Thread by @JorgeCondeBio

1/ Biotech is a tough business.

There are 10,000+ human diseases out there. How do startups w/ promising platforms choose where to focus?

Choose wisely. @andy23tran @a16z & I offer a framework for finding your Platform-Disease Fit (PDF)
🧵👇

a16z.com/2021/01/08/pla…

2/ Finding PDF early in life is essential to success.

Your first disease tends to become your adjective: “Acme Co, a cancer company…”.

So what funnel criteria do you use?

3/ First step: find your superpower. What’s your platform edge?

It’s not enough to solve a problem; what problem can you uniquely solve?

Can you tackle an unknown or unreachable area of disease biology?

Can you dramatically improve on or leapfrog competitors?

4/ Next, think through two core axes:

In which diseases do you have high potential to successfully intervene?

For which diseases can you create + capture meaningful value?

Here’s a handy table to help you weigh some key factors👇

5/ Do (or can) you know what drives a disease?

Is it possible to get early signals that you’re on the right track?

Do you have good assays, cell lines, screens?

Are there established animal models that faithfully reproduce the human disease?

6/ What does a successful clinical trial need to show for a disease?

Can you identify + recruit patients quickly?

Investors/partners look for demonstrated risk reduction: time to IND, proof of concept (PoC).

7/ When it comes to market size, patient benefit can be more important than patient population.

Transformative, curative potential commands lofty price tags (like Novartis’ $2.1m gene therapy).

8/ Some indications have smaller market sizes but early/fast PoC (like rare diseases); others have blockbuster potential but a history of late-stage failures (like autoimmune diseases).

It’s a varied menu — determine your risk appetite and season to taste.

9/ What does the competitive landscape look like? You need 360-degree vision.

It’s not only commercialized products, but also pipeline (and under-the-radar) programs. And don’t forget about substitutes like surgery.

10/ Sometimes the best market signal is heat—look for evidence of active BD or M&A interest from biopharma companies.

Deal size + structure is a good industry barometer for promise and potential.

11/ The road to making a medicine is bumpy and long; maintain a high hurdle:

Do you have the potential to be first-in-class or best-in-class?

Can you change or become the standard of care?

12/ There are only so many programs a single company can work on.

Once you have your PDF picks, you need to assess strategic alignment.

PDF tells you what you CAN do; this tells you what you SHOULD do.

13/ If a disease doesn’t match your vision for the company, out-license it.

If you need a well-equipped + experienced guide, find a partner.

Focus on your ‘goldilocks’ opportunities, where you have go-it-alone potential to build a strong foundation for your company.

14/ Finding your PDF is an art, not a science.

As an entrepreneur I really struggled with this process, knowing these decisions would shape my company’s destiny.

I hope we have given you a canvas to help you sketch out your journey.

15/ A huge shoutout and thank you to our friends @Camp4tx for sharing their thoughts on indication selection, many of which have been adapted for this piece.