In the past three years, pharmaceutical companies have committed roughly USD 10 billion in acquisitions aimed at one therapeutic category: radiopharmaceuticals. Bristol Myers Squibb paid USD 4.1 billion for RayzeBio. AstraZeneca paid around USD 2 billion for Fusion Pharmaceuticals. Eli Lilly paid USD 1.4 billion for Point Biopharma. Novartis added Mariana Oncology for up to USD 1.75 billion. This capital is not chasing a molecule. It is chasing a platform — one that the Asia-Pacific nuclear medicine market, according to MarketsandMarkets, is projected to grow from USD 2.13 billion in 2025 to USD 4.68 billion by 2030, at a 17.1% compound annual growth rate. It is the fastest-growing region in the world for this category. And yet, across most of Southeast Asia, the infrastructure to deliver these therapies at scale does not yet exist.
Theranostics pairs a diagnostic radiopharmaceutical with a therapeutic one that share the same biological target. A patient is imaged with a radioactive tracer that binds to a specific molecular target on cancer cells. If the tracer lights up, the same targeting molecule, now carrying a therapeutic radioisotope, is infused to deliver targeted radiation to those cells. Two approvals changed the commercial trajectory of this field. In 2018, the FDA approved Lutathera (Lu-177 DOTATATE) for neuroendocrine tumours. In 2022, it approved Pluvicto (Lu-177 PSMA-617) for metastatic castration-resistant prostate cancer. Unlike neuroendocrine tumours, prostate cancer is a high-incidence disease. Pluvicto reached close to USD 1 billion in annual sales in its first full year.
What makes theranostics commercially distinctive is that the therapy cannot be separated from the infrastructure that delivers it. Unlike a small-molecule oncology drug, which can be manufactured at one site and shipped to pharmacies worldwide, a theranostic therapy depends on a local stack that has to be assembled piece by piece. Before a patient can be treated, they must be imaged using a short-lived diagnostic tracer produced by a local cyclotron to confirm they are a candidate. The therapeutic isotope, reactor-produced and imported, must then be combined with a targeting molecule under sterile conditions in a licensed GMP radiochemistry laboratory, quality-controlled before release, and administered by a clinical team trained in radiation medicine, dosimetry and radiation safety. For the next generation of theranostics, the cyclotron's role expands further: the more potent isotopes that will define the category's next decade require cyclotron-based production, not just reactor imports. Remove any one of these components — cyclotron, isotope supply, radiochemistry lab, GMP licence, qualified radiopharmacist, accredited clinical programme — and the therapy cannot be delivered. The binding constraint on the category's growth is not chemistry or clinical evidence. It is infrastructure.
Building this stack takes far longer than most investors assume. A cyclotron can be installed in two years. But GMP certification, supply chain agreements, regulatory and accreditation standing, and the specialist talent each take years to develop independently, and none of them start until the facility is built. Turning an installed cyclotron into an operating theranostics business takes closer to five years, and most of the work is not engineering — it is regulatory, operational and human. The 2024 Lancet Oncology Commission on Radiotherapy and Theranostics, led by the IAEA, concluded that supply chains, workforces and regulatory challenges limit the global use of radiopharmaceutical therapies. A separate IAEA regional survey published in 2025 found that nearly half of surveyed Asia-Pacific countries do not practice theranostics at all.
Across Southeast Asia, the infrastructure that does exist sits in various stages and shapes.
Singapore has a comprehensive stack. Two operating cyclotrons — one hospital-based at Singapore General Hospital and one commercial at Singapore Radiopharmaceuticals under the RadLink group — have the broadest tracer menu in the region, including F-18, Lu-177, Ga-68 and Ac-225. A GMP radiopharmacy supplies both the diagnostic and therapeutic sides of the programme. SGH's clinical programme delivered the first peptide receptor radionuclide therapy in Southeast Asia in 2012, and in 2025 became the first centre in the region accredited by the European Association of Nuclear Medicine as a Theranostics Centre of Excellence.
Malaysia, Thailand and the Philippines each have established theranostics practice running. In the Philippines, KHealth Corporation's cyclotron at the National Kidney and Transplant Institute is one of the leading centralised radiopharmaceutical suppliers to the National Capital Region's network of nuclear medicine centres — a position paper in Nuclear Medicine Communications notes that theranostics became practical in the country once KHealth began supplying Lu-177 PSMA, and St. Luke's Medical Center stood up the country's first theranostics service in 2018. In Thailand, Chulabhorn Hospital's National Cyclotron and PET Centre produces and distributes radiopharmaceuticals nationally, and Lu-177 PSMA therapy has been running at multiple university hospitals for several years. In Malaysia, Sunway Medical Centre offers Lu-177 PRRT and Lu-177 PSMA therapy, with trained nuclear medicine physicians running accredited programmes.
Vietnam and Indonesia have established nuclear medicine practice but theranostics remains at an earlier stage.
For a region of nearly 700 million people, that is a remarkably narrow operating footprint. The facilities that have assembled even part of this stack are the only ones with any prospect of participating in what comes next. The implication is not that Southeast Asia is excluded from this wave. It is that the asset base enabling participation is extraordinarily narrow, and the cost, time and complexity of building it from zero are structurally high. The small number of operating assets that exist today are not peripheral to this story — they are the entry point. And the capital that follows will need to treat infrastructure, not pipeline, as the constraint.
KPA advises investors, acquirers and operators on radiopharmaceutical assets across Southeast Asia. The operating infrastructure described in this article is the same landscape we work in — a narrow asset base, high barriers to entry, and a small number of transactions that actually come to market. Our work spans venture building, project advisory and capital structuring across the region.