Ep204: Troy Wilson on Precision Cancer Drugs and Combos
Troy Wilson, CEO of Cura Oncology, discusses his journey from mediocre student to serial biotech entrepreneur, the development of Ziftimenib (a Menin inhibitor approved for AML), and the company's strategy of combining precision cancer drugs like farnesyl transferase inhibitors with emerging RAS inhibitors to overcome treatment resistance.
Summary
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.
About this episode
Troy Wilson, CEO of San Diego-based Kura Oncology, on his career in biotech and developing targeted cancer drugs.
Key Insights
- Wilson was a mediocre student until high school at Chadwick School challenged him to write and think critically, after which he pursued rigorous scientific training but initially lacked direction toward a specific career.
- Scanning tunneling microscopy work imaging DNA at age 19 was formative but also sobering—a reporter asking 'how does it feel to have done the best work of your career at age 19' made Wilson realize he needed to sustain achievement through additional training.
- Pete Schultz, Wilson's PhD advisor, recommended business school over law school despite Wilson's preference for law, suggesting Schultz recognized entrepreneurial phenotype in Wilson before Wilson recognized it in himself.
- Wilson's role at GNF as general counsel and head of business development taught him industry dynamics across big companies, startups, and universities through apprenticeship under mentors rather than formal instruction.
- Ambrex spent 20 years before J&J acquisition realized its highest value in antibody-drug conjugates despite initially pursuing protein medicinal chemistry, demonstrating that the best application of a technology may not be obvious at founding.
- Wilson co-founded multiple companies (Wellspring, Araxis, Cura, Avidity) simultaneously in San Diego and managed all of them during early years, which became unsustainable once companies entered development stage requiring different management approaches.
- Menin inhibition works by tricking leukemic blasts into differentiation and natural cell death rather than direct killing, enabling deep responses and combination potential unavailable to traditional cytotoxic approaches.
- Differentiation syndrome, the primary toxicity of Menin inhibitors, becomes manageable through combination therapy because co-administered agents eliminate most blasts upfront, reducing the shock load from simultaneous differentiation of many cells.
- Farnesyl transferase inhibitors, abandoned as monotherapy by major pharma in the 1980s-90s due to poor efficacy and lack of complementary targeted drugs, are positioned for comeback specifically as combination agents blocking resistance escape routes.
- Ziftimenib approval was achieved with only 112 relapsed/refractory patients in a single-arm trial because the effect size was large enough that the agency accepted this narrow population, with frontline expansion now underway in phase three trials.
- Revolution Medicines' Deraxon RASib doubling pancreatic cancer survival to 13 months OS still represents inadequate outcome for Wilson, motivating Cura's combination strategy with Darleyfarnib to drive deeper and more durable responses.
- Wilson maintains that San Diego's continuous turnover of well-trained scientists from acquired companies creates an ecosystem where entrepreneurs are willing to take risks knowing failure is not career-ending due to abundant subsequent startup opportunities.
Topics
Transcript
Welcome to the Long Run. This is a podcast for biotech adventurers. I'm your host, Luke Timmerman. Today's guest is Troy Wilson. Troy is the co-founder and CEO of San Diego-based Cura Oncology. The company, founded in 2014, has gone all the way through R&D to develop its own novel cancer drug. It's called Ziftimenib, brand name CumZifty. It's an oral pill that inhibits a target called Menin. Ziftimenib was approved by the FDA back in November of 2025, initially for a small set of patients with acute myeloid leukemia that have specific genetic alterations such as NPM1 mutations or KMT2A rearrangements. Now this is the start. Cura hopes to demonstrate that the drug will help a broader group of…
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