Mariana Oncology arrived at the J.P. Morgan Healthcare Conference this past January with momentum. The radiopharmaceutical drug developer had secured $175 million in fresh funding four months prior and, in the time since, seen two competitors in its field acquired via multibillion-dollar acquisitions.

The result was a full calendar of meetings for Mariana’s executive team. “The inbound interest was broad and almost frenetic,” said company CEO Simon Read in an interview. “The business development deals in the run-up to J.P. Morgan had really conditioned the marketplace.”

One of those conversations led to Mariana’s own deal, a $1 billion buyout by Novartis that the companies announced Thursday.

According to Read, Mariana saw the chance to combine with Novartis, a radiopharmaceutical leader that sells two of the targeted radiation drugs, as a “perfect marriage.”

“If you want to maximize the value of [your pipeline], it helps to be able to add scale. You can carry on raising more and more money, but having a party that can add scale, knows how to commercialize these drugs, that’s probably a better strategy,” Read said.

Novartis has a good claim at being expert. The company invested heavily in radiopharmaceuticals, acquiring its approved drugs Pluvicto and Lutathera through a pair of acquisitions several years ago and building out the manufacturing to support them since.

Novartis’ success with Pluvicto in prostate cancer has motivated others, Mariana among them, to follow into the field. “We began thinking in mid-2020 about the makeup of the company. We had been struck by the compelling efficacy that was coming out the clinic with Pluvicto,” Read said.

Eli Lilly’s $1.4 billion purchase of Point BioPharma last October, meanwhile, gave Lilly a potential competitor to Pluvicto, as well as an entry point into radiopharmaceuticals.

Radiopharmaceuticals combine an isotope, like lutetium or actinium, with a targeting molecule meant to shepherd the cell-killing radiation directly to the tumor. Essentially, the drugs offer a more precise way to target cancers with less risk of harming healthy tissue, as beamed or implanted radiation can.

But they’re tricky to manufacture and, because radioactive isotopes degrade over time, require a precisely choreographed supply chain to get doses to patients in just the right window.

Even Novartis has run into challenges, temporarily pausing production in 2022 to resolve certain quality issues and then struggling to keep up with demand for Pluvicto.

The company has added new factories and scaled up capacity in response. A new plant in Indianapolis came on line earlier this year, for example, increasing the number of doses Novartis can make annually to 250,000.

“It was a significant investment for the organization,” said Jeevan Virk, therapeutic area strategy head for radiopharmaceuticals at Novartis, in a February interview. “We now feel we’re in a space where we’re able to deliver on the promise of unconstrained supply.”

Spanning some 70,000 square feet, the facility currently has two manufacturing lines operating, but has space to quadruple that if needed, according to Sergio Cerdas, Novartis’ global head of radioligand therapies.

Novartis has additional radiopharmaceutical facilities in New Jersey, Italy and Spain, and is planning to open sites in Japan and China.

Mariana has its own manufacturing already set up, which it will use to supply its lead radiopharmaceutical candidate for small cell lung cancer when that enters clinical testing later this year.

That distinguishes its deal with Novartis from other recent acquisitions of RayzeBio by Bristol Myers Squibb and of Fusion Pharmaceuticals by AstraZeneca, Read said.

“The narrative of those deals were about, ‘let’s secure supply chain, let’s secure manufacturing as table stakes to get into this space,” added Read. “[Mariana’s deal] was slightly different in so much as this was about a fantastic pipeline and portfolio complementarity.”

Mariana hasn’t yet disclosed the target of its small cell lung cancer treatment, but the candidate uses actinium, which a number of other companies, Novartis included, are exploring as an alternative radioisotope to lutetium.

The biotechnology company’s pipeline also contains other preclinical-stage programs in solid tumors like breast and prostate cancer.

Importantly, Read said, Mariana can match the isotope to the tumor it’s targeting. “We have the flexibility to put any payload we want on our molecules.”