In the words of author Neil Gaiman, magic and science are “rarely compatible.”
The two are an uncomfortable pairing — antithetical realms that simply don’t get along.
And yet, the vast majority of articles written about antibody-drug conjugates — arguably the most scientifically complex platform available for delivery of anticancer medicines — make some reference to Paul Ehrlich’s ‘magic bullet’ theory. Initially, this collision of science and magic didn’t sit well with me.
Among other incredible contributions to immunology, the Nobel Prize-winning scientist theorized that it was possible to create disease-seeking chemicals that would selectively target specific pathogenic organisms, without harming the infected host.
When talking about ADCs — targeted medicines that can deliver toxic agents to cancer cells without harming healthy cells — Ehrlich’s theory has become an almost irresistible anecdote. As such, using it in this month’s cover story was a bullet that I had fully planned on dodging.
But it turns out that in addition to being a brilliant scientist and physician, Mr. Ehrlich was a uniquely interesting person, and his story captivated me. A workaholic with an affinity for chain-smoking cigars, he was known for engaging in drunken conversations about chemistry. He hated exercise, liked using bright colors in his lab and had a habit of scribbling notes on anything, coworkers included, whenever he was inspired.
Ehrlich didn’t lack culture either: His hypothetical magic drug, which he named ‘zauberkugel’ in German, was actually a nod to a romantic opera. The opera referenced German folklore about a marksman who made a deal with the devil to obtain bullets that couldn’t miss their target.
Admittedly, this was far more interesting than a person in a cape and top hat trying to guess my card.
And yet, whether it’s the telling of a 600-year-old folktale or pulling a rabbit from a hat, it comes down to selling an audience. Magic, not unlike science, is a learned skill — one that requires practice and refinement of each element of the show.
In the context of ADCs, this comparison makes more sense. Early efforts, as illustrated by Wyeth’s Mylotarg saga, were not smooth. Much like an amateur magician, the industry had to work out the kinks if it wanted to inspire the crowd.
Over time, advances in ADC design and construction were achieved by optimizing the drug’s components piece by piece. ADC treatment now spans across more than 10 different cancer indications, with the most approvals in lung, bladder and breast cancers. The FDA has greenlighted 13 ADCs, with the majority of those approvals happening in the last five years. The clinical space is busy and perhaps most telling is that all of the top 10 pharma companies (per Citeline data) have at least one ADC program in their pipelines.
With industry fully acknowledging the importance of scientific and manufacturing mastery, and with that, the need to choose the right partner, ADCs are lighting up pharma’s deal-making stage.
As these awe-inspiring modalities revolutionize cancer care, they are rightfully stealing the show. And as for Ehrlich’s magic bullets — the science might have made me a believer.