A ‘Big, Crazy Idea’ He Couldn’t Ignore

July 15, 2020

Antoine Papiernik is managing partner and chairman of Sofinnova Partners. He has served on RefleXion Medical’s board of directors since 2014. He was the company’s first institutional investor.

If anyone can spot a winning investment, it’s Antoine Papiernik. He’s been picking winners for more than 20 years. “My three key criteria are: people, people, and people. Everything else falls by the wayside,” he said. “If you have the wrong people, it will break the company. If you have the right people but the wrong plan, you can always change the plan. If you have the right people, they will have the ability to go into unknown territory and find a way forward.”

Papiernik’s instincts about people motivated him to bet on the oncology technology startup RefleXion Medical. He admitted he wasn’t intrigued by the company initially because “it was the epitome of what we should not be doing—namely, investing in large capital equipment. That’s venture capital 101.”

Despite his reservations, in 2011 he met first with Jay Watkins, RefleXion’s chairman of the board, then with RefleXion co-founders Sam Mazin and Akshay Nanduri. “I have huge confidence in Jay. I was captivated by Sam and Akshay, and what they were telling me about their vision for RefleXion,” he said. “But I still wasn’t convinced at first because it was large capital medical equipment.”

Sofinnova Partners did its due diligence, which included calling industry and regulatory experts. Everything checked out, so Papiernik gave the go ahead. “It was a big, crazy idea because 99 percent of these ideas fail,” he said. “I always ask myself the question, ‘What if they are right?’ If the answer is ‘It doesn’t matter,’ then you don’t do the deal. But if the answer is ‘This could change the world,’ then that’s when you know you need to start doing the diligence.”

He liked Sam and Akshay’s vision, and the fact that the co-founders knew they would need help to realize RefleXion’s vision. “They were humble about what they knew and what they didn’t know. This was key,” he said. “They wanted to recruit the best people, people who knew a lot more than they did. They had ambition and humility from the start.”

Mazin can recall a particularly memorable dinner with Papiernik in early 2011. He and Nanduri had spent the two years prior in search of venture capital funding—to no avail. Most VCs told them to come back when they had a product or revenue, neither of which were on the horizon at that time. Mazin remembers asking Papiernik if his VC firm would even consider “early-stage” life-science ventures in their portfolio. He will never forget Papiernik’s answer. “He said to me, ‘Sam, we do ONLY early-stage investing.’ To this day, I have the utmost respect for Antoine and the Sofinnova team as true venture capitalists willing to take on a very large amount of the technical, product, regulatory, clinical and market risks in funding young companies that need the cash to turn over the next card.”

Today, Sofinnova Partners invests across the spectrum of early-stage to later-stage ventures. And the firm has broadened its investments from pure healthcare, both drugs and devices, to new domains in the life sciences, such as industrial biotechnology. “Unlike everyone else at Sofinnova Partners, I’m not an engineer, a scientist, or a doctor,” Papiernik said. Sofinnova has benefited from Papiernik’s varied background. He started his career as a brand manager for consumer goods before settling into finance after he completed his MBA. He worked for the French government in Prague before moving on to the French financial organization Caisse des Dépôts et Consignations (CDC) after the Berlin Wall came down. He joined Sofinnova Partners in 1997.

His company invested in RefleXion to leverage the combination of diagnostics and therapeutics in a single modality for oncology, even if the vehicle for this is capital equipment. It’s important to think like a biopharma company to unlock the true value of RefleXion. “What I love about RefleXion is that we started from scratch and went on to defy all the odds and proved the technology could work,” he said.

One of the biggest risks was whether they could make the technology work—could the machine turn at 60 rpm, fast enough so that once the tumor emissions were detected, the linear accelerator would have time to respond with minimal tumor movement? Papiernik recalled when RefleXion bought two second-hand ring-gantry radiotherapy machines for proof-of-concept development. “They cost almost half a million dollars, and they arrived on a semi-truck. We took all those parts to prove the machine could do what we said it could do. And we did. We got the proof of principle,” he said. “I remember Sam in front of the system, practically in tears, post proof of principle. That was a truly memorable moment.”

RefleXion’s $11M series A funding was tied to that assumption—that is, getting the machine to turn at 60 rpm. Another major milestone was getting U.S. Food & Drug Administration (FDA) clearance for SBRT/SRS/IMRT. “It’s like climbing Everest: 60 rpm was basecamp, and SBRT clearance was one camp above. We still have a hard climb ahead, but this FDA clearance is an important milestone,” he said. “The summit will be able to treat cancer patients that would have died otherwise. And that is what they are going to do.

“Now it has come full circle with Stanford purchasing the first machine, and since that is where Sam earned his Ph.D., it has special significance,” he said.

While the significant milestones lie ahead for RefleXion, the company has achieved a great deal, especially in the last few months. “When you participate from the start and feel like you were there from the birth, it’s really special. I am incredibly proud of what they have done,” he said. Although he “loves” all of his portfolio companies, Papiernik calls RefleXion his “favorite child,” because he knew from the outset that RefleXion would be a “disruptor.”

Editor’s note: In addition to Sofinnova Partners, Venrock and Pfizer Ventures were also instrumental in providing Series A equity. Since then, RefleXion has built a top-tier investor syndicate that also includes PSP Investments, TPG’s The Rise Fund, KCK Group, T. Rowe Price, and Johnson & Johnson Innovation, JJDC Inc.