Step Pharma's synthetic lethality approach targets two redundant enzymes in the same pathway. Deleting one makes cancer cells entirely dependent on the other. This direct dependency is harder for biology to circumvent compared to approaches targeting different, interconnected pathways, creating a "cleaner" kill mechanism.

To overcome on-target, off-tumor toxicity, LabGenius designs antibodies that act like biological computers. These molecules "sample" the density of target receptors on a cell's surface and are engineered to activate and kill only when a specific threshold is met, distinguishing high-expression cancer cells from low-expression healthy cells.

CZI's New York Biohub is treating the immune system as a programmable platform. They are engineering cells to navigate the body, detect disease markers like heart plaques, record this information in their DNA, and then be read externally, creating a living diagnostic tool.

Create's strategy is not limited to a single cell type. They view success in solid tumors as requiring the programming of all immune cells. Their platform can specifically engineer myeloid cells, T-cells, and NK cells in vivo, orchestrating a coordinated, multi-pronged attack on cancer.

Instead of focusing solely on T-cells, Create's platform first targets myeloid cells, which constitute up to 60% of some solid tumors. Programming these cells transforms the tumor microenvironment, enabling a 5-10x influx of CD8 T-cells. This overcomes a key barrier for T-cell therapies in solid tumors.

While personalized cancer vaccines require extracting and processing a patient's tumor, Create Medicines' in vivo approach is entirely off-the-shelf. By delivering the programming directly into the body, they enable the patient's own immune system to do the complex, personalized work of attacking the cancer itself.

While complex gene editing may be challenging in vivo, Colonia's platform presents a novel opportunity: targeting different immune cell types (e.g., T-cells and NK cells) with distinct payloads in a single treatment. This could create synergistic, multi-pronged attacks on tumors, a paradigm distinct from current ex vivo methods which focus on engineering a single cell type.

Accession's second product is a bispecific antibody that binds to all cancer cells. While this would be dangerously toxic if delivered systemically, their targeted virus delivery system ensures it is only produced inside the tumor. This strategy makes previously "undruggable" therapeutic concepts viable.

Instead of just killing cancer cells, the primary mechanism is to insert a gene that forces the infected cell to produce and secrete a potent drug, like an anti-PD-L1 antibody. This creates a hyper-concentrated therapeutic effect directly in the tumor microenvironment, a concept termed "molecular surgery."