The Catalyst
Earnings week split life sciences in two. Several of the largest drug companies reported strong third quarters and rose: Lilly raised its 2026 revenue guidance by about 6% at the midpoint, to $91B to $92B, and added about $136B in market value over the week, and Regeneron rose 13% on Friday on record sales of Dupixent, EYLEA HD, and Libtayo and a $1B upfront payment from an expanded Sanofi collaboration. Medtech went the other way. Stryker cut its 2026 organic growth outlook by about two percentage points, to 6.5% to 7.0%, and described a market slowdown in hips and knees, Boston Scientific cut its adjusted earnings guidance by about 4%, its third cut this year, and the median medtech stock fell in every size tier. The XBI rose 4.3% and IBB 4.8% while the XHE fell 2.1%. Within biotech, the gains again stopped short of the smallest companies: the micro-cap median slipped 0.5% while small and mid/large-cap medians rose more than 3%. Outside earnings, the FDA and CMS announced coordinated steps on the same day toward a clearer path for individualized gene editing therapies and for paying for cell and gene therapies, and Prime Medicine rose 29%. Clinical news cut the other way for Acumen and Iovance, and for the third week running a company's value fell most on a competitor's data, this time Bicara after Genmab's Phase 3 results in head and neck cancer.
Sector Performance by Market Cap
Rates were not the story this week. The Federal Reserve held its target range at 3.75% to 4.00% on October 28, with two members dissenting in favor of a hike (Federal Reserve, 10/28), and the 10-year Treasury yield ended near where it started, at 4.98% (FRED, 10/29). Company results did the work instead. Biotech rose: the XBI gained 4.3% and IBB 4.8%, small and mid/large-cap medians rose 3.5% and 3.2%, and 80% of mid/large-cap biotechs finished higher. The micro-cap median fell 0.5%, and fewer than half of micro-caps rose. Within the small and mid/large tiers, development-stage companies rose more than commercial-stage companies (3.6% versus 2.7% in small caps, 4.4% versus 3.0% in mid/large caps). Medtech fell in every tier, and the XHE dropped 4.0% on Friday alone, the same day Stryker and Alphatec fell after cutting guidance.
Top Gainers & Laggards
Gainers
Rose 13% on October 30 after reporting third-quarter revenue up 36% to $5.1B, with record sales of Dupixent, EYLEA HD, and Libtayo; global Dupixent sales, recorded by Sanofi, rose 35% to $6.5B. The company also announced an amended antibody collaboration with Sanofi that carries a $1.0B upfront payment and up to $7B in milestones (Regeneron 8-K, 10/30; 24/7 Wall St, 10/30).
Rose 34% on October 29 after reporting record third-quarter sales of $211.0M, up 58%, led by its iDose TR and Epioxa launches. It raised 2026 sales guidance to $775M to $785M from $680M to $700M and introduced preliminary 2027 sales guidance of $1B (Glaukos 8-K, 10/28; Seeking Alpha, 10/28).
Rose 23% on October 28 with its first launch update for TUDRIQEV, its oncolytic immunotherapy for melanoma given with nivolumab, which received accelerated approval in August. The first patients received product on October 6, more than 15 institutions had prescribed it, and about 20 had added it to formulary (Replimune 8-K, 10/28; TIKR, 10/28).
Rose 29% on October 29 after reporting third-quarter revenue of $2.94B, up 10%, raising its full-year revenue, adjusted EBITDA, and cash-flow guidance, and authorizing a $50M share repurchase (Bausch Health 8-K, 10/28). The stock had risen 10% the day before, when Bausch + Lomb, in which it holds a majority stake, reported its own quarter and raised guidance (Bausch + Lomb 8-K, 10/28).
Laggards
Fell 25% on October 29 after third-quarter results. Net product revenue was $1.29B, including $1.13B from Amvuttra, but management said U.S. demand growth had slowed and guided total TTR revenue to the low end of its $4.2B to $4.5B range (Alnylam 8-K, 10/29; Trefis, 10/30).
Fell 35% on October 29 after updated results from its Phase 2 IOV-LUN-202 trial of lifileucel in previously treated non-squamous non-small cell lung cancer. The overall response rate was 24.6%, with responses concentrated in patients without KRAS mutations (43.3% versus 11.4%), and the company outlined a biomarker-enriched strategy with a supplemental BLA planned for 2027 (Iovance 8-K, 10/29; RTTNews, 10/29).
Fell 44% on October 28 after Genmab reported that the first interim analysis of its Phase 3 LiGeR-HN1 trial of petosemtamab with pembrolizumab in first-line PD-L1-positive head and neck cancer met both primary endpoints, with an overall survival hazard ratio of 0.50 (Genmab, 10/28). Head and neck cancer is the lead indication for Bicara's ficerafusp alfa (Investing.com, 10/28).
Fell 91% on October 30 after its Phase 2 ALTITUDE-AD trial of sabirnetug in early Alzheimer's disease missed its primary endpoint at both doses tested, despite significant amyloid reduction. The company is ending development of sabirnetug, reducing spending, and exploring strategic options (Acumen 8-K, 10/30).
This Week's Financing Activity
Two biotech IPOs priced on October 29 with different receptions: Bambusa Therapeutics upsized its offering, while Aspen Neuroscience priced at the low end of its range.
| Company | Stage | Amount | Type |
|---|---|---|---|
| Bambusa Therapeutics (BBTX) | Public | $169M | IPO |
| Aspen Neuroscience (ASPE) | Public | $141M | IPO |
| Setara Biosciences | Private | $90M | Series A |
The Week's Narrative
Pharma Raised, Medtech Cut
Third-quarter results split the sector by business. Lilly raised its 2026 revenue guidance to $91B to $92B from $85B to $87B as Mounjaro sales reached $10.7B and Zepbound $5.4B (Lilly 8-K, 10/29), Gilead raised its base-business revenue guidance by about 3% at the midpoint, to $30.7B to $31.0B (Gilead 8-K, 10/29), and Regeneron reported record sales of Dupixent, EYLEA HD, and Libtayo. Large pharma rose broadly on Friday, with Lilly, Gilead, Vertex, Amgen, and Merck all higher, and Lilly alone added about $136B in market value over the week.
Medtech's quarter brought cuts. Stryker lowered its 2026 organic growth guidance to 6.5% to 7.0% from 8.3% to 9.3%, and its CEO said "it is now clear that there is a market slowdown" in hips and knees, pointing to higher premiums and deductibles and more prior-authorization denials (MedTech Dive, 10/30). Boston Scientific cut guidance for the third time this year, attributing it to an August cybersecurity incident (MedTech Dive, 10/29), and Alphatec fell 37% for the week after lowering its revenue outlook (Yahoo Finance, 10/30). Not every medtech report was weak: Glaukos, Axogen, OrthoPediatrics, and Pulmonx each rose 26% to 64% on their results. But the median medtech stock fell 1.2% for the week, and only 42% rose.
A Clearer Path for Individualized Gene Editing
On October 27, the FDA and CMS announced coordinated steps on gene therapies for rare diseases (HHS, 10/27). The FDA issued draft guidance describing how a sponsor can submit an individualized genome editing product with multiple patient-specific variants in a single BLA, and how new variants can be added after approval (FDA draft guidance). The same day, the CMS Innovation Center said it is broadening its Cell and Gene Therapy Access Model, under which CMS negotiates outcomes-based payment agreements with manufacturers on behalf of state Medicaid programs, beyond sickle cell disease to other cell and gene therapies (CMS, 10/27).
Gene editing developers rose on the news. Prime Medicine gained about 21% on October 27 and 23% on October 28, finishing the week up 29%, and Beam Therapeutics rose 16% on October 28.
Biotech Rose, Medtech Fell, at Every Size Above Micro
Median weekly return by market cap: commercial-stage biotech, development-stage biotech, and medtech.
Above the micro-cap tier, biotech medians rose about 3% to 4% and medtech medians fell. Development-stage biotech led in both the small and mid/large tiers, while micro-caps in all three groups finished flat to lower.