Making Cancer Look Like Something Else - Christopher Bradley, Co-Founder and CEO of Loki Therapeutics

SHIV GAGLANI: Hi, I'm Shiv Gaglani, and today on Raise the Line, I'm happy to be joined by Chris Bradley. Chris is the co-founder and CEO of Loki Therapeutics, an immune-oncology company focused on treating solid and metastatic tumors. Prior to Loki, he also co-founded and served as the CEO of Mana Health, an award-winning health data startup that was acquired by Comcast in 2018. I'd like to thank my long-time advisor and friend Ken Karpay for introducing me to Chris and thank you, Chris, for taking the time to be with us today.

CHRIS BRADLEY: Thanks, Shiv for having me. I really appreciate it.

SHIV GAGLANI: So you've had a pretty impressive background at the intersection of healthcare, data, biotech, now with Loki. Can you tell us a bit more about your background, how you got interested in all of these fields, any other career highlights?

CHRIS BRADLEY: Absolutely. So I've always had a passion for helping people one way or another. The joke I always tell -- and I think a lot of you at Osmosis and on the show could appreciate this -- I was raised by a family of physicians, and so it was not if, but when and how I would get into medicine. That was sort of the stage that was set. And so I did. My undergraduate was in neuroscience, biology, pre-med track, and I really was passionate about helping people, but I realized pretty early on I didn't want to do straight medicine and be a practitioner. So I asked myself, "How else can I help people?" At the time computer science was starting to really take a much more primal role in medicine and in the digitization of medicine and I saw that as a trend that I wanted to hopefully contribute to.

So I ended up getting a computer science degree, which was extremely strange conversation to have with my two physician parents, and combining those two passions of mine into the first company, Mana Health and as you mentioned, it was in health IT. Actually, one funny tidbit related to your passion at Osmosis is we started out as trying to digitize the medical school diagnostic decision trees that my father had been teaching as part of his medical school teaching sort of side gig.

So that was our first foray into digital health is “How can we better help physicians decide how to diagnose more effectively and efficiently?” That kind of got me into healthcare data, which then showed me all the challenges we have with data interoperability. That ended up being what Mana Health focused on first, is creating interoperability amongst different medical record systems. So anyway, fast forward six years, it was a very interesting journey and we ended up selling to Comcast.

I knew during this whole time my true passion was to somehow get closer to the life sciences and figure out how to help people really with treatments and cures and that's really where Loki came into the picture. So I was introduced to Dr. Claudia Gravekamp who is an incredible mind who's been focusing on immuno-oncology for most of her career. So just decades and decades of research. I was immediately enticed by the core technology that then became Loki, and that's where we are now.

SHIV GAGLANI: Yeah. I would love to hear more about what is the core technology underlying Loki, and then what results can you share at this point? Or maybe it's maybe too early to talk about that, let us know.

CHRIS BRADLEY: Sure. So if I were to summarize it at the highest level, what Loki Therapeutics is all about is treating cancer by using your immune system to detect and kill cancer. As most of your audience is probably familiar, it's the broad strokes of what immunotherapy is all about.

What we're doing differently is instead of trying to teach your body to recognize cancer, which is very difficult to do, we forced the cancer to look like something you've already been vaccinated against. So think childhood vaccinations like tetanus, measles, mumps, polio…we make the tumor look like polio or look like tetanus. And what's powerful and elegant about this, and this is really credited to Dr. Gravekamp, is your body knows what to do with tetanus. If you've had that vaccination, it killed it. It's very straightforward. It alerts the immune system tetanus has been found. That's bad. Kill it. You completely skip the part about training your body to recognize tumors.

The concept really was quite elegant to me and I was very intrigued by it, but what got me to start Loki around this tech, was the results. We have animal models -- and there's always this quantum leap between animals and people, obviously, so we really want to do this next as a phase one clinical trial in people to test safety -- but in animals, we have 90% plus reduction in tumors and metastasis in very difficult to treat cancers. Pancreatic cancer, ovarian cancer, and the whole array of other solid tumors. 

One treatment can reduce in the mice essentially all of the cancer, 90 plus percent of the cancer, and the mice survive. Another story I always tell is I did a visit with the lab and I was able to meet the mice that were not supposed to be there because they have a terminal illness and they're not dead. And it seems obvious. It seems sort of trite, but I mean, the proof was there. These mice were alive. So when you combine the innovative approach with the data, it just felt like this is something that has to be fleshed out and has to be tried. Lives depend on it.

SHIV GAGLANI: Totally. Given that you're focused on turning cancer cells to look like things that people have been vaccinated against, one obvious question is what if someone hasn't been vaccinated or what if the mouse hasn't been vaccinated before? And obviously the anti-vaxxers are doing their best to make sure that more and more people are not vaccinated. So we’ll obviously get into COVID in a minute, but what are your thoughts on that? You just can't treat patients like that or would they have the ability to cure themselves of other kinds of antigens?

CHRIS BRADLEY: Yeah, so it's a really, really good question. And the short answer is if you don't have preexisting memory T-cells then you're sort of stuck in the same boat.  As we age, it gets harder and harder to teach your body to recognize new things. This is just a natural part of aging. So when you're trying to teach them whether it's to recognize tetanus or cancer, there's always that challenge of teaching an older immune system something. So it really does need the vaccination to have happened or some previous exposure. I think that's just one more reason why everyone should get vaccinations when it's safe and effective, their physician thinks it's a good idea and you should definitely get those childhood vaccinations because here's some interesting uses that no one had anticipated.

SHIV GAGLANI: That's definitely something we even worked on at Osmosis, to raise public health awareness of all the vaccines, including now COVID-19. So one of the positive things that has come out of COVID, one of the few, is public consciousness of the role that healthcare professionals and scientists play, the hero positions, and then also just how corona viruses work, how vaccines work. There has been a lot of debate and discussion about it. How has COVID affected the work that you do at Loki?

CHRIS BRADLEY:  There's a lot of answers. I think on the negative side, this is a heck of a time to try to start a new company and I think any entrepreneur could relate because so much of entrepreneurship in general is human relationships. It's getting to know people. It's trusting them, especially when you have to raise lots of money or you have to treat patients or both. There's a lot of interaction that's required. So that's always already hard and it's been tougher with COVID, obviously. But on the positive side, you already mentioned it, I think there's so much focus on biotechnology and the potential of biotechnology to really fix and change how we live and our health.

And also more specifically how vaccines work. Even though I have a background in biology, I had to get a crash course in how vaccines work at the molecular level. You know, what's the theory. I think now as a nation, we're all a lot more knowledgeable, unfortunately, about vaccines…what works, what doesn't, this concept of memory and how long vaccines last.  I think for our purposes, all of this is positive. As more people understand how they work, then I think it'll show how this approach to cancer treatment can be really powerful.

SHIV GAGLANI: Yeah, I couldn't agree more. And in some ways I assume that the funding environment has been positive for any company doing innovative things around biotech. Can you talk a bit more about that? Like where are you in terms of fundraising, what are your next milestones, and what do you think the ideal outcome of Loki would be? I know innovative biotech companies tend to then be bought by larger companies and then go from phase one to phase four, hopefully.

CHRIS BRADLEY: Yeah, definitely. So we are a very young company. We've really only been around for almost a year now after leaving Comcast, after the acquisition. So it's been a rollercoaster. Thankfully we've had funding from investors who have already interacted with me before at Mana and elsewhere, as well as myself and those who were founders at Mana. That's been positive, especially in healthcare, especially in life sciences, there's always more that's needed. We're always actively looking for, in this case, the Series A to be able to start clinical trials in people. That's the exciting thing.

Normally it can take years to get to the point where you're ready to actually now make the leap into humans and we've gotten to that point. So that's really our stage. I think the positive is we've seen now -- I think the genie is out of the bottle -- when there's a great need, things can go quickly. The fact that we were able to get a vaccine that got FDA approval in less than 12 months I think is game-changing. It shows that if there's a will, there's a way we can do this quickly. Hopefully, knock on wood, it's also as safe as it looks and as effective as it looks. That's been really positive. 

This is a personal part of the story, and I'm sure everyone has these stories. You know, I've lost several people close to me to not just cancer generally, but pancreatic cancer. One of them was my uncle and the other one is actually Reggie Bradford, who was the lead investor for my previous company. We actually found out about it right around the time I was introduced to Dr. Gravekamp. There was sort of this divine aspect, that sort of “coincidence beyond coincidence” aspect, that this very large investor and person in my life had this around the time I may have found something that could help. That was also the reason we did it. So I'm committed and passionate on multiple levels to get this into the clinic and hopefully saving lives.

SHIV GAGLANI: That's awesome. I'm sorry to hear about your uncle and your investor. It certainly imbues the work that you're doing with even more personal purpose. Is there anything else you want to share with our audience about Loki before I switch over to your general thoughts on COVID as well as maybe some more about Mana?

CHRIS BRADLEY: Sure, no, I think that was the high-level. I could talk about it all day, so I'll probably mention it again in a second.

SHIV GAGLANI: Okay, great. Well, let's hear about Mana a bit. I mean, clearly you had a successful outcome with that. Comcast is not a player that a lot of our audience knows going into healthcare, but I know they have Comcast Ventures and do a lot around healthcare that people are not as familiar with. So can you talk about Mana, about the decision to join Comcast? Anything you can share that would be interesting to our audience of healthcare professionals.

CHRIS BRADLEY:  Absolutely. So it's interesting…it seems obvious in retrospect, but wasn't obvious at the time. Mana was trying to figure out “how do we create a revenue stream that's predictable and replicable while also helping to improve the healthcare system?” I think healthcare has a lot of areas where you can potentially profit, but not necessarily at the same time as improving the overall setup. And so beyond obviously care of patients and the direct care, I think that's great.

At Mana, we were trying to figure out, “all right, how do we help improve the information sharing aspects of healthcare, the digitization aspects of healthcare?” Naively, I thought it was a technological problem -- which it is, there is a technology problem -- but it's also an incentive alignment problem. In other words, data.

I think this is starting to change, but for very many years, data has been considered an asset to protect and the moment it's an asset to protect -- even if I have a magical solution to share it -- no one wants to do that. And of course, again, naive, right? It seems obvious in retrospect. So for me, Mana was this journey of also figuring out “how do I thread the needle and get people and different stakeholders who do not want to work together and who fundamentally have business models opposed to each other in many cases, how do we get them all to play nice so that the patient can then ultimately benefit?” We did it through this concept of not just sharing data, but sharing data with the patient.

We had a patient portal. We actually won a competition to become the state portal for New York State and that was our first contract that really put us on the map. We're really proud of that work and just basically being representatives of the patient, getting patients their data, however we can.

So when Comcast started knocking at our door, we're having the strategic decision, “do we raise a second series of financing or do we figure out how to partner with someone larger than us?” And I quickly realized for us to create this interoperability layer to healthcare, we really needed to get as much firepower behind us as possible. Honestly, with Comcast, that story resonated because although Comcast is now a mega corporation -- there's a lot of different companies -- the fundamental was a cable company. They became profitable and who they are today because of the work they put into networks and the pipes and sort of the unsexy parts of getting information to you and into your household. And so I think they resonated with that. There's a lot of value in doing that in new areas, like in healthcare.

SHIV GAGLANI: Yeah. We've been following like the EHR story for a long time, right? I mean, they were supposed to change how we do healthcare and they've turned doctors and other clinicians into expensive record keepers, it seems in many ways and there's a lot of dissatisfaction. We've had other guests on the Raise the Line podcast, including Eric Topol and Vivian Lee, who've written extensively about the issues here.

Where are we in your opinion today with interoperability and do you think COVID is going to have a positive, negative or neutral effect in terms of driving more interoperability and patient centered data?

CHRIS BRADLEY: We're definitely now on the cusp of major changes. The legislation, what it does, what it's called, it's constantly changing. But I think everyone now is clear that interoperability and access to data, especially for patients, is a core requirement and a major need. That wasn't the case even 10 years ago when Meaningful Use was being legislated and the incentive structure around Meaningful Use was being put together. Interoperability was not a requirement. You needed a medical record system, but it didn't need to output to JSON or FHIR or some of these formats that you may be familiar with, that didn't exist.

And so of course, if you don't require it and there's no incentive to do it, then no one's going to do it, right? That's changed, so that's one. I think COVID has shown, if nothing else, how important information sharing is…understanding what's happening with the single patient in front of you, maybe where else they've been, and what's happening at the population level. It's really critical. Lives depend on it. Not in some abstract sense, but in a very real sense. So I think that it couldn't be a stronger narrative to support the need for information sharing appropriately, right? I think privacy has to be there, it's very important, but the ability for patients to know what's going on just seems like a no brainer now, in retrospect.

SHIV GAGLANI: Totally. I can’t say that better. What other kind of changes do you think will happen to the healthcare system as a result of COVID?

CHRIS BRADLEY: So I think one of the things -- and this is sort of me brainstorming at this stage -- but for those who are unlucky enough to get it and lucky enough to survive it, but would maybe need a lot of medical care in between those two points, how is insurance going to have to deal with this? We're going to have to have a conversation around the cost of healthcare. And again, this is a perennial conversation. We all know it's too expensive, but I think given the scale of what's happening, I hope that that provides impetus to start reexamining how healthcare is paid for, because it's a for-profit business and at the same time, it's all about negative economic activity.

When I'm sick, I need to get better before I can continue contributing to society. So for me, honestly, fundamentally that equation doesn't make sense. How can I create a profitable industry from humans that are not able to create value at that point in time because they're sick, right? Beyond the important ethical issues of helping people -- that's an obvious for me -- but how can you possibly profit off of that? And in fact, the only way to profit off of it is to overcharge for it. That's sort of my opinion.

So I'm hoping that because of what's going on, we can maybe re-examine the incentive structures at a deeper level and figure out how can we make this an industry that people are incentivized to help cover and pay for, but also not at the expense of patients.

SHIV GAGLANI: Yeah, that's a very interesting way to look at it. And I agree with a number of our guests -- including Marcus Osborne at Walmart and Vivian Lee who wrote the book The Long Fix - who talk about how COVID can be a catalyst for value-based medicine and other payment structures. Plus obviously the change in the administration that's happening.

You know, Osmosis is a teaching company at its core. We educate millions of current and future health care professionals, as well as patients and their family members. If you could give us a recommendation for a topic or a course that you could snap your fingers and we would create it, what type of thing would you love for us to create? Whether it's for consumers or health professionals?

CHRIS BRADLEY: That's a really good question. So first of all, I think it's incredible that Osmosis and the people that you're serving are going to hopefully become healthcare providers. We need more of them. We clearly can't get enough right now and they're heroes. I mean, there's just no way about it. They're heroes. So thank you to frontline workers.

But at the same time, what's interesting is we're seeing how much difficulty we're getting because of communication, because of scientific literacy amongst the people you're treating, because of technology. So I think a course that basically combines the fundamentals of medicine and how to use human psychology to get people out of their own way with the use of technology, I think that is really what seems to be the gap that COVID has shown. Which is that people don't necessarily, for reasons that are not nefarious, always act in their own self-interest. How do you communicate and effectively use human psychology and behavioral psychology to get people to do the things that they really should be doing for themselves and of course, ideally, also for society? As you know, a lot of healthcare is already that, right? A lot of it is behavior-based. Not everything is in our control, but a lot of it is. So I think that seems to be an area where there will be a lot of fruitful work to be done in the future.

SHIV GAGLANI: 100%. And the definition of healthcare provider and caregiver will be expanding as a result. You don't necessarily need a traditionally four-year med school, four-year residency trained physician to do behavioral counseling on quitting smoking. You can have a health coach as we're starting to see.

My last question for you is, this is a really transformational event, once in a generation event for our audience. What advice would you give them about meeting the demands of COVID or, if there were a student deciding on a career in healthcare, out of healthcare, what advice would you want to give them?

CHRIS BRADLEY:  I would say this generally for anyone wanting to do something that they're passionate about, whether it's entrepreneurship or whether it's a more traditional career in healthcare, there's always going to be a moment where it seems like this may have been a bad idea or nothing seems to be working or no one wants this thing, this gizmo, that I've made. You name it. And our world now is changing so, so quickly. So many things continuously change, evolve, come back to what they were that a lot of time, there's a lot of virtue in a certain level of stubbornness. If you just hold on, things can change and in some cases they can change incredibly positively from a situation that otherwise seems very dark.

An example from tech perspective is all these telemedicine companies that have been hacking away at telemedicine for decades who have been saying how important it is to be able to reach people through technology. Obviously those who were able to last are now having a field day.  Put yourself in the position of the person who had to run some of those companies for a long time where they weren't popular. There's a lot of uphill battles. Things can change, things will change.

And so that would be my two cents, whether it's healthcare, whether it's out of healthcare and something else, just stick with it. Do what you're passionate about and don't give up.

SHIV GAGLANI: I like that advice. I like that term virtue and stubbornness. Another guest we had, Burck Smith from StraighterLine, put it well. He said, "Your timing is perfect if you stick around long enough." 

CHRIS BRADLEY: Yeah, that's great.

SHIV GAGLANI: Well with that Chris, thanks so much for taking the time to be with us today and more importantly for the work that you're doing at Loki. I'm wishing you and your team the best as you seek to offer a new innovative therapy for cancer.

CHRIS BRADLEY: Thanks so much Shiv. Thanks for having me and stay safe.

SHIV GAGLANI: I'm Shiv Gaglani, thank you for our audience for checking out today's show and remember to do your part to flatten the curve and raise line since we're all in this together. Take care.