Voyager CEO Al Sandrock outlines a focused strategy: remain specialists in neurology, but broaden the therapeutic modalities (gene therapy, proteins, oligonucleotides). This allows them to pursue well-validated CNS targets that are considered "undruggable" by traditional small molecules, which have historically been the only option for crossing the blood-brain barrier.

Immuno-oncology is not a one-time fix because cancer cells are described as "smart" adversaries that quickly adapt and develop resistance. The future of treatment lies in staying a step ahead, constantly switching therapeutic mechanisms to outmaneuver the cancer's ability to learn.

To maintain a competitive edge, BridgeBio only pursues programs that are either "first in class" (a novel treatment where none exists) or "best in class" (a demonstrably superior option, like an oral pill versus a daily injection). This strict strategic filter is the core of their entire R&D pipeline selection process.

The future of medicine isn't about finding a single 'best' modality like CAR-T or gene therapy. Instead, it's about strategic convergence, choosing the right tool—be it a bispecific, ADC, or another biologic—based on the patient's specific disease stage and urgency of treatment.

While many cell therapies rely on complex genetic engineering with viral vectors, Adaptin Bio manipulates patient T-cells without it. This simpler, non-viral process is a strategic choice to reduce costs, speed up manufacturing, and make the therapy accessible to a broader patient population.

Rather than moving through distinct lines of therapy, a future strategy could involve an "ADC switch." When a patient progresses on an ADC-IO combination, the IO backbone would remain while the ADC is swapped for one with a different, non-cross-resistant mechanism, adapting the treatment in real-time.

Glioblastoma isn't a single mass but has finger-like 'tentacles' (diffuse infiltration) extending into brain tissue. It is also genetically and cellularly diverse, meaning a single-pathway drug will inevitably miss many tumor cells, leading to rapid recurrence and treatment failure.

Create Medicines chose LNP-delivered RNA for its in vivo platform to give physicians control. Unlike permanent lentiviral approaches, repeatable dosing allows for adapting to tumor antigen escape and managing durability and safety over time. This flexibility is a core strategic advantage for complex diseases like solid tumors.

The T-cell delivery system is versatile. It can carry T-cell engagers for cancer, but also antibodies for Alzheimer's or oligonucleotides. By using different T-cell types (like regulatory T-cells), it can also be used to reduce inflammation, expanding its applicability beyond oncology.