In the real world, the selection of a therapeutic modality like an antibody or peptide is often driven by a company's existing expertise and technology platform rather than a purely agnostic approach to finding the single best tool for a clinical problem. Organizations default to the tools in their toolbox.

Breakthrough drugs aren't always driven by novel biological targets. Major successes like Humira or GLP-1s often succeeded through a superior modality (a humanized antibody) or a contrarian bet on a market (obesity). This shows that business and technical execution can be more critical than being the first to discover a biological mechanism.

The company focuses on disease-specific 3D protein conformations, which exposes new binding sites (epitopes) not present on the same protein in healthy cells. This allows for highly selective drugs that avoid the toxicity common with targets defined by genetic sequence alone.

In the competitive oncology market, Step Pharma differentiates itself by highlighting its novel, "first-in-class" mechanism and excellent safety profile. This strategy attracts interest by focusing on a unique therapeutic opportunity and potential for combination therapies, rather than competing directly on incremental efficacy gains.

To build investor confidence in the high-risk neuroscience field, Neurocrine employs a dual strategy. It highlights its own proven track record while simultaneously de-risking its pipeline by targeting biological pathways already validated by competitors, aiming to create superior, best-in-class medicines rather than pursuing unproven science.

Arcus's HIF2 inhibitor strategy focuses on a 'TKI-sparing' regimen, which delays the need for more toxic therapies. This offers patients a significantly better quality of life for several years. This value proposition creates a distinct therapeutic category, not just an incremental improvement over competitors.

Terry Rosen saw an opportunity as big pharma culturally shifted from deep R&D towards an asset-management model. He founded Arcus to fill this gap, building a company focused on the small molecule drug discovery expertise that the industry was starting to abandon, creating a counter-cyclical advantage.

The success of Praxis's small molecule for a genetic epilepsy presents a strategic alternative to cell and gene therapies. In an era where complex modalities face funding, safety, and commercial hurdles, advanced small molecules offer a viable and potentially more practical path for treating genetic disorders.

In crowded fields like oncology, most companies flock to a few validated ideas, like kids chasing a soccer ball. Delpha Therapeutics' CEO Kevin Marks argues the real opportunity lies in pioneering novel biology in the wide-open parts of the field, creating a strategic advantage and potential scarcity effect.