Novartis manufacturing associate checking punches at compressing machine.
Source: Novartis
In 2010, a volcano erupted in Iceland. For Dr. Oliver Sartor, a cancer research professor at the Tulane University School of Medicine, it was a problem.
Ash from the eruption disrupted flights across Europe — including a time-sensitive shipment of experimental radioligand therapy that Sartor was expecting from Norway.
Radioligand therapy, also called radionuclide or radiopharmaceutical therapy, is a targeted form of cancer treatment that delivers radiation directly to cancer cells. While other forms of cancer treatment can target any rapidly dividing cells in the body, radioligand therapy’s precision helps limit damage to healthy, surrounding tissue.
It’s an effective form of treatment that many experts and patients are excited about, but there’s a significant catch — the medication expires within days after it’s manufactured.
A radioligand is made of a radioisotope, which emits radiation that damages cells, and a targeted ligand — a molecule that binds to specific markers on cancer cells. The radioactive component has a very short half-life, or the time it takes for the radioactivity to decrease by 50%. Once the radioactivity decays, it can no longer kill the cancer cells as effectively, which means radioligand therapy has a limited window of viability. By the time it is packaged and ready to ship, the treatment has to reach patients in a matter of days.
“It takes planning,” Sartor told CNBC. “It’s not something you just sort of walk in and say ‘Oh, I think I’ll give you [this] today.'”
Pharmaceutical company Novartis believes the returns will be worth the challenge of mastering this race against time.
Novartis currently produces two radioligand therapy treatments called Lutathera, which treats neuroendocrine tumors, a rare form of cancer in the digestive tract, and Pluvicto, for patients with a specific type of prostate cancer. They were both approved by the Food and Drug Administration.
As of October, Novartis had treated more than 16,000 neuroendocrine patients and 4,000 prostate cancer patients in the U.S. Pluvicto was approved only last March and demand is increasing. As many as 60,000 U.S. patients could ultimately benefit from the medicine, said Jeevan Virk, head of radioligand therapy at Novartis.
The drugs are expensive. The list price (wholesale acquisition cost) of Pluvicto is around $42,500, while Lutathera is around $53,200, and most patients require between four to six doses. Novartis, which generated more than $50 billion in net sales last year, believes Pluvicto holds multibillion-dollar peak sales potential.
But in order to realize that potential, Novartis has to move the medication through the supply chain seamlessly.
Expensive to produce and ship fast
Nuclear medicine has been used to treat cancer for decades, and radioligand therapy itself is not new. The therapy has previously been used to treat cancers like lymphoma, but it was not always widely accepted or used by members of the medical community.
“I think it was challenging for it to find its place,” said Dr. Delphine Chen, director of molecular imaging and therapy at Fred Hutchinson Cancer Center in Seattle.
Dr. Leo I. Gordon, a professor of cancer research at Northwestern University’s Feinberg School of Medicine, said the hesitation often comes down to finances.
Producing radioligand therapy is expensive, and companies have to be willing to shoulder the costs and navigate a challenging supply chain in the hope that they can eventually make a profit.
“I’m not sure it’s a great message to send that everything is based on profit mode and all,” he said, “but it certainly does exist in medicine, oncology and the world.”
For lymphoma, it’s not a long-term investment any company has been willing to make, Gordon said. But since Pluvicto and Lutathera outperform existing treatments available for certain prostate and neuroendocrine cancers, they are being seen to have significant commercial promise.
“There’s a lot of excitement around it,” said Chen, who has administered both drugs to patients. “A lot of patients feel better on it, so that’s really exciting and gratifying to me as a physician to be able to offer something that actually is helpful with minimal toxicity.”
Novartis engineers in packaging facility.
Source: Novartis
Novartis manufactures radioligand therapy at three sites in Italy, Spain and New Jersey, and has a fourth facility slated to open in Indiana next year. Virk said between 70 to 150 people work in each facility, and the site in Indiana will be Novartis’ largest to date.
For both Pluvicto and Lutathera, the manufacturing process begins with a mineral. The minerals are enriched into a stable isotope and exposed to radiation in nuclear reactors, where they ultimately become radioactive after around two to three weeks. During the irradiation, the enriched isotopes are placed into capsules to keep them secure.
The strength of the radiation starts to decay as soon as the capsules are taken out of the reactors, which means Novartis begins a race against a ticking clock. The radioactive atoms have a half-life of just six and a half days.
The capsules are transferred to an isotope-precursor production facility where they are further purified and concentrated into a radioactive liquid salt solution. At the end of this stage, which takes around 48 hours, there is enough radioactivity in one vial to treat between 30 and 50 patients.
The final step takes place in a labeling facility where the radioactive atoms are attached to targeting molecules, or the medicine itself, and that takes around 24 hours. After the final product has been packaged and inspected for quality, it is ready to be shipped.
The drugs have different shelf lives depending on how much radiation Novartis can load into one vial. Pluvicto expires five days after it’s packaged at the factory, while Lutathera has a 72-hour shelf life.
“We basically need to get the product distributed around the world, just in 72 hours, from those three production sites,” Virk said. “This includes anywhere from Tokyo to Anchorage, so it’s an incredible distance that needs to be covered.”
Novartis scientist in lab packing materials for transportation.
Source: Novartis
Pluvicto and Lutathera are packaged inside a small lead container, roughly the size of a credit card. Lead is a strong insulator, so it doesn’t allow the radiation to escape. The drugs are also placed inside an additional container called a Type-A container, which is made of Styrofoam and helps with temperature control.
The risk of radiation exposure is so minimal that radioligand therapy is often transported via commercial airlines and cargo planes. When doses have to be transported on the ground, Virk said Novartis often uses a private courier van service to ensure they reach their destination as quickly as possible.
The process is timed to the minute, said Virk, and there’s a team of around 30 to 40 people at Novartis who oversees the complex logistics.
“It’s a 24/7 operation as you might imagine, because we really have customers around the globe that depend on ensuring that patients get their doses,” he said. “That’s really the fuel that keeps us going.”
Mistakes can happen, and things do go wrong in the supply chain occasionally, Virk said. But errors are costly, because if the shipments do not reach patients in time, the doses can’t be salvaged, and the manufacturing process has to start over.
Patients feel the difference
Radioligand therapy is administered through an IV infusion, and though it does help limit damage to healthy tissue, patients can experience some side effects.
Chen of the Fred Hutchinson Cancer Center said patients who receive Pluvicto can experience some nausea, vomiting, diarrhea, constipation, and fatigue in the short term. “Most of them have had only mild nausea that we’ve observed, and so Pluvicto is very well tolerated compared to chemotherapy,” she said.
Chen said patients can experience many of the same symptoms with Lutathera, but the diarrhea can be exacerbated, and some patients contend with worsening bowel obstruction. In rare cases, patients may be unable to maintain their blood pressure.
But for many patients, these side effects are worth it.
Vanue Lacour Jr. was first diagnosed with prostate cancer in 2007, and underwent a “tough” surgery to remove his prostate after his diagnosis. He stayed cancer-free for eight years, but in 2015, he learned he had relapsed with an advanced form of prostate cancer that had spread into his bones.
“I was determined to win,” the 80-year-old told CNBC. “I’m determined to live.”
Lacour began a grueling round of chemotherapy that he described as a “very, very hard, harsh medicine.” He incurred painful damage to nerves in his foot and leg that he still lives with today.
The chemotherapy helped stabilize his cancer, but Lacour said his doctors were not satisfied. In 2018, Lacour enrolled in a clinical trial for Pluvicto and received six doses over eight months. Now, he is officially in remission.
“I had no real side effects,” Lacour said. “I’m getting back to doing a lot of the things I like to do.”
Radioligand therapy has also helped Josh Mailman, who learned he had a softball-sized neuroendocrine tumor of the pancreas in 2007. The cancer had also spread to his liver.
“I didn’t know how much time I had,” the 61-year-old Oakland, California, resident told CNBC. “There were very few treatments for pancreatic neuroendocrine tumors at the time.”
Mailman decided to join a support group, and he said the other members encouraged him to learn as much as possible about his disease. In 2008, he traveled to a medical conference in Toronto where he heard about radioligand therapy for the first time. As his symptoms worsened over the next six months, his doctor agreed to give Mailman his first dose of radioligand therapy under compassionate care in 2009.
Mailman received three doses of radioligand therapy in 2009 and 2010, and he said it kept his cancer stable for the next six years. He has since had two follow-up treatments — one in 2016 and one in 2020, after the FDA approved Lutathera.
“I’m still here 15 years later,” he said. “It’s been a game-changer in the neuroendocrine tumor space.”
Because of his success with radioligand therapy, Mailman has become deeply involved in patient advocacy, where he works to raise awareness about nuclear medicine and neuroendocrine tumors.
“I would say I’m retired, my wife disagrees,” Mailman joked.
Mailman also runs virtual patient groups twice a week, where patients, friends and family members can come together to discuss their diagnosis and treatments. Mailman said radioligand therapy is discussed in more than 90% of the sessions.
“Either someone’s going to have it, someone had it, someone wants to know more about it,” he said.
During one session CNBC observed in early November, more than a dozen patients met and discussed their experiences with and concerns about radioligand therapy. Patients who had already received it answered questions about their side effects and shared tips about how to overcome fear about needles and radiation.
It is common for patients to express unease about the radiation, said Chen, but there are clear precautions in place to limit exposure and protect others.
Completion was expected in the second half of next year, the Swiss pharma group said.
Arnd Wiegmann | Reuters
The road ahead
As demand for radioligand therapy increases, Novartis’ challenge is to scale up access and awareness about the medication.
Virk, head of radioligand therapy at Novartis, said the company is working with health care systems, governments and other regulatory agencies around the world to improve its operations.
“From my perspective, [radioligand therapy] as a platform is still very much in its infancy,” he said. “So [we’re] really excited about the drug, [but] very acutely aware that we’re just at the beginning of this radioligand therapy revolution.”
Sartor at the Tulane University School of Medicine said there is still work to be done, particularly in terms of optimizing the supply chain but that radioligand therapy makes a real difference for patients.
“I think radioligand therapy has arrived in a way that is meaningful for patients today,” he said. “I’m anxious for patients to be able to receive the therapy in an FDA-approved manner, and also to do the next generation of clinical trials to ensure that even more people will have access in the future.”
Talk about a monster quarter. Apple delivered a great September quarter Thursday evening, even as iPhone supply was constrained by strong demand. The stock really got going after the company’s strong forecast for the holiday quarter. Revenue in Apple’s fiscal 2025 fourth quarter, which ended Sept. 27, rose 8% year over year to $102.47 billion, outpacing the $102.26 billion consensus estimate compiled by LSEG. Earnings per share of $1.85 increased 91% (or 13% when excluding a one-time charge in the year-ago period), exceeding the $1.77 consensus estimate, according to LSEG. AAPL YTD mountain Apple YTD Shares of Apple jumped as much as 5% in after-hours trading to around $285 before cooling off to around $278. The stock, which got off to a horrible start in 2025, has jumped roughly 30% in the past three months, as of Thursday’s close. For the year, it has gained more than 8% — and earlier this week, it joined the $4 trillion market cap club. Bottom line In addition to reporting a September quarter record for sales earnings and operating cash flow, the higher margin services segment set an all-time revenue record across all geographic regions. Overall, Apple set September quarter records in all regions – the Americas, Europe, Japan, and the rest of Asia-Pacific – except Greater China. While Greater China sales were down in the quarter, much of that was due to iPhone supply constraints. On the post-earnings conference call, CEO Tim Cook stated that he expects to see the region return to growth in the current quarter. Apple’s consolidated gross profit margin also exceeded the high end of management’s prior guidance, expanding by 70 basis points sequentially and nearly 100 basis points, or 1 percentage point, year over year, thanks to a favorable sales mix that came despite a $1.1 billion tariff-related cost headwind. Why we own it Apple’s dominant hardware and growing services businesses provide a deep competitive moat and plenty of bundling opportunities. Management’s net cash-neutral strategy provides confidence that free cash flow will continue to fund dividends and buybacks. Competitors: Samsung, Xiaomi, OPPO, Dell , and HP Inc. Most recent buy : April 8, 2014 Initiation : Dec. 2, 2013 While iPhone sales grew 6% to $49.03 billion, they did come up short of expectations. However, Cook noted that it was due to a lack of supply for several iPhone 16 models and newer iPhone 17 models, as demand is very strong. Perhaps most importantly, management guided current quarter (fiscal 2026 first quarter) revenue to be well above expectations, with Cook saying on the post-earnings conference call that December quarter revenue will “be the best ever for the company and the best ever for iPhone.” It’s clear the iPhone 17 is seeing a ton of demand – and the massive installed base of active devices, which did indeed hit a new all-time high, is driving continued growth in services. Given the iPhone momentum and management reaffirming that a new, smarter artificial intelligence Siri will debut in 2026, we continue to think that the best thing members can do with shares of Apple is “own them, not trade them.” We are, therefore, increasing our price target to $300 from $240. We are, however, maintaining our 2 rating, as we wait for a better price level to upgrade shares back to our buy-equivalent 1 rating. Products highlights Products revenue achieved a September quarter record, driven by growth in iPhones and Macs. While growing more than 5% to $73.72 billion, Product sales did miss expectations. Apple’s installed base of active devices reached yet another all-time high. It was a September quarter record for the iPhone despite supply constraints, as the device achieved September quarter records in Latin America, the Middle East, and South Asia. In India, iPhone sales reached all-time highs. It was an all-time high for the iPhone’s active installed base and a September quarter record for upgraders. Mac sales, driven by strength in MacBook Air, were up in all geographic segments, with CFO Kevan Parekh calling out strong double-digit growth in emerging markets. The installed base for Mac also reached a new all-time high, with nearly half of all buyers being new to the product line. Mac sales increased 12.7% to $8.73 billion in the quarter. iPad installed base also reached a new all-time high. September quarter record for upgraders, with over half of buyers being new to the product. Sales for the iPad were flat at $6.95 billion. Sales in the Wearables, Home & Accessories segment dipped slightly to $9.01 billion but beat estimates. They were driven by growth in the Apple Watch and AirPods, both of which saw their installed bases reach all-time highs. Apple Watch upgraders also set a new September quarter record. Services highlights All-time revenue record for the Services segment – up 15% in the September quarter to $28.75 billion. All-time revenue records were realized in advertising, App Store, cloud services, music, payment services, and video. All-time highs were realized for both transacting and paid accounts. Outlook Apple doesn’t provide formal guidance. However, we did get some exciting commentary about the current quarter. As Parekh noted on the call, this outlook assumed no change in global tariff rates or policies and no change in the macroeconomic outlook, which has been worsening. December quarter revenue is expected to increase 10% to 12% versus the year-ago period, a whole heck of a lot better than the 6% the Street was anticipating, according to LSEG. If realized, it would mark a record quarter for the company. iPhone revenue is expected to grow at a double-digit rate year over year, which would also amount to Apple putting up its best quarterly iPhone results ever. Mac sales are seen up against a difficult year-over-year comparison, given the launch of the M4 MacBook Pro, Mac Mini, and iMac in the year-ago period. Services revenue is expected to grow at a year-over-year rate similar to what Apple reported for all of fiscal year 2025, which was about 13.5%, ahead of the roughly 12% the Street was looking for, according to FactSet. Gross margin for the December quarter is expected to be between 47% and 48%, exceeding expectations at the midpoint, despite an estimated $1.4 billion tariff-related cost headwind. Operating expenses are expected to be between $18.1 billion and $18.5 billion, higher than expected; however, acceptable in our view as Apple is ramping up investments in artificial intelligence. Capital allocation Apple ended the September quarter with $132 billion in cash and marketable securities. Excluding debt, net cash was $34 billion. During the quarter, Apple returned $24 billion to shareholders, including $3.9 billion in dividends and equivalents and another $20 billion via share repurchases. (Jim Cramer’s Charitable Trust is long AAPL. See here for a full list of the stocks.) As a subscriber to the CNBC Investing Club with Jim Cramer, you will receive a trade alert before Jim makes a trade. Jim waits 45 minutes after sending a trade alert before buying or selling a stock in his charitable trust’s portfolio. If Jim has talked about a stock on CNBC TV, he waits 72 hours after issuing the trade alert before executing the trade. THE ABOVE INVESTING CLUB INFORMATION IS SUBJECT TO OUR TERMS AND CONDITIONS AND PRIVACY POLICY , TOGETHER WITH OUR DISCLAIMER . NO FIDUCIARY OBLIGATION OR DUTY EXISTS, OR IS CREATED, BY VIRTUE OF YOUR RECEIPT OF ANY INFORMATION PROVIDED IN CONNECTION WITH THE INVESTING CLUB. NO SPECIFIC OUTCOME OR PROFIT IS GUARANTEED.
SpaceX’s Starship rocket 38 launches during the 11th test flight on October 13, 2025 as seen from South Padre Island in Texas.
Gabriel V. Cardenas | Afp | Getty Images
SpaceX said it has pitched NASA a “simplified mission” to put astronauts back on the moon following criticisms over delays by Sean Duffy, the space agency’s acting administrator.
In a company blog post out Thursday, Elon Musk’s aerospace and defense contractor said: “We’ve shared and are formally assessing a simplified mission architecture and concept of operations that we believe will result in a faster return to the Moon while simultaneously improving crew safety.”
Earlier this month, Duffy said in an interview on CNBC’s Squawk Box, that SpaceX was behind schedule on building its lunar landing system for NASA’s Artemis III mission and that the agency would reopen the landing contract for that mission to competitors such as Jeff Bezos‘ rocket maker Blue Origin.
A NASA spokesperson in an email to CNBC said that the agency “has received and is evaluating plans from both SpaceX and Blue Origin for acceleration of HLS production.”
“Following the shutdown, the agency will issue an RFI to the broader aerospace industry for their proposals,” the spokesperson said. “A committee of NASA subject matter experts is being assembled to evaluate each proposal and determine the best path forward to win the second space race given the urgency of adversarial threats to peace and transparency on the Moon.”
NASA had previously said that SpaceX and Blue Origin would have until Oct. 29th to propose new ways to speed up the project.
Musk initially responded to Duffy by posting to his social network X, “Sean Dummy is trying to kill NASA!” In another post, Musk wrote: “The person responsible for America’s space program can’t have a 2 digit IQ.”
SpaceX’s massive Starship has flown 11 test flights so far, uncrewed. The last two flights were deemed successful, but the company has not yet shown all the in-orbit refueling capabilities it requires before embarking on the Artemis III, manned lunar mission.
Blue Origin has been developing a lunar lander for NASA and has received about $835 million from the space agency since their contract began in 2023. The company plans to launch a smaller scale version of their lander, known as Blue Moon Mark 1.
Meanwhile, China is aiming to land its astronauts on the moon by the end of the decade.
In September, in an all-hands meetings with NASA employees, Duffy told his staff that he was irked by “shade thrown” on the space agency at a Senate hearing in which some attendees doubted that the U.S. could put astronauts back on the Moon before China could land its astronauts there.
Besides its lunar mission, China also announced it is sending a new crew to its orbiting lab, the Tiangong space station, this week. China built this space station after it was excluded from access to the International Space Station due to U.S. national security concerns.
SpaceX is paid when it achieves different milestones under its NASA contract for the HLS (human landing system integrated lander).
According to USA Spending, which tracks federal contracts, NASA has already paid approximately $2.7 billion to SpaceX for the “design, development, manufacture, test, launch, demonstration and engineering support” of the HLS. The agency is obligated to pay around another $300 million for milestones SpaceX achieved, and Musk’s company stands to earn a total of $4.5 billion (or another $1.5 billion) from the HLS contract if they achieve all milestones.
SpaceX today said, in their company blog post, that they “self-funded” 90% or more of the program, which would imply they have spent over $30 billion already.
As CNBC previously reported, some NASA employees have been required to work without pay for the space agency during the federal government shutdown if their jobs support Artemis missions.
SpaceX and Blue Origin did not immediately respond to CNBC’s requests for comment.
While many of the largest tech companies race to build massive data centers for their artificial intelligence ambitions, Apple is taking a more modest approach.
Instead of simply buying as many AI chips as possible, Apple buys computing capacity from outside partners, finance chief Kevan Parekh explained Thursday on the company’s fourth quarter earnings call.
When Apple does build servers for its AI software, the company is using its own chips — not those from Nvidia or AMD — to power a service it calls Private Cloud Compute.
“I don’t see us moving away from this hybrid model, where we leverage both first-party capacity as well as leverage third-party capacity,” Parekh said.
Apple’s results on Thursday closed out a busy week of earnings for the tech industry. Alphabet, Microsoft, and Meta reported on Wednesday, while Amazon reported on Thursday.
All of the companies said they planned to boost spending on capital expenditures to secure the computing capacity needed to develop next-generation AI and serve users.
Alphabet said it expects to spend about $92 billion on capital expenditures this year. Microsoft said it spent about $34.9 billion on capex during the September quarter and will spend more in capex for its fiscal 2026 than it did the year prior.
Meta stock got whacked after CEO Mark Zuckerberg defended the company’s plan to spend about $71 billion on AI chips and other expenses in 2025. On Thursday, Amazon raised its 2025 spending forecast 6% to $125 billion.
Compared to them, Apple’s barely spending at all.
In its fiscal 2025, which ended in September, Apple spent $12.72 billion on capital expenditures.
And yet, that’s up 35% from what it spent last year, a significant increase. Parekh said Apple is expecting further increases. Analysts expect Apple’s capex to increase to $14.3 billion this year, according to FactSet.
“In ’25 we did have capex costs associated with building out our Private Cloud Compute environment in our first party data centers,” Parekh said. Earlier this month, Apple announced that it was starting to ship those servers from a factory in Houston.
Last year, the company released Apple Intelligence, a suite of AI tools that runs on the company’s chips that can summarize notifications, generate images like new emojis, and pass complicated queries to OpenAI’s ChatGPT.
Apple Intelligence has received mixed reviews from critics, and one of its centerpieces, an improved Siri assistant, was delayed by the company in May until 2026. The improved Siri is on track to come out next year, Apple said Thursday.
But if Apple’s decision to take a different approach to AI puts the company’s hardware sales at risk, it hasn’t happened yet.
Apple CEO Tim Cook told CNBC’s Steve Kovach that the consumer response to the company’s iPhone 17 models was “off the chart,” and the company said that overall sales would rise between 10% and 12% in the company’s December quarter. Apple executives were effusive on a call with analysts about the new iPhone’s popularity.
Still, Apple executives are aware that that AI features like Apple Intelligence are a factor in smartphone purchasing decisions.
“We’re very bullish on it becoming a greater factor,” Cook said.
Apple’s “hybrid” approach means that some of what the company spends on compute for AI ends up as an operating expense, instead of a capital expense. Analysts pressed Apple executives that the company’s operating expenses rose 11% in the past year to $15.91 billion.
“We are increasing our investments in AI, while also continuing to invest in our product roadmap,” Parekh said. “The vast majority of the increase to our operating expenses are driven by R&D.”
