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Interview: Amethyst’s Stéphane Carré on Fremman Capital deal, European expansion, and radiotherapy investment

Amethyst, a pan-European private cancer care provider specialising in radiotherapy, was recently acquired by Fremman Capital, a European private equity firm, from its founding shareholders and The Rohatyn Group (TRG), an asset manager focused on emerging markets.

Founded 15 years ago in Romania, Amethyst now operates 17 centres across six European countries, treating more than 50,000 patients annually. Fremman Capital sees the acquisition as closely aligned with its focus on supporting essential service providers.

HBI spoke with Amethyst CEO Stéphane Carré about the new partnership, expansion plans, the investment climate in radiotherapy, and the role of public-private partnerships in Amethyst’s model.

Carré said the deal with Fremman was finalised after nearly a year of negotiations.

“From our first conversations with Fremman in June last year, it was clear we were closely aligned, both in Amethyst’s growth potential and the strategic direction we’ve taken since I joined. Fremman quickly stood out as the right partner in terms of scale, strategic alignment, and operational support.”

Carré explained that while radiotherapy remains Amethyst’s core focus, the company aims to broaden its offering.

“Our aim is to expand into therapies that enhance radiotherapy outcomes such as chemotherapy and diagnostic services. We’ve already begun strengthening our diagnostic capabilities, and this next phase will allow us to invest further in our strategy and footprint across Europe. Priority will go to countries where we already operate, but we’re also eyeing new markets.”

Germany, Carré confirmed, is high on the list.

“There’s one country we can’t ignore — and that’s Germany. We’re not there yet, but it’s definitely a target.”

He emphasised that Amethyst’s approach is holistic, covering every phase of the care pathway.

“Our aim is to support patients from the earliest stage of diagnosis right through to the end of treatment. And even beyond that we offer post-treatment services such as psychological counselling and generic advice, both of which are crucial to patient wellbeing.”

Ultimately, he said, the goal is to cover as much of the care pathway as possible, offering peace of mind, reducing delays, and maintaining control across every stage of treatment.

In parallel, Amethyst is developing a digital tool, an app designed to help patients take greater ownership of their care journey.

“This tool will also support patients in better understanding their cancer including the specific nature of their disease.”

At the core of this approach is Amethyst’s “one point of contact” model, an integrated strategy designed to simplify and unify the patient experience.

On AI’s role in this work, Carré said the technology is increasingly key in enhancing radiotherapy.

“AI enables us to tailor treatment plans to each individual — each tumour, each case. We’re already using AI during treatment planning and the contouring phase. As you may know, radiotherapy consists of three main stages: planning, tumour contouring, and treatment delivery.”

“At present, AI provides valuable support to clinicians and physicists, particularly in the first two phases. Dose distribution remains at an earlier stage of integration, but we’re seeing real progress.”

“When it comes to image analysis, AI can be more accurate than humans in spotting early signs of cancer. It will play a major role in prevention, and we plan to integrate it as we expand our diagnostic capabilities.”

He also highlighted adaptive radiotherapy as a major innovation:

“This allows radiation to be adjusted in real time during treatment taking into account patient movement, such as breathing, to maintain precision. It’s a major step forward in personalised cancer care.”

Amethyst was founded with the aim of bringing radiotherapy to underserved regions. Many areas continue to face so-called ‘white zones’, where patients are forced to travel significant distances to access treatment.

Carré spoke further about addressing these white zones, noting significant variation in radiotherapy access across Europe.

“Regulators recommend seven radiotherapy machines per million people. But actual figures range from just two or three in some countries, up to around ten. Romania, for example, has only two to four; the UK is also on the lower end. At the top, Switzerland has close to ten, and France and Germany hover around the average.”

“At Amethyst, we take a pragmatic approach. We don’t follow a fixed model. We invest where it makes strategic sense. That includes upgrading existing centres and launching new ones. In Romania, for instance, government licensing is still underway, so there are opportunities for greenfield development. We’re currently preparing to open two new centres there.”

“In mature markets like France and Germany, we focus on acquisitions buying private centres and then upgrading their technology, treatment options, and capabilities. For example, we recently acquired a centre where we’re installing stereotactic radiotherapy, a highly precise method not previously available there.”

“Our strategy is always shaped by local infrastructure, regulation, and patient needs.”

Plans beyond Europe?

When asked about the possibility of expanding outside of Europe, Carré was clear:

“No — our strategy remains firmly rooted in Europe.”

However, he said the company is actively working to increase access for international patients.

“We already welcome patients to our centres in the UK and Austria, from the Balkans, the Gulf, even New Zealand. I’d like to expand this significantly. There’s growing demand for second opinions, and for access to advanced treatment options.”

“In particular, we see strong interest from the Gulf, parts of Africa, and the Balkans. Where needed, we offer patients the opportunity to receive treatment at our European centres, for example, Gamma Knife radiotherapy in the UK.”

“This is a key area of development. But when it comes to physical presence outside Europe, that’s not our focus. There’s still enormous opportunity within Europe both in our existing countries and in new markets.”

Consolidation in the radiotherapy market

“There’s a clear and growing need for consolidation and I say ‘need’ deliberately,” said Carré. “Cancer care requires major capital investment, and public systems across Europe increasingly struggle to meet that demand.”

Private operators, he argued, have a vital role to play.

“The sector is still fragmented. For it to mature and deliver high-quality care consistently, consolidation is essential. That’s why private equity interest from both European and international funds is increasing.”

“Recently, an Australian fund invested significantly in the UK. This shows how widely the opportunity is now recognised.”

Carré identified four key drivers behind rising demand for cancer care:

• Ageing populations — “Cancer is often a natural evolution of cells. As people age, the likelihood increases.”
• Lifestyle factors — “Modern habits and environments expose us to more risks.”
• Improved diagnostics — “We’re detecting cancer earlier, which improves outcomes but also increases treatment volumes.”
• Cancer as a chronic condition — “We’re seeing patients live longer with cancer. Many require ongoing or repeated treatments, adding pressure to the system.”

Public-private partnerships (PPPs)

Carré also reaffirmed the importance of PPPs in Amethyst’s growth model.

“Healthcare budgets are under severe pressure, and that’s not likely to improve given the global climate. PPPs are a vital way to support public systems.”

“From the beginning, Amethyst has positioned itself as a preferred partner to public health providers. That started in Romania, where we offered infrastructure support such as radiotherapy bunkers to public hospitals.”

“Today, the same principle applies. We help public facilities increase their treatment capacity, modernise equipment, and improve access. In countries like France, if a public hospital can’t treat a minimum number of patients annually, it risks losing its licence. By operating on their behalf, we help them maintain accreditation, treat more patients, and enhance care.”

“It’s an innovative model that’s still underutilised in Europe and we’re committed to playing a leading role in its development.”

We would welcome your thoughts on this story. Email your views to Rakshitha Narasimhan or call 0207 183 3779.