From Wall Street to biotech: how Adam Mostafa navigated X4 Pharma to FDA approval

A biotech CFO's journey through capital challenges, drug commercialization, and industry transformation—combining scientific passion with financial expertise to bring WHIM syndrome treatment to patients

For biotech CFOs like Adam Mostafa, the role extends far beyond traditional finance functions. At X4 Pharma, his responsibilities encompass not just finance but also business development and aspects of legal oversight. “It's a small company, you wear a lot of hats,” he notes. “You're a lawyer and chief commercial officer and a lot of things along the way, but it's good for learning.”Adam Mostafa, CFO, X4 Pharma

Mostafa’s seven years of experience at X4 Pharma included guiding it to its FDA-approved drug XOLREMDI. A selective CXC chemokine receptor 4 (CXCR4) antagonist, XOLREMDI is the first therapy specifically indicated in patients with WHIM (warts, hypogammaglobulinemia, infections and myelokathexis) syndrome, a rare, combined primary immunodeficiency and chronic neutropenic disorder caused by CXCR4 pathway dysfunction.

“Getting to a drug, getting something approved that's out there and will help people—I wanted to make that happen or play a role in that,” Mostafa reflected on his tenure at X4 Pharma. His commitment to staying through challenging times speaks to a deeper motivation that transcends financial metrics.

Mostafa journeyed to biotech leadership via an acceptance to medical school, he ultimately chose to combine his scientific interests with business acumen, landing on Wall Street in healthcare finance before transitioning to his corporate role. This background gives him a distinctive lens through which to view the industry's challenges.

“That connectivity with being involved in business and with companies that are looking at curing disease and sickness was a good fit for what I was trying to do,” said Mostafa.

This multifaceted role becomes particularly evident during critical phases like commercialization. Mostafa describes how his team began planning for their drug launch “years in advance” with more concentrated efforts ramping up about 18 months before approval.

“We first did a new product profile, what the product's going to look like, what the label might be, what parts of the market we should include, etc. Those decisions even play a role in how you design your trials,” explained Mostafa of the advanced planning.

“Then you get ready for potential approval and launch - you begin hiring sales force and training them and getting materials ready,” said Mostafa. “On the finance side, certainly at a small company, you have a hand in many things…pricing decisions—we have a committee that relates to pricing the drug or pricing growth decisions—how we account for all the financial pieces of making our drug with our CMO, getting it to patients, managing specialty pharmacy relationships, and handling payment flows from payers, and so on.”

CFO perspectives

One of the most significant challenges for biotech CFOs is managing capital in an industry notorious for burning through cash. Mostafa observes that the CFO role has evolved significantly, with capital markets expertise becoming increasingly crucial. “Being able to understand the investor lens, how the banks work, raising capital, different transaction structures—all that is becoming more and more critical for a biotech company,” he explains, noting that traditional accounting skills, while still necessary, may be “becoming secondary, tertiary to the financial strategy and capital flow element of things.”

The path from private to public company brings its own set of tradeoffs. Mostafa articulates these clearly: “Public access to capital, larger amounts of capital is typically quicker, more likely easier...tradable stock, liquid stock.” This advantage is particularly valuable in biotech's capital-intensive environment. However, public companies face “red tape and public company costs and SEC disclosure and governance issues” that can be “time consuming, a little bit distracting.”

For private companies, while raising capital may be harder or slower, they benefit from greater nimbleness and flexibility. “You don't have all these rules to deal with disclosure-wise. You can move more quickly. You can keep your head down,” especially valuable during challenging market conditions.

Current challenges

The biotech industry faces broader challenges beyond financial considerations. Mostafa points to the increasing competition from China, noting their different approach to innovation. “We are very modular in that, for example, I innovate something, it's mine...And I will protect it at all costs,” he explains of the American approach. In contrast, China takes “more of a beehive approach” where ideas can be freely built upon and improved.

“They've already shown they can develop much more quickly and commercialize much more quickly and more cost efficiently,” Mostafa observes. “I don't think that's going to slow down. If anything, they are going to take more and more of the pie.”

For biotech executives, stress management becomes a critical skill. “It's a constant roller coaster ride. It's ambiguities and uncertainties left and right,” Mostafa acknowledges. His approach? “You just have to get numb to that... that's just the table stakes. And then given that crazy roller coaster, you learn to harness the chaos to help solve the problem.”

This pragmatic philosophy has served him well through X4's journey to drug approval, despite stock price pressures and financial challenges. “When you go through tough times, you learn a lot more than the other way around,” he reflects. “Having to navigate all these challenges and near-death experiences and survival—I've built up a lot of expertise, knowledge, and learned a lot from people along the way, so it's been rewarding.”

Adam Mostafa will be speaking at the upcoming Finance & Accounting for Biosciences.

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