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Biggest Oncology Disruptor of 2025: ADCs or Radioligand Therapies?

Federico Somaini
Feb 53 min read

This image shows a scientist in a lab who is working on the developmental stages of organs-on-chips.

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Antibody-drug conjugates (ADCs) and radioligand therapies (RLTs) share a vision: improving cancer therapy by increasing efficacy while minimizing harm to healthy tissues. Although they achieve this goal through fundamentally different mechanisms, their promise has ignited unprecedented investment in recent years. As they look to push the boundaries in cancer care, will ADCs or RLTs have a greater impact on oncology in 2025? 


Radioligand Therapies 


RLTs are composed of a radioactive isotope linked to a molecule called a ligand that binds to target receptors on tumor cells or their surrounding microenvironment. This combination delivers a lethal dose of radiation directly to the cancer site, minimizing collateral damage to healthy tissues. RLTs leverage different isotopes depending on tumor characteristics: 


  • Alpha particle-emitting isotopes: Provide highly localized, potent radiation, making them ideal for targeting smaller tumors in precise areas. 

  • Beta particle-emitting isotopes: Effective for treating larger tumors due to their greater penetration range. 


The same radioisotopes used in radioligand therapies can also serve diagnostic purposes, forming the basis of the rapidly growing field of radiotheranostics. 


Industry Developments


  • The RLT market is expanding rapidly, with Novartis firmly positioned as the dominant player. Their drug Lutathera, approved in 2018, was the first RLT approved by the FDA. 

  • Pluvicto's 2022 approval for prostate cancer was a pivotal milestone, introducing the first PSMA-targeted RLT, designed to precisely deliver radiation to prostate tumors. 

  • Building on these successes, Novartis has aggressively pursued growth in its RLT pipeline with the $1 billion acquisition of Mariana Oncology and large deals with Ratio Therapeutics and PeptiDream. 

  • Competitors have also made big moves in the RLT space, with BMS acquiring RayzeBio for $4.1 billion, AstraZeneca acquiring Fusion Pharmaceuticals for $2.4 billion, and Lilly picking up Point Biopharma for $1.4 billion.  


Challenges


  • Manufacturing and distribution complexities, exemplified by initial struggles to meet Pluvicto demand (1).

  • Talent shortages and specialized handling requirements for short-lived isotopes, which have to be delivered by trained physicians in specialized centers (2). 

  • Regulatory and reimbursement hurdles. 


However, these obstacles may offer a competitive advantage in the long run, protecting radioligand therapies from generic and biosimilar competition. 

 

Antibody Drug Conjugates (ADCs)


ADCs combine the precision of monoclonal antibodies with the potency of cytotoxic drugs. An ADC consists of three key components: 


  • The antibody: Ensures tumor selectivity. 

  • The cytotoxic payload: Induces cell death. 

  • The linker: Releases the drug in a controlled manner at the tumor site. 

 

Industry Developments


  • Massive recent acquisitions highlight ADCs as a focal point for investment, including Pfizer’s $43 billion purchase of Seagen and AbbVie’s $10.1 billion acquisition of ImmunoGen. 

  • China has emerged as a key player, with half of the top ten ADC developers hailing from the country (3). Major pharma companies have taken notice, with Roche kicking off 2025 by securing a $1 billion licensing deal with Innovent, and GSK recently striking ADC agreements with Hansoh Pharma and DualityBio worth $2.7 billion combined. 

  • As of 2025, fourteen ADCs have been approved, with more than half achieving blockbuster status.  

  • There has already been one new approval in 2025: AstraZeneca and Daiichi Sankyo’s Datroway® for metastatic breast cancer. 

 

Challenges and Innovations


  • Complex pharmacokinetics and significant toxicities are key hurdles. Tubulin-binding payloads can cause peripheral neuropathy and DNA-damaging agents may lead to myelosuppression. 

  • Solutions in development include refining linker chemistries and combining ADCs with immune checkpoint inhibitors. 

  • Bispecific ADCs and novel payloads, such as protein degraders and siRNAs, are emerging as promising areas of innovation. 


The View from the Crow’s Nest


Radioligand therapies and antibody-drug conjugates are shaking up oncology care by enabling more precise, targeted cancer treatment. 


  • For Radioligand Therapies, success will depend on building out reliable radioisotope supply chains and expanding physician expertise to handle complex treatment protocols. Innovations in alpha-emitting isotopes and radiotheranostics should continue driving growth. 

  • For Antibody Drug Conjugates, success will depend on advancing payload technologies to improve tumor selectivity and minimize off-target toxicity. Overcoming issues related to drug resistance, refining linker stability, and optimizing dosing regimens to ensure consistent therapeutic efficacy will also be critical.  


ADCs and RLTs each bring unique strengths to the oncology landscape, with ADCs currently leading thanks to broader indications and more developed pipelines. While they may seem like rivaling modalities, the real disruption may come from exploring how they can complement each other, as combination therapies have demonstrated potential in recent clinical trials (4,5,6). 


 
If you are interested in learning more, get in touch at strategy@spinnakerLS.com. 

Spinnaker offers true partnership and comprehensive guidance to help leaders navigate the complexities of the Life Sciences industry and chart a path to success. From early-stage market assessment through commercial execution and ongoing lifecycle management, we deliver tailored solutions to ensure optimized practicable results.
 

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