The world is moving towards precision medicine at a rapid pace, particularly for critical and chronic illnesses such as cancer. However, in Asia Pacific, treatment decisions are limited to one-size-fits-all guidelines, particularly in India, where healthcare is largely affordable but standardised to a degree that specialised care is prohibitively expensive.
For instance, in India, there are about 2.5 Mn active cancer cases and 1 Mn cancer diagnosis are happening each passing year. Many healthcare experts also said that 50% of the patients diagnosed globally belong to the Asia Pacific regions, accounting for 9 Mn cancer diagnosis, annually.
Despite the high density of cancer cases in India and Asia, the primary genomics data which can help deliver advanced treatments is based on Caucasian population and mostly comes from the Western markets and developed countries like the UK and the US. So the big effort is to build up the genomic data capacity in India to inform diagnoses, treatment selection and cancer management.
Startups such as Bengaluru-based 4BaseCare, which is currently working on localised genomics data that is specific to an individual’s ancestry and ethnicity, are at the forefront of the genomics revolution. In addition to 4BaseCare, MapMyGenome, MedGenome, Strand Life Sciences, Onco, Positive Bioscience, Novogene, Ambry Genetics, Invitae, and CeGat among others are also working in this budding field within the broader healthtech ecosystem. Besides providing gene-based medical reports and exposing risks in the long run, the big part of the effort is to build a genome data bank that can one day be used to provide advanced treatments faster and detect diseases such as cancer at an earlier stage.
4BaseCare offers personalised cancer care solutions specifically designed and targeted to each form of cancer and the risk level for an individual, based on data from Indian patients. At times, if a patient’s genetic background is not represented in the cancer biobank, chances are that patient might miss out on certain cures, said Hitesh Goswami, cofounder and CEO.
Cancer biobanks are complex systems where large amounts of medical data and tissue samples are systematically stored digitally and programmed, which is primarily used for research purposes and for recommending treatments at scale.
Leveraging advanced genomics techniques, at present, a lot of genomic-driven, research startups are burgeoning in the ecosystem.
Speaking to Inc42, Goswami said that most companies in the space today provide diagnostic tests, based on global genomics data. Even if a majority of the companies do provide genomics solutions in cancer care, it is just a tiny speck in their large portfolios.
4BaseCare, on the other hand, is completely focussed on cancer care, he claimed, and develops gene panels based on the comprehensive DNA and RNA profile collected from thousands of Indian cancer patients. Currently, the company has generated close to 1000 patients data in India — it also claims to be the first in the world to do population-specific genetic tests, identifying specific tumour mutations and providing tailored treatments for cancer patients.
“The whole idea was to create a solution that is precise, personalised and population-specific, completely focused on the research and genomics data collected from the Indian population,” said Goswami.
The Long Road Towards Precision Cancer Care
Founded in 2018 by Goswami and Kshitij Rishi, best friends since the start of their professional careers at Piramal Life Sciences. Before venturing into 4BaseCare, Goswami had cofounded a genomic startup called Bionivid Technology in 2011, which offered tech and research-based solutions to researchers, doctors and hospitals in the genomics and genome informatics space.
Rishi moved from Piramal to Deloitte Consulting after an MBA, where he was working for the healthcare and life sciences department. After this, he worked at GE Healthcare for five years, before the entrepreneurial bug bit him, and he joined forces with Goswami.
Both had always been fascinated with the latest technological trends in the healthcare industry so it was a good fit. They also knew the gaps that existed in precision medicine and genomics, particularly in the oncology space due to their line of work. As they looked for solutions to the existing industry problems, they met Dheeraj Jain, managing director of Redcliffe Lifesciences, and Lalit Wadhwa, an angel investor.
It was also chosen by the Illumina Accelerator programme and is one of the first Asia pacific companies to have graduated from this programme. The company also won a grant of $70K from the Karnataka State Government, under the Elevate programme in 2019.
The Four Pillars: Allied Care, Global Research, Technology And Clinical Care
At present, genomics technology has evolved, thanks to techniques such as next-generation sequencing (NGS), where the profiling of tumor samples has become much more efficient, cost-effective and faster, compared to the first Human Genome Project (2004-2020). Sequencing the first human genome for cancer took about fifteen years and cost about $3.2 Bn, said Goswami, so it needs to be made more cost-efficient.
But 4BaseCare claims that it can complete genome sequencing for 20 to 30 individuals in a day, thereby significantly reducing the cost, effort and time. “We are personalising cancer care using genomics and digital health technology. Genomics is our forte. But, when it comes to leveraging digital healthcare platforms, we are only looking at it as a support system, and don’t want to go deep and become another healthcare application company where we offer hospitals and doctors personalised apps and tools to manage their workflow,” Goswami clarified.
Adding to this, Rishi told Inc42, that currently its digital application called the 4Care App is restricted to its patients that take tests from 4BaseCare. The app lets them manage their medical records, online doctor consultation, order medicines, onco-specific tags, ask for a second opinion and more. “This has also given us time to improve the app, customise it before we make it available for cancer patients across India,” Rishi said.
“For providing personalised cancer care for patients, we have identified four key areas, which includes allied care, global research, technology and clinical care. Today, all these areas are working in silos, therefore at 4BaseCare we are working towards bringing them together,” added Goswami.
4BaseCare is currently backed by industry leaders and experts such as George Church, professor at Harvard Medical School and MIT (also known as the father of synthetic biology); Dr. Sandeep Nayak, director of surgical oncology, robotic and laparoscopy at Fortis Hospitals; Dr. Amit Dutt, principal investigator at ACTREC, Tata Memorial Centre, Mumbai among others; and Dr. Giridharan Periyasamy, head of Centre for High Throughput Phenomics (CHiP-GIS) at the Genome institute of Singapore among others.
Can Genomics-Based Care Be Affordable?
The biggest hurdle in this space is that genomic-based treatments are often out of reach for ordinary Indian consumers. Cost-wise, today a lot of companies that offer 150+ gene panel testing, charge anywhere between INR 50K to INR 80K. However, 4BaseCare’s smallest 352 gene panel test costs about INR 30K. “We are trying to minimise cost based on various efficiencies, which can be brought down through collaboration,” added Rishi.
He said the best way would be to help oncologists by providing them maximum data to make the best decisions at a lower cost. In 2018, the company launched a set of gene testing solutions, where the smallest test was 352 gene panels, where it not only provided mutation data for those genes, it also showed allied biomarkers such as tumour mutation burden (TMB) or microsatellite instability (MSI) and others.
Currently, with a team size of 14 members, 4BaseCase has tied up with over 20 hospitals, primarily cancer care, multispeciality hospitals and diagnostics chains. In addition to this, it has provided reports close to 350+ patients
4BaseCare is in talks to raise funds to further build its research team and expand in India and the Asia Pacific regions. Goswami said it is also looking at setting up a testing lab in Singapore. “We will be creating a unified healthcare solution for cancer care through a collaborative approach, because, together, we can beat cancer.”