STERIS is acquiring Xodus Medical for $2.1 billion at closing and up to $150 million in earnout payments tied to 2028 performance targets. STERIS expects about $300 million in cash tax benefits, which brings its estimated net purchase price to $1.8 billion. Xodus makes surgical consumables and patient-safety products: Hot Pink Pad for patient temperature management, See Sharp for laparoscope cleaning and defogging, and Pink Pad Biodegradable and Pink Pad Air-Assist for positioning patients in surgery. It is expected to generate about $245 million in revenue and $135 million in adjusted EBIT in 2026, and closing is expected by 31 December 2026.

Xodus expects to keep 55 cents of adjusted EBIT from every dollar of revenue. STERIS paid 15.6 times that EBIT, or 13.3 times net of the tax benefit.

The price is for the margin. At $2.1 billion STERIS pays about 8.6 times expected 2026 revenue, or about 7.3 times on the $1.8 billion net figure, for products bought procedure by procedure. The earnout is where STERIS holds back: $150 million waits on 2028 performance, so 93% of the value is committed at closing and the rest depends on how Xodus trades two years after the sale. It is the week’s largest cheque, and the second week running in which the largest deal bought a healthcare business with no molecule attached.

Galderma is acquiring 100% of ZO Skin Health from shareholders including funds managed by Blackstone Tactical Opportunities and the Obagi family, at an enterprise value of $1.5 billion in an all-cash transaction. ZO is a physician-dispensed skincare brand with more than 40 products made in the US and sold through more than 16,500 physician, medical spa and online accounts in more than 40 countries, backed by its own sales force and skincare education team. Its daily regimens centre on retinol and acid-based protocols. Closing is expected in Q4 2026 or Q1 2027, subject to regulatory approvals.

Galderma disclosed no revenue for ZO, so the price cannot be set against sales. Its one financial marker is Core EPS neutral in the first full year.

Neutral earnings in year one put the return on growth through the channel. ZO joins Cetaphil and Alastin in Galderma’s dermatological skincare portfolio, and the asset is 16,500 physician and medical spa accounts that dispense and teach a regimen, a channel a dermatology company can extend to its own products. Week 41 ran the same way, when Option Care’s buyers paid for an infusion network with no molecule attached. With STERIS, the two largest cheques this week, $3.6 billion together, went to businesses that sell into clinical settings.

Labcorp is buying BioReference Health’s laboratory testing businesses from OPKO Health for $722 million in cash and up to $150 million in milestones tied to revenue from the 4Kscore test, an FDA-approved blood test for the risk of aggressive prostate cancer before a biopsy decision. The deal includes clinical, women’s health, urology and corrections testing and more than 80 patient service centres. Agilent is acquiring Proscia for $240 million in cash and up to $30 million in performance-based milestones, taking Concentriq, a vendor-agnostic digital pathology platform, its 510(k)-cleared version for primary diagnosis, and an AI portfolio for pathology image analysis and biomarker research. Stryker is putting about $400 million (£300 million) of preferred equity into CMR Surgical for exclusive US rights to commercialise the Versius surgical robot, with an option to acquire the remaining equity.

Every contingent dollar among the five is tied to commercial performance. None waits on a regulator or a trial.

The five put $4.96 billion on the table, 96% of the $5.14 billion upfront disclosed this week, and the largest disclosed drug upfront was Vir’s $90 million from Gilead. Biopharma buyers spent at the discovery stage, and the cash went to businesses that already invoice. Stryker’s structure repeats McKesson’s at Option Care in Week 41: equity and the US channel now, an option on the rest later. Across the 11 deals that disclosed both upfront and total, 50% was paid at signing, against 80% in Week 41.

Vir Biotechnology granted Gilead worldwide rights to three PRO-XTEN dual-masked T-cell engagers against solid tumour antigens, designed with its dAIsY AI protein engineering platform, for $65 million in cash and $25 million in equity at $14.16 a share, a one-day premium of 30%, plus up to $45 million in preclinical milestones and $1.74 billion beyond. Insitro granted AstraZeneca rights to therapies for MASH and cardiomyopathies drawn from its Virtual Human AI platform, for $40 million upfront and up to $1.46 billion in milestones. Generate Biomedicines granted Zealand Pharma two multispecific proteins for obesity and metabolic disease, with an option on a third, for $30 million upfront, $35 million in early preclinical milestones and up to $1.2 billion beyond. Rona Therapeutics licensed Roche an extrahepatic RNAi therapy against ALK7 for obesity, for up to $100 million in upfront and near-term payments without a breakdown, and up to $1.06 billion in milestones.

Roche and Zealand both licensed preclinical obesity programmes on 13 October, one from an RNAi platform and one from generative AI.

Discovery-stage deals carried 53% of the week’s disclosed value and 3% of its upfront. The buyers are paying for each platform’s next candidate, and 96.6% of the three AI licences’ value waits on discovery, development and sales. Vir’s $25 million came as equity at a premium, so 28% of Gilead’s upfront is an investment in Vir itself. Pfizer’s licence of Enodia’s Sec61 inhibitors, worth up to $500 million including the upfront, and Rona’s bundled payment do not separate upfront from milestones, so neither enters the upfront figures. Novo Nordisk took a non-exclusive licence to Ablexis’s AlivaMab Mouse antibody platform, with no terms.

Velaris Therapeutics is reverse merging with Alaunos Therapeutics, and the combined company will take the Velaris name and focus on pulmonary arterial hypertension and related cardiopulmonary diseases with VLR-199, VLR-247, VLR-258 and VLR-360. Alaunos brings ALN-1003, a preclinical obesity candidate, and its HunTR platform. Alongside the merger, Alaunos raised $350 million in a private placement of Series C non-voting convertible preferred stock led by Fairmount, putting the combined equity value at about $554 million at a reference price of $1.4357 a share. Existing Alaunos shareholders keep about 3.8 million shares worth $5.45 million, 0.98% of the company, and Velaris shareholders receive the equivalent of about 138.34 million shares worth $198.61 million, 35.76%.

The PIPE investors hold about 63% of the company, mostly in non-voting preferred. The shareholders whose listing carried the deal hold under 1%.

A reverse merger is a listing with a financing attached, so Velaris sits outside the upfront ranking and the disclosed total. Aquestive granted Eton Pharmaceuticals US rights to Libervant, a buccal benzodiazepine film for seizure clusters in epilepsy, for $10 million upfront, up to $47.5 million in milestones and mid-teens royalties, and keeps manufacturing under a 20-year supply agreement; the $10 million due on first US sale falls to $5 million if full approval for ages 2 to 5 has not arrived. Armed Cell Therapeutics bought Lakefront’s armed CAR-T constructs for €8 million upfront and up to $230 million in milestones, and ABL Texcell bought IntegraGen’s genomics business and its 16 employees in Évry for €100,000. Eight of 22 deals released no terms, including Elion’s in-licence of EL-777, a Phase II-ready inhaled antifungal, Visara’s ex-China rights to Hiteck’s nerve growth factor eye drop for neurotrophic keratitis, and Jocasta’s option on Diamond’s 5-HT2A agonists designed to avoid hallucinogenic effects.