Ryan Knutson and Wall Street Journal biotech reporter Xavier Martinez trace how Moderna's individualized cancer vaccine went from an idea the company could not afford to a phase three melanoma result that arrived early, with archival tape of CEO Stéphane Bancel and president Stephen Hoge on why they stayed out of oncology and why they eventually went in. The episode covers the founding bet on mRNA, the Merck partnership, the pandemic detour, the post-COVID cuts, and what still stands between the shot and a patient.
Host: Ryan Knutson
Also on: Xavier Martinez, biotech reporter, The Wall Street Journal; Stéphane Bancel, chief executive, Moderna, in recorded interviews; Stephen Hoge, president, Moderna, in recorded interviews; Lane Florsheim, The Wall Street Journal
Published: 28 August 2026 on The Journal.
Show notes | 26 min
Key Takeaways
Moderna's stock fell more than 90% from its peak before the melanoma result landed
"It's gone down more than 90% from its peak." — Xavier Martinez
"You look at the stock chart and it just looks like the tallest mountain in the world." — Martinez
The vaccine hit both goals of the study, on recurrence and on spread
"That study met two goals in both preventing the growth of any cancer, but also preventing it spreading from other organs in the body or metastasizing." — Martinez
Martinez rates it as potentially the biggest cancer advance in a quarter century
"It could be one of the biggest advancements in cancer that we've seen in the last 25 years."
The oncology program exists because a hedge fund manager mailed Moderna a check
Bancel had told him no; a FedEx envelope with "a check from that hedge fund manager for $500,000" arrived days later
Bancel's caution was about biology, not ambition
"Because if we pick the wrong biology, it might not be the technology issue, it might be the biology, but everybody including us is going to believe it's the technology."
Merck paid to find out whether mRNA and Keytruda worked together, while doubting it would
"Merck agreed to pay Moderna $200 million to fund research into how its mRNA vaccine might work in combination with Keytruda." — Knutson
COVID and the cancer trial were competing for the same manufacturing equipment
"It is actually very bad for the program. They're using the same equipment that they used for the cancer vaccine." — Martinez
The COVID franchise funded the expansion and then left a hangover
"Earlier this year, the short interest in Moderna hit 20%" — Knutson
A 2022 interim look at phase two is why the cancer program survived the cuts
"Moderna and Merck get interim looks at the data in 2022 and the results are really promising for them." — Martinez
Phase three ran past a thousand melanoma patients, all of them on Keytruda
"This was a very big trial. It was over 1,000 patients" — Martinez
Bancel has redefined the company off the back of one readout
"We are now an oncology company." — Bancel, as relayed by Martinez
Nothing has been published yet, and nothing is approved
Moderna has not disclosed how well the treatment worked or in what share of patients, and says it will present at a medical conference later this year
A Stock Down More Than 90%, Then a Result Nobody Expected Yet
Martinez sets the collapse first: COVID urgency faded, US vaccination rates fell, and sales dropped with them.
The company was, in his words, running out of money while the chart flattered its past — "It's gone down more than 90% from its peak. The company is bleeding cash."
The phase three news broke while Martinez was on a call with a different pharmaceutical company and his editor started waving at him through a meeting room.
Knutson's read of the moment: "Hang up the phone now. There's breaking news."
The study cleared both of its endpoints — "That study met two goals in both preventing the growth of any cancer, but also preventing it spreading from other organs in the body or metastasizing."
The vaccine is for people who have already had melanoma, and is designed to stop the cancer coming back or moving to other parts of the body.
Martinez's framing of the stakes: "It could be one of the biggest advancements in cancer that we've seen in the last 25 years."
On the corporate side, he calls it a rescue: "This is really bringing Moderna back from the brink financially. They've been hemorrhaging cash for the last two and a half years."
Knutson: "Their cancer's in remission."
The Instruction Manual Moderna Was Built On
Moderna was founded in 2010 as what the industry calls a platform company, meaning every drug it would ever make would be built on mRNA.
Knutson runs the explainer for the audience — mRNA carries instructions that teach the body how to make proteins such as antibodies, and the founding question was what happens if scientists write those instructions themselves.
Martinez describes the molecule as "a temporary instruction manual or a blueprint" whose job is to shuttle directions from DNA to the rest of the body.
The oncology version of that idea is a targeting instruction — "the goal here is that you can actually encode different sets of instructions to tell your immune system"
Cancer was not on the early roadmap at all. Martinez: the biology is still only partly understood, so using mRNA against any one component of the immune system was an unproven bet.
Why Moderna Stayed Out of Oncology in Its First Years
The company deliberately picked easier targets, working on things like flu and genetic diseases instead.
Bancel's reasoning, in tape from almost a decade ago, was that a failure in cancer would have been read as a failure of the platform — "Because if we pick the wrong biology, it might not be the technology issue, it might be the biology, but everybody including us is going to believe it's the technology."
"We are very worried in the early days, kind of paranoid worried, of going the wrong way and taking so long to realize we are in the wrong way on the science that we might kill the company." — Bancel
Martinez, who sat down with Bancel and other executives last week, describes the CEO as the realist of the group: prove the technology elsewhere first, then consider oncology.
Cost was the other half of the argument — "we were actually kind of afraid of going into oncology too early because it was going to be so cost intensive."
"It cost millions of dollars to enroll patients in clinical trials", and previous therapeutic cancer vaccines had all failed.
Hoge, the Optimist Who Would Not Let the Idea Go
Stephen Hoge, a physician and former McKinsey consultant, is cast by Martinez as the dreamer of the executive group against Bancel's realism.
"I have come to realize that optimism is my greatest privilege." — Hoge
On joining in 2013: "It was trying to pursue a phenomenally big idea, like sort of farcically big, that we're going to figure out a way to turn medicine into information or information into medicine."
The wave of immune-focused cancer therapies in the early and mid-2010s is what made Hoge push for a serious look at mRNA in oncology.
He showed Bancel the science and lost the argument on money. Moderna had fewer than a hundred employees, no product on the market and no revenue, so a cancer program was too expensive and too uncertain.
The $500,000 Check That Started the Program
In 2013 an early investor whose wife had been diagnosed with stage four lung cancer called Bancel directly to ask whether mRNA might be useful against it.
Bancel said no, and priced the no — "Sorry, no, it's going to be way too expensive. Even just to hire a couple of researchers, it's going to cost $500,000, half a million dollars."
Days later, back at his office in Cambridge, a FedEx envelope arrived with "a check from that hedge fund manager for $500,000."
That money hired two cancer researchers and the oncology program began.
The hard part was that each patient's cancer is different, so every vaccine has to be tailor-made, and bespoke shots are expensive.
Bancel pushed the team to get the cost down. A couple of employees locked themselves in a room and sketched the approach on a whiteboard in green, purple, red and pink marker; Bancel still has the photograph.
Once they worked it through, they realized testing it in actual patients, rather than on the whiteboard, would take far more money than they had.
Why It Had to Be Merck
Moderna went looking for a partner that already knew how to run trials, work with academic centers, make experimental medicines and distribute them.
"there's all these great pharmaceutical companies that, a, they know how to do clinical trials. They know how to work with academic centers." — Martinez, on the search
They settled on Merck, the company behind Keytruda, which unlike chemotherapy stimulates the immune system rather than poisoning tumors — the same logic Moderna was pursuing with mRNA.
Bancel and Hoge pitched Merck in 2016 and were met with skepticism.
"And the Merck executives have tons of questions. And at the end, these Merck executives are still doubtful. They frankly don't necessarily think it's going to work."
Moderna was not selling certainty either — "we don't want to hype this up too much. We just want to see if this will yield anything."
Merck funded it anyway — "Merck agreed to pay Moderna $200 million to fund research into how its mRNA vaccine might work in combination with Keytruda." — Knutson
A phase two study began in 2019, dosing a small number of cancer patients.
COVID Took the Equipment the Cancer Trial Needed
Six months into the phase two study, the pandemic hit and Moderna pivoted to a COVID vaccine.
From the start of development to FDA authorization on the Operation Warp Speed pathway took under a year, which Martinez calls extraordinarily quick against normal drug timelines.
It proved to the public, to investors and to scientists that the company could put a drug on the market.
The cost fell on the cancer program, which shared the manufacturing line — "It is actually very bad for the program. They're using the same equipment that they used for the cancer vaccine."
The company had to choose between making individualized vaccines for cancer patients already enrolled in the trial and producing COVID vaccine for the public. It chose the COVID vaccine, and Martinez says the executives found the decision neither easy nor fun.
Knutson: Moderna won more than a billion dollars from the Trump administration to accelerate the shot, which was authorized for emergency use that December.
"in the first two years the vaccine was on the market, it generated $36 billion in sales" — Knutson. That money paid for expansion, oncology included.
The Hangover: Cuts, a Falling Stock and 20% Short Interest
"Oh, I mean, a hangover doesn't even begin to describe it." — Martinez, on what followed the pandemic
As COVID revenue fell away, Moderna cut jobs and killed development programs to protect the ones it believed in most, including research into a pediatric RSV vaccine and other cancer therapies.
The market positioned for more pain — "Earlier this year, the short interest in Moderna hit 20%" — Knutson.
The individualized cancer vaccine survived every round of cuts, which is the question Knutson puts to Martinez directly: among all the things they cut, why not that one?
The 2022 Interim Look That Protected the Program
Martinez points to the inflection: results from the phase two study came back in 2022.
Phase two is the industry's make-or-break gate — "they represent the make or break moment", and "You're not going to push something beyond a phase two if you don't really think it's going to read out well."
"Moderna and Merck get interim looks at the data in 2022 and the results are really promising for them."
Merck then committed to a full partnership to make and sell the vaccine with Moderna, and the work moved to phase three.
"This was a very big trial. It was over 1,000 patients" — a thousand high-risk melanoma patients had their melanoma removed, with the tissue and a blood sample sent to Moderna and Merck to sequence the mutations, then were dosed for about a year.
In both studies every patient took Keytruda; only some also received Moderna's vaccine.
Moderna had guided all year to a second-half 2026 readout. It arrived earlier than anyone expected.
Champagne, Sparkling Juice and a New Identity
The companies announced high-level results last week: the combination appears to stop the cancer returning or spreading in high-risk patients.
The detail is still unpublished. Moderna has not said how well the treatment worked or in what percentage of patients, and says it will present the results at a medical conference later this year.
"I mean, it was like your birthday and Christmas and the day you got married all wrapped up into one." — Martinez, on the scene inside the company
Staff packed into the cafeteria with champagne and sparkling juice, with colleagues dialing in from Asia at midnight or one in the morning. People cried and hugged.
"The Moderna CEO is reading off a note card because he doesn't trust himself to not choke up or say things eloquently."
Bancel's line to the company was a repositioning as much as a celebration — "We are now an oncology company." Martinez calls that a bold statement for a firm built on infectious disease with a pipeline mostly unrelated to cancer.
What Still Has to Happen Before a Patient Gets It
The vaccine needs FDA approval, and Knutson notes the Trump administration has shown skepticism about mRNA technology.
Martinez expects the unmet need to carry the day — "if a technology is effective, it's probably going to be looked fondly upon by the FDA."
The companies are hoping for approval next year.
The result is narrow for now: still in trials, and still only in melanoma. Vaccines for other cancers may be possible but are a long way off.
Pricing is unresolved. Some existing cancer therapies run up to $500,000 per patient, and Bancel says this treatment will be priced below that.
Martinez's verdict on the platform strategy — "It's a very risky bet, but it can really pay off if it pays off" — with Moderna's first entry into the oncology market as the prize.
A New Sunday Show in The Journal's Feed
Lane Florsheim joins at the end to introduce My Monday Morning, a series she is hosting that runs in The Journal feed on Sundays.
The premise is a single question put to people who are good at what they do: what does your Monday morning actually look like.
"it's a surprisingly revealing way to get people to open up about how they think, how they work, and what they've figured out about themselves along the way."
The first guest is Suze Orman, and the sleep gap is the hook: "She says she can make it on as little as three hours a night."
"I'll be talking to an astronaut, actors, the model Twiggy." — Florsheim on the rest of the series
Moderna spent more than a decade insisting that mRNA was a platform rather than a product, and one melanoma readout has now turned that argument into a company that calls itself an oncology business.
Products, Companies & Tools Mentioned
Moderna (Founded 2010 as an mRNA platform company; stock down more than 90% from its peak and burning cash before the phase three melanoma result)
The individualized melanoma vaccine (Bespoke shot built from each patient's own tumor mutations, tested alongside Keytruda in a trial of over 1,000 high-risk patients)
Merck and Keytruda (Immunotherapy partner that paid $200 million to test the combination while doubting it would work, then committed to a full partnership after the 2022 interim data)
Moderna's COVID vaccine (Authorized under Operation Warp Speed in under a year; generated $36 billion in its first two years and funded the oncology expansion, but competed with the cancer trial for the same equipment)
The Food and Drug Administration (Approval is the next gate; the companies want it next year, against an administration Knutson describes as skeptical of mRNA)
Pediatric RSV vaccine and other cancer therapies (Programs cut during the post-COVID retrenchment while the individualized cancer vaccine survived)
My Monday Morning (New Sunday series from Lane Florsheim in The Journal's feed, opening with Suze Orman)
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