartis earlier this month when it struck a deal to buy Mariana Oncology for $1 billion. Novartis already has two therapies on the market: Pluvicto, which treats a type of advanced prostate cancer, and Lutathera, which targets neuroendocrine tumors. Eli Lilly completed its $1.4 billion acquisition of Point Biopharma in December and in February, Bristol-Myers Squibb finalized its $4.1 billion acquisition of RayzeBio. Then in March, AstraZeneca said it plans to purchase clinical-stage biopharmaceutical company Fusion Pharmaceuticals for $2.4 billion. “Any big pharma with an existing oncology presence probably wants to get into this game of radiopharmaceuticals because the data looks pretty good already,” said Jefferies analyst Andrew Tsai. “What you’re seeing is that these companies [are] not necessarily acquiring the lead asset of these companies, but more so the manufacturing, the know-how. It seems very complicated to do it yourself,” he added. A growth opportunity into the next decade Still, radiopharma is just a part of each company’s larger portfolio. Novartis is the leader in the space with its two therapies already on the market and several clinical trials underway. “Acquiring Mariana … gives them even greater discovery capabilities,” said Oppenheimer analyst Jeff Jones. But Novartis shares have been underperforming the market. The stock is up about 1% year to date, and the average analyst rating is hold. Analysts predict about 8% upside based on the average price target, reported by FactSet. The investor attention on Eli Lilly, which is up 38% year to date, largely thanks to its diabetes drug Mounjaro and weight loss treatment Zepbound. Meanwhile, Bristol-Myers Squibb shares have been struggling, down 18% so far this year as investors focus on the loss of patent protections on some of its older drugs later this decade. AstraZeneca, however, is up 17% year to date. It has an average analyst rating of overweight and nearly 6% upside to the average analyst price target, per FactSet. Analysts believe big pharma’s acquisitions are just the beginning as both the larger companies and smaller biotech firms work to improve upon current therapies and discover new ones. The end result could be better efficacy and a wider set of tumors the therapy can treat. William Blair said investing in the sector will likely provide investors with a secular growth opportunity well into the next decade. Read more on this trend: This up-and-coming cancer treatment could be a $25 billion market opportunity — it’s already a hotbed for M & A “Ownership of isotope production could be viewed as a significant competitive advantage in the lens of big pharma,” analyst Andy Hsieh wrote in a March note following AstraZeneca’s announcement. “Upon the achievement of stable, robust, and redundant supply chain, the next focus will likely be optimizing modalities (radioligands, engineered peptides/proteins, nanobodies, or antibodies) for specific targets (preferably beyond PSMA and SSTR2) and tumor indications, which in our view could usher continued investor engagement and innovation in the radiopharmaceutical field in the long term,” he added. A $25 billion market Meanwhile, RBC Capital Markets sees a $25 billion market opportunity for the space. “We believe TRT development is still in its early stages, and next-generation technologies that enable improvements in therapeutic potency and address a wider range of cancer targets have the potential to drive value creation in the space,” analyst Gregory Renza, M.D., wrote in a February note. One place to look is among the clinical-stage biotech companies working in the area, which may be prime candidates for an acquisition. These stocks could make for an interesting investment for those with an appetite for some risk. A name Jones likes is Perspective Therapeutics , which he rates outperform. The company is nearing a $1 billion valuation, currently sitting at around $888 million. Shares are up 280% year to date, which Jones said is driven by the enthusiasm around the space. CATX 1Y mountain Perspective Therapeutics year to date Cantor Fitzgerald is also bullish on the name. “Even though the stock has had a good run this year … we still see room for shares to go higher. Our [discounted cash flow] analysis arrives at an equity value over $4B, compared to its current market cap of ~$1B,” analyst Louise Chen wrote in a note last week. The company has been a bit under big pharma’s radar since it did a reverse merger to go public just last year, Jones pointed out. Perspective currently has trials underway to target neuroendocrine cancer and melanoma using alpha emitters as opposed to beta emitters, which are used in Novartis’ treatments. “Alpha [emitters] have a much stronger punch … in a much more targeted way. So it’s really an ideal profile,” said Piper Sandler analyst Edward Tenthoff, who doesn’t cover Perspective Therapeutics. Dan Lyons, a portfolio manager and research analyst at Janus Henderson Investors, is bullish on Perspective and its possibilities. “They have a long experience in radiopharma,” he said. He also likes and holds Novartis and Eli Lilly in the big cap space, and biotech company Immunome , which has a $865 million market cap. Immunome is in the discovery phase in a targeted radioligand therapy for certain lung, breast and esophageal solid tumors. Then there is Lantheus Holdings , which calls itself a radiopharmaceutical-focused company and has a $5.6 billion market cap. “Lantheus Holding is a company firmly entrenched on diagnostics [and] moving towards therapeutics,” Jones said. The company’s diagnostic imaging is used in conjunction with Novartis’ Pluvicto. On the therapeutic side, Lantheus partnered with Point Biopharma on a targeted radiation therapy for metastatic castration-resistant prostate cancer. In December, the treatment met its primary endpoint in a phase three trial, just before Eli Lilly closed its acquisition of Point Biopharma. LNTH YTD mountain Lantheus Holdings year to date The company also struck multiple strategic agreements with Perspective Therapeutics in January, including an option to exclusively license Perspective’s clinical stage alpha therapy developed for the treatment of neuroendocrine tumors and an option to co-develop certain early stage therapeutic candidates targeting prostate cancer. In addition, Lantheus agreed to purchase up to 19.9% of Perspective’s outstanding shares of common stock and Perspective will acquire assets and associated lease of Lantheus’ radiopharmaceutical manufacturing facility in New Jersey. The average analyst rating on the stock is a buy, according to FactSet. Among those who like the company is Leerink Partners analyst Roanna Ruiz. She has a $106 price target on the stock, which suggests more than 30% upside from Wednesday’s close. She expects the recent M & A activity will continue to intrigue investors. “We believe this further validates Lantheus’ recent partnership with Perspective Therapeutics … as Lantheus has ‘last look’ rights to match any bid price on Perspective along with opt-in opportunities,” she wrote in a May 2 note.

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