In the Swiss city of Basel, two pharmaceutical giants face off on opposite banks of the Rhine River. But managers located just a few miles apart look to be on vastly different paths as they seek to rebuild their stature.

Roche Holding and Novartis, dealing with individual scientific, corporate and management issues, embody opposing approaches to solving a fundamental puzzle: how to placate shareholders and keep growing in an industry where the hunt for the next blockbuster drug — often long and expensive — is paramount.

In Roche’s case, success wouldn’t just give it a chance to catch up with rivals. It’s also what the company needs to regain investor trust and arrest a slump in its stock that’s wiped out 130 billion francs ($152 billion) in market value over the past two years.