Ep. 107: Sid Sijbrandij On Beating Cancer with First Principles, n = 1 Personalized Treatments and Special Access Regulatory Pathways

**Nicholas** (0:01)
Welcome to the Stranded Technologies Podcast, where we explore how to accelerate the future. Imagine a world of abundance, longer lives, clean energy, transparent markets, robots and AI doing the toiling labor. Why don't we have those things yet? Join us as we explore the biggest problem that holds back frontier tech over regulation. Now we have real solutions, start up cities, network stays and on-chains finance. Please find ways to support us in the show notes. Now enjoy this episode. All right. Today is March 28th in 2026, and my guest is Sid Sijbrandij. Sid is known as the co-founder of GitLab, a publicly listed software company. And today he's here with an incredible story. Sid, welcome to the show.

**Sid Sijbrandij** (0:47)
Yeah, thanks for having me.

**Nicholas** (0:48)
So without further ado, let's jump right into it. Tell us your story.

**Sid Sijbrandij** (0:53)
Yeah, my story is that in 22, I got bone cancer, and I did all the standard of care treatments. I had a lesion growing in my upper spine, and we did surgery, radiation, chemo, trying to get rid of it.
Also, in 22, something else happened. Clickchemistry won a Nobel Prize. And coincidentally, I had become the biggest investor in the first company to bring Clickchemistry to humans. And Clickchemistry is a technology where you can have a reaction in a human that's very specific. It happens very reliably. You don't have any side effects, any reactions that you don't want to. It's an awesome mechanism. And in my Y Combinator batch, there was a guy who was using it to get cancer drugs to target. And I thought that was a great idea. I started investing for small checks, but then nobody believed in it. All the biotech species is like, this is the only Clickchemistry company in the world. This is not going to work. So, over time, I became his biggest investor. And now that I became, now that I had cancer, I had a chance to become a patient. And he moved things. He had an amazing network. And we were able to get a single patient IND. We were able to get this drug outside of a big regular trial and do it just for me. And that opened up my eyes like, oh, this is, it's not easy, but it's possible. Despite those efforts, two years later, 24, my cancer was back. It was growing. My oncologist did not have any treatments he would recommend to me. There was nothing left in standard of care. He said, maybe there's a trial. I looked for trials, but it's a relatively rare disease and there was nothing. And it was like an oh shit moment. So, I quit my day job running the public software company. And I said, okay, what are we going to do? And I decided to do four things. I started doing every single diagnostic I could get my hands on. And it turns out there's a lot of diagnostics. There's not just a simple test. I did a test that tested for like 500 cancer mutations, but you can do whole genome sequencing, you can do RNA sequencing, you can do single cell, you can do spatial, you can do TCR sequencing. And I started doing just everything. We wouldn't know what we would need, but we started doing. And if there were no medicines anymore, we started creating them. So, we started developing more than 10 medicines, with all kinds of different people.
We also started to do treatments in parallel. Well, anything we came across that made sense, we started doing, we started looking, hey, can we, are the side effects profiles? Like, do they reinforce each other or are they different? If they're different, we can do the treatments at the same time. Because most people, I think, run out of time.
And I think a lot of times, if you do a cancer treatment, the tumor escapes the treatment, and you do the new one, but it escapes that one, too. And now you've got metastasis. And by trying to do as much as is reasonable, at the same time, you have a better shot at cure. And I think we learned that the industry as a whole is very conservative. Doctors and mostly hospitals are there to minimize liability. They don't want you to die basically from a side effect of one of the treatments. You as a patient have a very different incentive. You want to maximize survivability. In fact, I'd rather die of a potential cure than from cancer. Cancer is a very slow and miserable way to go. So recognizing that these incentives are different, you can see that the bar for combining treatments, in my view, is too high. Typically, doctors say, hey, we need a randomized control trial that shows that these things work together. These trials are extremely expensive. Getting a cancer drug approved is $2.7 billion. So you're not going to have that trial for many combinations. So instead, we went back to first principles, like, do they hit different organs with their side effects? How do we feel? Maybe we also kind of were conservative on some of the doses because we were combining them. We had a pathologist in the loop who was really good at, like, looking at the different organs and the effects there. We also worked a lot with AI to try to reason through it. There's not a lot of data. There's no randomized trials. So you try to do it from first principles. The last thing we did is we discovered that there's a lot of things that were easier than I thought. It wasn't easy, but it was easier than I thought. And we try to make it accessible to other patients. Last year, I started 10 biotech companies that are patient first in the sense that they want to get into patients within the first year, but also that the patients have to pay for it. Because a lot of these things, we're not doing the $2.7 billion approval process. And frequently, the drugs are specific to the patient. It doesn't mean that they can be used by someone else. We're focused on the patient. The patient helps fund the R&D for the treatment. And some of these companies have already gotten to five patients.