Podcast: Building the future of childhood cancer medicines

00:00:00 Dylan Kissane

The last few years, last few decades, we've only had a handful of drugs that are approved specifically for childhood cancer.

00:00:08 Dylan Kissane

Why has this just been neglected commercially?

00:00:10 Dylan Kissane

Is it just that rational decision making on the part of pharma companies?

00:00:15 Tony Hickson

Well, yeah, I think it is.

00:00:16 Tony Hickson

I mean, I know the data is in the last 20 years, there's only been 9 approvals exclusively for children from the EMA and the FDA in the USA.

00:00:26 Tony Hickson

So compared to 60

00:00:29 Tony Hickson

adult indications alone in a single year in 2024.

00:00:33 Tony Hickson

So there is a real dearth of new medicines being developed for paediatric child and young people's cancers.

00:00:41 Tony Hickson

And the reason for that is that they are generally small patient groups.

00:00:46 Tony Hickson

they're very difficult to actually drug.

00:00:50 Tony Hickson

Much of the biology here is developmental.

00:00:52 Tony Hickson

I mean, children are not small adults, they are still developing.

00:00:56 Tony Hickson

So their biology is different and a lot of it is very complex.

00:01:00 Tony Hickson

There's fusion proteins and transcription factors and all sorts of things involved that are traditionally difficult things to hit with a drug.

00:01:08 Tony Hickson

And then of course there's just the market size type thing.

00:01:11 Tony Hickson

Many of these conditions are also by definition rare conditions.

00:01:16 Tony Hickson

Now, sometimes you see some great successes like the day one sort of story where there is an adult follow on to that.

00:01:24 Tony Hickson

So you start into pediatric cancer and then you can progress into adults.

00:01:27 Tony Hickson

And there's a commercial case to be made for that.

00:01:29 Tony Hickson

It's a sort of orphan drug story.

00:01:31 Tony Hickson

But sometimes there are tragically a number of childhood cancer conditions that just don't have an adult follow on.

00:01:37 Tony Hickson

They will only ever be in that market.

00:01:39 Tony Hickson

And I think that's where we're very interested as a charity in trying to help sort of

00:01:44 Tony Hickson

correct this broken market problem.

00:01:48 Dylan Kissane

I want to ask a little bit more about one of these companies, which is SeeFurther.

00:01:52 Dylan Kissane

They've got two therapeutic programs at the moment, CF012 and CF033.

00:01:58 Dylan Kissane

What are these programs trying to do?

00:02:00 Dylan Kissane

What are they focused on?

00:02:04 Tony Hickson

Yeah, so just to be clear on that, SeeFurther is not a company.

00:02:07 Tony Hickson

It's a joint venture between Astels, Cancer Research Horizons, COUK,

00:02:14 Tony Hickson

Life Arc is another charity in the UK and they're focused on rare diseases and Great Ormond Street Hospitals charity, which clearly is focused on pediatrics.

00:02:25 Tony Hickson

So we've all come together and put some money on the table and some support and people and teams to try and move forward some ideas in this space and really put a bit of pressure on the system because you end up caught in a cycle where because there is no market for them,

00:02:43 Tony Hickson

there's no impetus to start development of them and then nothing happens.

00:02:47 Tony Hickson

So we're trying to put some pressure on the system at the start to say, well, actually, we are developing some molecules here.

00:02:52 Tony Hickson

They're novel and we need to find a route forward for them.

00:02:55 Tony Hickson

So let's sort of embrace that challenge and move forward with that.

00:02:57 Tony Hickson

So CFurther is that joint development.

00:03:02 Tony Hickson

It has raised about $50 million so far.

00:03:06 Tony Hickson

and announced the funding of two programmes, but we have several more that we're currently sort of homing in on and hope to, and almost certainly will announce more before the end of this kind of year.

00:03:19 Tony Hickson

The first two programmes, one is developing a drug against Ewing sarcoma, which is a sort of bone and soft tissue disease primarily in children.

00:03:28 Tony Hickson

It's with ourselves, the University of Virginia Cancer Center, Dana Farber and Mass Brigham in Boston.

00:03:36 Tony Hickson

And we're trying to develop a new sort of small molecule, first in class small molecule for that.

00:03:42 Tony Hickson

And what we offer we see further is it's not just a here's a grant, go and do it.

00:03:47 Tony Hickson

We're offering our drug discovery capabilities alongside the funding, alongside the biology capabilities within those universities.

00:03:54 Tony Hickson

So it's really trying to bring it all together.

00:03:57 Tony Hickson

The other programme is slightly different.

00:03:59 Tony Hickson

It addresses several different types of childhood cancer and it's with actually Mink Therapeutics and the University of Southampton working together and it's an off-the-shelf cell therapy format.

00:04:12 Tony Hickson

So we're trying a very different type of approach, looking at sort of trying to address some of the limitations in that therapy area.

00:04:19 Dylan Kissane

Is it more difficult to find the academic researchers in the 1st place who are interested in childhood cancers just because?

00:04:27 Dylan Kissane

of this commercial, this lack of commercial appeal.

00:04:35 Tony Hickson

Yeah, I mean, I think, yeah, there are, the pediatric oncology community is a very tight knit and very well networked community who do an amazing job.

00:04:45 Tony Hickson

They're incredibly good at engaging with patient advocates and they're highly impassioned people who really want to fix this market broken problem here.

00:04:54 Tony Hickson

So they're all looking for different solutions and certainly

00:04:57 Tony Hickson

we feel very embraced by that community and bringing new ideas, expressions of interest to us and trying to move things forward.

00:05:04 Tony Hickson

But I think they would admit along with us that that community is still relatively small in the grand scheme of things.

00:05:11 Tony Hickson

And that means there's only a select number of new start points for therapeutic medicines for us to sort of harvest and mine and move forward.

00:05:21 Tony Hickson

And there's lots of challenges in developing those medicines.

00:05:24 Tony Hickson

So I think it's important that we

00:05:26 Tony Hickson

focus both on the academic community as a source of new ideas, but also on industry, on biotechs and pharmaceutical companies who may have stored or shelved assets.

00:05:38 Tony Hickson

So maybe for a pharmaceutical company, they stop development or something because they don't consider the market to be big enough, but we could help them move it forward.

00:05:47 Tony Hickson

Or it may be for a small biotech company that their venture capital funders are focusing all of their efforts on their lead molecule in a certain indication.

00:05:56 Tony Hickson

And then number two and number three, which could be great in childhood cancer, are being sort of neglected a bit.

00:06:02 Tony Hickson

Again, could we help get out, structure a deal, move it forward?

00:06:07 Tony Hickson

So I think that whilst it can be challenging to find some of these ideas, I think that there is still plenty of scope for us to move forward a number of exciting programs.

00:06:17 Dylan Kissane

You've described See Further in the past as a child-first approach to discovery and development rather than just adapting adult science.

00:06:25 Dylan Kissane

And you mentioned children are not just small versions of adult, they're very different biology.

00:06:30 Dylan Kissane

What does that actually mean in terms of mindset and what sort of practical impact does that have on the science?

00:06:38 Tony Hickson

So I mean, I think there's child first and child only and See Further will do both.

00:06:44 Tony Hickson

But what we won't do is adult only.

00:06:46 Tony Hickson

So we are child first is of, well, child only is of particular interest to us because as a charity, we are uniquely positioned, you know, and as a group of charities, we've got and LifeArc to take on the risk of moving these things forward and find novel ways of getting them funded, novel access to clinical trial structures and things like that.

00:07:08 Tony Hickson

And frankly, it's very unlikely that industry or venture capital will ever take forward some of those sort of niche conditions.

00:07:15 Tony Hickson

Child first is also of interest as well because the incentives that have been created by governments, which are great to see, have not always worked in terms of getting the biopharmaceutical industry to run pediatric trials either alongside or shortly after the adult ones.

00:07:33 Tony Hickson

There's a very large delay, historic delay between starting a pediatric study and the adult drug reaching the market.

00:07:40 Tony Hickson

Most of the time the adult drug actually reaches the market well before they even start the first pediatric

00:07:45 Tony Hickson

Some recent legislation changes in the US have helped start to create that, but there's still sort of more to be done there.

00:07:52 Tony Hickson

So I think we are very interested in that child first model.

00:07:56 Tony Hickson

in terms of building a portfolio alongside the child only model.

00:07:59 Tony Hickson

And you want a mixed portfolio of both really, because that maximizes the chance of seeing success.

00:08:05 Tony Hickson

And it maximizes the chance of us leveraging more money for Sea Further in the future.

00:08:10 Tony Hickson

Because we're going to need more than $50 million.

00:08:12 Tony Hickson

We're going to have to raise money against this.

00:08:13 Tony Hickson

We need philanthropy and industry and other people to gather around it and sort of believe in the cause we're trying to create.

00:08:20 Dylan Kissane

So what does success look like then for Sea Further if we're thinking five years ahead, 10 years ahead?

00:08:27 Tony Hickson

I mean, I think we want a science, we want to see a science-led portfolio.

00:08:31 Tony Hickson

So the first task is to create a portfolio because of this attrition problem we've spoken about before.

00:08:37 Tony Hickson

We need a significant portfolio of assets all being developed all at different stages.

00:08:42 Tony Hickson

So early preclinical, late preclinical, in the clinic and so on to really show the model is moving and we're moving a number of things forward.

00:08:49 Tony Hickson

And we'd like to see that a mixed bag of child first and child only indications within that covering a broad depth of diverse cancers.

00:08:57 Tony Hickson

We don't want to all focus on certain types of cancer.

00:09:01 Tony Hickson

And then I think we're also thinking about the commercial model.

00:09:04 Tony Hickson

So how do we move these ideas forward?

00:09:07 Tony Hickson

There'll be a combination of licensing some to industry, some there won't be any sort of industry take-up.

00:09:15 Tony Hickson

There may be the risk is considered higher, so we're going to have to take it further into the clinic before we'll get industry engagement.

00:09:22 Tony Hickson

And then the third category is there will never be industry engagement.

00:09:26 Tony Hickson

And they're the ones we're really going to have to think about novel models with.

00:09:30 Tony Hickson

And I guess the final part is we want to become a voice in this market.

00:09:34 Tony Hickson

We want to shout from the rooftops.

00:09:36 Tony Hickson

This market is broken.

00:09:38 Tony Hickson

It has a problem.

00:09:39 Tony Hickson

We need collective solutions here.

00:09:40 Tony Hickson

We need everyone to crowd in and work with us or us work with others to help solve this.

00:09:45 Tony Hickson

So we'll probably put out some white papers and some policy influencing things as well alongside the developing of the drugs.