Fourth Industrial Revolution

Taking some of the uncertainty out of cancer treatment

In the dystopian sci-fi film Elysium, the world of 2159 possesses a scanner that can simultaneously detect and treat cancer in a single pass. This technology may seem like magic compared to the cancer treatments of today, but in the words of famed science fiction writer Arthur C. Clarke, “Any sufficiently advanced technology is indistinguishable from magic.”

We are a long way away from a machine that can instantly cure cancer. Too many cancer patients, survivors, and their families still have to spend years mired in prolonged treatment plans and the uncertainty that comes with them. At Guardant Health, we have commercialized technology that is quickly bridging this gap. Our goal is to create a new, smarter paradigm for cancer treatment that is not only more effective at catching the disease, but also better at treating it.

Going blindly into battle

Mainstream cancer diagnostic tests use blood or radiography to detect the progression of cancer. However, they fail miserably when it comes to deciding what should come next in a patient’s treatment plan. As an oncologist friend of mine put it, “A CT scanner tells you the what, but not the why.” The “why” is critical. Without it, oncologists are not able to figure out why a current drug regimen failed, nor to subsequently match their patient with next most appropriate therapy.

This approach is like devising a war plan based only on information gathered before the war began. That information is hardly relevant six months into battle, let alone five years later. Unfortunately, this is close to the current state of solid tumor oncology. Why don’t oncologists collect the requisite information for effective treatment management? Because historically, the only way of charting the next course of treatment for solid tumor cancers, such as breast, lung, and prostate, has been to physically cut out a piece of the tumor and run molecular testing on that specimen — i.e., biopsy molecular profiling. This repeated testing is necessary because like HIV, cancer can be highly genetically heterogenous and tends to develop new genomic mutations under therapeutic pressure.

The reality is that individuals have “cancers” in the plural, rather than “cancer” in the singular. The disease changes over time. However re-biopsying beyond the point of initial diagnosis is often not performed, especially in the community oncology setting, due to difficulty, cost, and risk to patients. As a point of reference, a minimally invasive lung biopsy costs an average of $14,000 when the 19.5 percent complication rate is factored in. Furthermore, oncologists are often (and understandably) reluctant to subject already-frail patients to additional risky procedures that may prove fruitless. As a result of these considerations, patients are often placed on subsequent treatment regimens empirically, after progression of the disease.

As you can see, there is a real-time information gap in cancer that prevents patients from getting the best possible care. My background is as an engineer, and I spent years witnessing the mind-blowing pace at which we gather information in all other areas of our lives. We are now able to track everything from our heart rate to how our mood fluctuates throughout the day, and so the existence of an information gap within cancer treatment both surprised and alarmed me.

Upon further examination, I discovered that this gap does not derive from a lack of spending. The U.S. spends over $130 billion a year on direct healthcare costs related to cancer. Today, there are a multitude of drugs priced at more than $100,000 per year per patient, and yet the overall survival rate for many cancers has only improved by a couple of weeks to months. The progress is so slow that cancer will soon surpass cardiovascular disease as the number one killer in the America. I believed there had to be a better solution.

The billiards table of oncology

The inspiration for Guardant Health actually came from my experience playing billiards back in high school. When playing pool, the probability of completing a successful combination shot grows non-linearly with every ball you add. Two, maybe three, ball combinations are possible, but anything higher remains out of reach. I later learned in an advanced physics course that a six or seven ball combination shot is so complex that successfully pulling it off requires incorporating the gravitational pull of every object and person in the room.

How does this relate to cancer? Well, if you were able to adaptively manage the course of each ball in the combination, one collision at a time, then you could theoretically pull off a near infinite combination. The same principle applies to oncology — adapting treatment one step at a time is the only way to keep up, and even get ahead. This is precisely what solid tumor oncology is missing: a tool that enables adaptive management of the disease in real-time. This is what my cofounders and I set out to build with Guardant Health. What emerged was a robust tool called Guardant360 that empowers oncologists to see, track, and monitor the genomic evolution of a patient’s cancer via a simple blood draw.

Based on just two tubes of blood, Guardant360 sequences a patient’s cancer across dozens of genes to identify genomic alterations and associated treatment options in real-time. Oncologists are able to “go into battle” with a much clearer idea of what they are fighting and the best strategies for overcoming the specific and dynamic disease.

Since the launch of Guardant360, we are seeing a new era in oncology where patients are finally being matched with effective therapies at an impressive rate. What I found most surprising was that many of these successful outcomes were not brought about by ground-breaking compounds in clinical trials, but rather by treatments that have been around for some time. The key difference was the ability to know when the cancer had evolved into a different class of disease, and thus to adapt treatment accordingly, to therapies already approved by the FDA.

This is extremely encouraging but only scratches the surface of what is possible with this technology. Guardant360 is the biological equivalent of a search engine for cancer in the body. We are starting with patients that are in greatest need, those with late-stage cancer, but this technology will soon give peace of mind to tens of millions of cancer survivors who live in fear everyday that their cancer will return. Eventually, our technology will extend to even broader swaths of the population with its ability to detect cancer at the earliest stages, when it is the most curable.

When you combine Guardant Health’s innovations with concurrent advances in cancer therapeutics and staggering performance increases in DNA sequencing, at last the future looks much brighter for our collective fight against cancer.

This article is published in collaboration with Medium. Publication does not imply endorsement of views by the World Economic Forum.

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Author: Helmy Eltoukhy, PhD, is a biotech pioneer with deep expertise in next-generation digital sequencing technologies and genetic analysis systems.

Image: A radiologist examines the brain X-rays of a patient who underwent a cancer prevention medical check-up at the North Bengal Oncology Center, a cancer hospital, on the outskirts of the eastern Indian city of Siliguri February 25, 2009. REUTERS/Rupak De Chowdhuri. 

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