RARECast

Matching the Right Therapy to the Right Child with a Rare Cancer

When Jim Foote lost his son, Trey, to osteosarcoma, it exposed the limits of one-size-fits-all cancer protocols. He co-founded First Ascent Biomedical to apply functional precision medicine to rare and pediatric cancers. First Ascent uses this approach to transform care for children with rare and relapsed cancers by moving beyond protocols built on averages to decisions grounded in each child’s tumor biology. Foote, CEO of First Ascent, discusses how combining genomics, functional assays, and AI offers a realistic path to better outcomes, fewer lifelong toxicities, and more rational use of existing anti-cancer drugs that are not yet used optimally for individual children.

From Treating Symptoms to Addressing Causes in Rare Autoimmune Diseases

When the immune system misfires, it can cause very different rare diseases that, on the surface, don’t seem related at all. Sanofi, though, is exploring similarities in rare autoimmune conditions that may allow it to treat a number of different disorders with a single therapy. We spoke to Pablo Sardi, head of rare disease research at Sanofi, about the company’s oral BTK inhibitor rilzabrutinib, the challenges of testing one drug in different rare diseases, and how this kind of approach might push doctors to focus less on symptoms and more on the root causes of a rare disease.

A Mother’s Journey to Rewrite a Neurodevelopmental Disorder

Špela Miroševič, a psychotherapist and biopsychologist working as a researcher at the Medical University Ljubljana in Slovenia became immersed in rare disease drug development after the birth of her son Urban. As an infant, Urban was diagnosed with the ultra-rare, neurodevelopmental condition CTNNB1 syndrome. Miroševič founded the CTNNB1 Foundation, which is now advancing Urbagen, an AAV9 gene replacement therapy named for her son. We spoke to Miroševič about how she assembled an international team of researchers, raised millions of dollars to fund research and development, and what it took to push a parent-led gene therapy all the way into a first-in-human clinical trial.

How a Foundation Built Its Own Drug Program for an Ultra-Rare Disease

Schaaf-Yang syndrome is an ultra-rare neurodevelopmental disorder that is closely related to but distinct from Prader-Willi syndrome. It typically presents from birth with poor muscle tone, feeding and breathing difficulties, and later evolves into a broad spectrum of more severe developmental delay, intellectual disability, autism, endocrine dysfunction, and disruptive sleep patterns. The Foundation for Prader-Willi Research’s GeneSYS initiative is leveraging antisense oligonucleotide technology to knock down the toxic truncated protein underlying Schaaf-Yang, orchestrating collaborations with academic scientists, contract research organizations, and patient families to move from cell and animal models toward first-in-human studies. We spoke to Theresa Strong, director of research programs for the Foundation for Prader-Willi Research, about the challenges of delivering therapy to the hypothalamus, navigating ultra-rare drug economics, and how patient-led organizations can drive sophisticated translational programs for conditions that affect only a few hundred people worldwide.

From Bloodletting to Breakthroughs in PV

Polycythemia vera is a chronic blood cancer in which bone marrow stem cells acquire mutations that drive uncontrolled production of red blood cells and other lineages, thickening the blood and causing fatigue, brain fog, and intense itching when in contact with water. The condition also raises the risk of dangerous blood clots. Current management relies on removing blood to lower red blood cell counts, using aspirin, and prescribing drugs to reduce blood cell production, all of which can be burdensome. We spoke with hematologist‑oncologist Marina Kremyanskaya and PV patient advocate Nona Baker about polycythemia vera, how it reshapes everyday life for patients and families, and the promise of new therapies in development.