It has been almost a decade since the commentary Molecular radiotherapy — the radionuclide raffle? by Gaze and Flux (2010). The overarching feeling then was that no individual or organisation has taken up the challenge, nationally or internationally, of championing molecular targeted radionuclide therapy in all its aspects. Here, we report on the recent NCRI–CTRad (Clinical Trials in Molecular Radiotherapy–Tribulations and Triumphs) meeting, held in London on the 8 June 2018. The meeting was organized by the NCRI–CTRad to review the challenges and opportunities for clinical trials in molecular radiotherapy, particularly focussing on investigator-led trials that incorporate imaging and dosimetry, and to discuss how the community can move forward. This meeting was organised in conjunction with the British Nuclear Medicine Society and reflects the progress of Nuclear Medicine in the UK.