Cancer: From Risk Detection to Diagnosis to Personalized Response


NewCo Shift Forum

Three innovators in the fight to beat cancer

After short presentations from each (all linked in the following names), Jeff Huber, CEO of Grail Bio, Emily Leproust, CEO of Twist Bioscience, and Jill Hagenkord, Chief Medical Officer of Color Genomics, sat down with moderator Dr. Jordan Shlain for a quick panel conversation. Each represents a core portion of the DNA/Biogenetics revolution: Color is focused on cancer risk detection, Grail on cancer diagnosis at the DNA level, and Twist is focused on the creation of personalized medicine based on that diagnosis (among other things). For the full experience, watch each panelist’s presentation, then catch the video below, or read the transcript, edited for clarity.

Jordan Shlain: Earlier we talked about consumerization, insurance, and the healthcare system. We don’t have a healthcare system. It’s a bunch of patches. It’s like a quilt of patches that all try to fix some other flaw.

Health insurance is really a financial hedge. It’s not something that actually cares for you. It is not an investment in your health. You don’t have fire insurance to prevent fires. It just pays for the fire after it happens.

Let me turn to you Jill. I know that your stuff’s on sale now, but when do you foresee the commercialization where a person could walk into a doctor’s office, or an online store and say, “I want to buy all this, and use it.” When do we see that coming?

Jill Hagenkord: Color’s already on the market with the preventative hereditary cancer panel. It’s a physician-ordered test. It is leveraging the expertise of many of our founders and senior executives, who come from Twitter, and Google, and e-commerce.

You order it. You don’t have to take a day off work, wait and get hours of genetic counseling, then go wait in another queue to get a blood draw, then wait four weeks and come back, and do the same thing. Everything can be done from your home. Everything is accessible from the computer. It includes genetic counseling and support, even after you’ve gotten the results of your test, and ongoing support after that. We’ve been around on the market for a few years, and looking forward to continuing to extend our product portfolio.

JS: In healthcare sometimes it’s a zero-sum game. When one thing’s introduced, when there’s a winner here, there’s a loser there.

The healthcare system is pretty taxed. I said “healthcare system.” The healthcare freak-o-system is kind of taxed as it is right now. Is this adding more complexity into an already overtaxed system? Even though it’s the right thing to do, but as you’re going into the market, do you see that?

JH: We don’t see it, at least in preventative genetics so far. There’s a lot of people who have been studying this. Is it like those full-body CAT scans that you could get at the mall a few years ago, who would pick up all these incidental-omas, and then you’d have to spend a whole bunch of money chasing them down just to have them be nothing?

So far, the studies that have been done haven’t detected that. I think we still need to watch it, and monitor it. If you’re looking for adult onset preventable disorders with established preventative guidelines, really everything you detect starts to become actionable, and move the needle.

I do get the question often whether preventative genetic companies are competing with companies like Grail Bio, and I actually think they’re perfectly complementary. We detect the risk, you then take it from there.

Jeff Huber: Exactly. If you’re a person who gets a reading from Color that says you’re at elevated risk, what are you going to do then?

The answer that we hope to provide very soon is the Grail test, which gives you the opportunity to screen and monitor, “Did I go from an elevated risk state to actually it being manifest cancer?” If you’re in that state, you want to catch it early to get the best outcome possible.

On timing, we are working very hard. Grail is a young company, but we didn’t start from scratch when it was announced a year ago. We’re building on two-plus years of work that was around the core science and biology, and great work with Memorial Sloan Kettering.

We’re in a new phase now, though. We’re doing our clinical development plans to ultimately make the case of demonstrating clinical rigor, from clinical evidence to clinical utility to impact on patients and improved outcomes, i.e., saving lives, and then ultimately demonstrating the healthcare economics.

That process is a significant investment in time and money. We anticipate that that’s a, on the order of four-year path for us, that is roughly a billion dollar path, which is what we’re raising, approximately, in our B round financing right now.

JS: A billion? That’s all?! Emily, of all the things that you listed, which are all fascinating, which ones are real-time working now? Which ones are near, and which ones are the most exciting to you?

Emily Leproust: They are all happening now with DNA. Just in December we shipped 10,000 genes. The research is happening. What’s most exciting to me is that though we are helping the healthcare system to go from a blockbuster drug where everybody gets the same drug, to a precision medicine, and then push that to personalized medicine.

If you look at the blockbuster drug, if you look at some of the clinical trials, you see that if you have a cancer, you take a drug, and the increase lifespan is one month.

You think, “Oh, that’s awful. You take all that treatment, spend all that money, it’s a one-month improvement.” I tell you what happens is, for 90 percent of the people there’s no improvement, but for 20 percent of the people you get 5, 10, 15 years.

The benefit of testing and writing DNA is, as you move to personalized medicine, everybody gets the 10, 15 years benefit, but it’s all a different drug. That’s what’s exciting to me. That’s what we are very excited to accelerate through our DNA.

JS: With respect to the DNA and the storage that you talked about — doesn’t DNA threaten the gigantic storage market right now? Could the cloud be a DNA Cloud or something?

EL: DNA is a slow storage, meaning you know that you will have to wait six hours to get the data back. It’s never going to replace the hard drive. What it’s replacing is the catastrophic failure of storage; basically tape. Tape is not a sexy market, but it’s a $15 billion market.

If you can come up with a product based on DNA where you don’t need a giant freezer to store the tapes, spend all that money in power to keep those cool.. and tapes, you have to copy them every five years because the data goes away. Then when you want to read the tape, you really need that data, the machine that reads that tape has been broken for six months.

When you move to DNA, it’s very tiny. You need 100 watts, the power for a light bulb to store it, and when you want to read it in 10 years, it may be read by Lumina, which is the current leader, but in 10 years it could be another technology. It’s a universal format. Over time, DNA will overcome tape as data storage.

JS: I see a question from the audience…

Audience Member: Hi. Former bench scientist, so thumbs up on all the DNA stuff.

I think we’re dealing with sort of an adoption curve issue, where the market has a certain resistance to paying for this kind of thing, and there’s all kinds of economics mad market size and that kind of stuff, but how do you think we can catalyze adoption more quickly? I think that right now, technology is way ahead, in many cases, of the industry.

Jeff H: I’ll take a shot around the diagnostic or testing case. If you look at the costs in the medical system of late stage treatment, they’re astronomical. A individual case study, my wife, for 18 months of treatment of stage 4 cancer, the price tag was $2.7 million.

Contrast that. If, five years, ago the Grail test had been available and…pick a price point for our test. We want to drive it down as low as possible, but even initially, say it were $1,000.

If that had caught the cancer at stage 1 or stage 2, and she’d been able to have a $20,000 surgery where the prognosis of surgery for colon cancer at that stage is excellent — 90 percent plus — $20,000 for a cure and positive outcome, versus $2.7 million spent ultimately in futility of fighting a fight where the odds were against you from the beginning.

We’re working with the payer systems to be able to demonstrate, and as we’re structuring our studies, to be able to demonstrate those kind of economics at an aggregate level that we think can lead to not only saving many millions of lives, which is our focus, but also saving many millions or billions of dollars.

JS: We have time for one more question.

Audience Member: Now, most people in here, I think, have more of a familiarity with the digital revolution and the impact of that tech space.

Could you talk about the parallels of where we are in the life sciences, biotech, genomics space? Is there any kind of parallel, or are we where we were in ’90s in terms of its scaling up impact and maturity as a full-blown tech space?

EL: I think, just at the beginning, 15 years ago it took 13 years to sequence one genome, and now it takes a day and a thousand dollars.

The way I see it, biotech is a new tech. In the ’50s you wanted to be in aerospace, in the ’70s you wanted to be in semiconductors, in the ’80s in computers, in the ’90s in software, in the 2000 in Internet.

Right now, you want to be in biotech and biogenes. It’s just the beginning of a massive economic value creation, and a massive positive impact on the world.

JH: I feel kind of like the hardware’s matured, to a point where it’s like late ’80s, early ’90s, and what we need now is the software and ultimately the Google, to come sit on top of us and tell us what it all means.

We can detect it pretty reliably and pretty inexpensively. Now we just need to organize it and figure out what it all means and how to use it.

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