Ep204: Troy Wilson on Precision Cancer Drugs and Combos

Troy Wilson traces his unlikely path to biotech leadership, beginning as an underachiever in Southern California who discovered his passion for science during undergraduate research at Lawrence Berkeley Lab, where he imaged DNA using scanning tunneling microscopy at age 19. After earning a PhD in organic chemistry from UC Berkeley under Pete Schultz—a mentor who figures prominently throughout his career—Wilson initially pursued law school before Schultz encouraged him toward business. Wilson's early career included roles at Genomics Institute of the Novartis Foundation (GNF) and founding or co-founding multiple companies: Ambrex (antibody-drug conjugates, acquired by J&J after 20 years), IntelliKind (PI3 kinase inhibitor), Avidity Biosciences (antibody oligonucleotide conjugates for rare muscle diseases, recently acquired by Novartis for $11 billion), and Araxis/Wellspring (KRAS G12C inhibitors developed with partner J&J). Cura Oncology, founded in 2014, emerged from Araxis work and represents Wilson's first attempt to build a fully integrated company from discovery through commercialization. The company's lead program, Ziftimenib (ComZifty), is a Menin inhibitor that received FDA approval in November 2025 for relapsed/refractory NPM1-mutant acute myeloid leukemia based on a 112-patient single-arm trial showing complete response rates above baseline expectations. The mechanism works by tricking leukemic blasts into differentiating into normal cells that naturally die within weeks, rather than killing cells directly. Phase one frontline data showed patients on intensive chemotherapy plus Ziftimenib achieving two-year disease-free survival with minimal side effects beyond differentiation syndrome (manageable through combination therapy). Wilson projects peak U.S. sales of $3 billion annually if frontline approval is achieved, treating approximately 50-60% of AML patients with susceptible mutations. Cura's second program, Darleyfarnib, is a next-generation farnesyl transferase inhibitor (FTI) positioned to complement RAS inhibitors like Deraxon RASib from Revolution Medicines, which recently showed survival doubling in pancreatic cancer. Wilson argues that FTIs, largely abandoned by pharma decades ago due to poor monotherapy efficacy and lack of complementary targeted therapies, are now positioned for comeback as combination agents that block resistance pathways—particularly relevant given 50 KRAS inhibitors in development competing for position. Cura plans combination trials with KRAS inhibitors in second-line pancreatic cancer and is exploring kidney cancer and additional AML applications. The company has grown to approximately 280 employees split between San Diego and Boston with remote workers across the U.S. Wilson emphasizes that his success stems from San Diego's biotech ecosystem, which continuously produces well-trained scientists from failed or acquired companies willing to take entrepreneurial risks. He attributes company culture to prioritizing patients in daily decisions, radical transparency about success metrics, generous praise with private constructive feedback, and empowering people to take bold scientific swings rather than incremental iterations. Wilson maintains visible leadership presence and celebrates employees' lives outside work, arguing that great performance at work and at home can coexist.