The scan that finds it is quick, safe, and has been around for years. Almost no cardiologist used it until a drug gave them a reason to look.
A non-invasive scan could spot ATTR cardiac amyloidosis, a common, deadly, long-overlooked cause of heart failure in the elderly, years before doctors used it. Diagnoses only surged after tafamidis (Vyndaqel) was approved for the heart in 2019. The treatment didn't create the disease; it created the diagnosis. The backstory, the economics, and why it matters.
Pfizer, Amgen, Lilly, Merck, and Astellas all failed at IGF-1R in cancer. Then a shelved Roche antibody became the only effective treatment for thyroid eye disease. Same receptor, completely different biology.
Five major pharmas spent two decades chasing IGF-1R as a cancer target. Every Phase 3 trial failed. The only IGF-1R drug ever approved is for thyroid eye disease — Tepezza, which generated $1.9 billion in 2024 and 8x exceeded its acquirer's peak forecast. Eleven more IGF-1R-for-TED programs are now in clinical trials, including the literal cancer-graveyard compound being resurrected by Sling Therapeutics. Targets don't travel. Disease context decides.
Nobody knew why it caused birth defects for 50 years. The answer launched a new era of drug design.
The worst drug disaster in pharmaceutical history accidentally revealed how to hijack the cell's protein disposal system. Celgene turned thalidomide derivatives into a $12.8B franchise without knowing the mechanism. When scientists finally identified the target in 2010, it launched targeted protein degradation - now one of the most promising modalities in drug development, with its first FDA-approved drug.
