Big pharmaceutical manufacturers and investors are re-engaging in cell and gene therapy (CGT) and competing to scale it up. CGT developers must scale up production and commercialization to overcome rare diseases. Firms such as Amgen completed the acquisition of Fusion Pharmaceuticals for $2.4 billion in 2024, strengthening the oncology portfolio. Amgen announced a $27.8 billion acquisition of Horizon Therapeutics in 2022 to expand rare disease drugs. Gilead has $29 billion in revenue by 2025 with a market cap of $135 billion. GSK plans to invest $30 billion in the US over the next five years. Novartis announced a five-year plan to invest $23 billion in the U.S. in April 2025. Roche will invest $50 billion in the U.S. over five years.