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.”
Apple CEO Tim Cook, center, watches during the inauguration ceremonies for President Donald Trump, right, and Vice President JD Vance, left, in the rotunda of the U.S. Capitol in Washington, Jan. 20, 2025.
Shawn Thew | Afp | Getty Images
Apple slid more than 6% in late trading Wednesday and led a broader decline in tech stocks after President Donald Trump announced new tariffs of between 10% and 49% on imported goods.
The majority of Apple’s revenue comes from devices manufactured primarily in China and a handful of other Asian countries. Nvidia, which manufactures new chips in Taiwan and assembles its artificial intelligence systems in Mexico and elsewhere, fell about 4%, while electric vehicle company Tesla dropped 4.5%.
Across the rest of the megacap universe, Alphabet, Amazon and Meta all dropped between 2.5% and 5%, and Microsoft was down by almost 2%.
If Apple’s postmarket loss is matched in regular trading Thursday, it would be the steepest decline for the stock since September 2020.
Trump on Wednesday afternoon said the new taxes on imported goods would be a “declaration of economic independence” for the country. He announced a 10% blanket tariff on all imports, and higher duties for specific countries, including 34% for China, 20% for European nations, and 24% for Japanese imports, based on what tariffs they charge on U.S. exports, Trump said.
“We will supercharge our domestic industrial base, we will pry open foreign markets and break down foreign trade barriers,” Trump said during his speech. “Ultimately, more production at home will mean stronger competition and lower prices for consumers.”
During his speech, Trump praised Apple, Meta, and Nvidia for spending money and investing in the United States.
“Apple is going to spend $500 billion, they never spent money like that here,” Trump said. “They’re going to build their plants here.”
The Nasdaq just wrapped up its worst quarter since 2022, dropping 10% in the first three months of the year, though the tech-heavy index rose in each of the first two days of the second quarter.
Guests including Mark Zuckerberg, Lauren Sanchez, Jeff Bezos, Sundar Pichai and Elon Musk attend the Inauguration of Donald J. Trump in the U.S. Capitol Rotunda on January 20, 2025 in Washington, DC. Donald Trump takes office for his second term as the 47th president of the United States.
Julia Demaree Nikhinson | Getty Images
Amazon submitted a bid to the White House to purchase the social media app TikTok from its Chinese owners, CNBC has confirmed.
The company sent its proposal in a letter this week to Vice President JD Vance and Commerce Secretary Howard Lutnick, according to a source familiar with the matter who asked not to be named because the discussions are confidential. The parties aren’t treating the bid seriously, however, given that it was submitted just days before a deadline staving off a U.S. ban is set to expire, the person said.
Amazon declined to comment.
The e-commerce company’s offer, which was first reported by The New York Times, comes as TikTok’s fate in the U.S. is up in the air. The short-form video app faces another potential shutdown in the U.S. on April 5 if ByteDance, its parent company, can’t reach a deal to divest TikTok’s American operations. Lawmakers passed a bill last year setting a Jan. 19 deadline for the sale, but Trump signed an executive order granting a 75-day extension for a potential deal.
Trump could announce a decision on TikTok’s fate in the U.S. as soon as Wednesday, sources familiar with the situation told CNBC’s David Faber. Mobile technology company AppLovin has also made a bid for TikTok, Faber reported separately, citing sources familiar with the matter.
TikTok has emerged as a major hub for e-commerce as it has poured money into growing its online marketplace, called TikTok Shop. TikTok’s lucrative marketplace, coupled with the app’s more than 170 million users, could be an attractive asset for Amazon. Following TikTok’s success, Amazon launched and then shuttered a short-form video service of its own.
Last August, the two companies formed a partnership that allowed TikTok users to link their account with Amazon and make purchases from the site without leaving the app. The deal attracted scrutiny from lawmakers who were concerned about its potential national security risks.
White House Senior Advisor Elon Musk walks to the White House after landing in Marine One on the South Lawn with U.S. President Donald Trump (not pictured) on March 9, 2025 in Washington, DC. Trump was returning to the White House after spending the weekend at Mar-a-Lago, his private club in Florida.
Samuel Corum | Getty Images News | Getty Images
Tesla shares rose Wednesday after Politico reported that Elon Musk could leave his post at the so-called Department of Government Efficiency, paving the way for the CEO to return his focus on the struggling EV maker.
The White House later called the report “garbage.”
The stock was last up about 5%. At its session lows, it had dropped as much as 6.4% on the back of weaker-than-expected vehicle deliveries for the first quarter.
The report — which cites Trump insiders — noted that, while President Donald Trump is pleased with Musk and the DOGE spending cuts that have been pushed through, the two decided in recent days that the billionaire would soon return to his businesses. NBC News is reporting that Trump told the cabinet Musk could leave in the coming months.
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TSLA recovers
Wednesday’s report comes during a tough stretch for Tesla. Despite Wednesday’s gains, the stock has dropped more than 5% over the past month. Year to date, it has tumbled more than 31%. Shares also shed 36% in the first quarter, marking their biggest quarterly drop since 2022.
Musk’s role in the White House is one factor weighing on Tesla’s stock. It has sparked waves of protests, boycotts and violent attacks on Tesla stores and vehicles around the world. Trump’s automotive tariffs are also a concern as they involve Tesla’s key suppliers — notably in Mexico and China.
“My Tesla stock and the stock of everyone who holds Tesla has gone, went roughly in half,” Musk said on Sunday night at a rally he held in Green Bay, Wisconsin, to promote a Republican judge he backed in Tuesday’s state supreme court election, Brad Schimel. “This is a very expensive job is what I’m saying.”
In addition to holding the rally in Wisconsin, Musk spent millions and frequently posted about the race on his social network X. Judge Susan Crawford, who won the seat on the Wisconsin Supreme Court, was backed by Democrats and progressive groups who criticized Musk, his money and influence on the race as well as his DOGE work in their campaigns.
Separately, New York City Comptroller Brad Lander urged the city to sue Tesla on behalf of NYC pension funds citing Musk’s work for the White House.
In a Tuesday statement, Lander’s office said: “The basis of the potential litigation are the material misstatements from Tesla claiming that CEO Elon Musk spends significant time on the company and is highly active in its management, despite his helming the Trump Administration’s DOGE initiative, spending little of his time actually managing Tesla, and promoting policies that are actively harmful to Tesla’s business.”