Excitement for detecting cancer before it grows and spreads is gaining steam. A start-up called Thrive Earlier Detection has launched with $110 million in series A financing to develop and commercialize liquid biopsies—or blood tests—that can spot the earliest signs of cancer in otherwise healthy people.
The company is based on the work of oncologist Bert Vogelstein and his Johns Hopkins University colleagues Kenneth Kinzler and Nickolas Papadopoulos. Last year, they published a study showing that a liquid biopsy they developed, dubbed CancerSEEK, could identify multiple types of cancer in people by analyzing fragments of just 16 genes and 8 proteins commonly mutated in cancer (Science 2018, DOI: 10.1126/science.aar3247).
Liquid biopsies have been plagued by high false positive rates. “The fraction of mutant DNA molecules is very tiny compared to normal DNA in blood,” Vogelstein says. It’s the classic needle-in-a-haystack problem. His group created a test with over 99% specificity, meaning that a little less than one in a hundred people would be wrongly told they had cancer. That may sound high, but it makes CancerSEEK one of the best-performing experimental liquid biopsies so far.
“Thrive is part of a shift towards investment in early cancer detection,” says CEO Steven Kafka, who helped launch the company as a partner at the venture capital firm Third Rock Ventures. Other companies, such as Guardant Health and Foundation Medicine—where Kafka was formerly president—already offer liquid biopsies to people diagnosed with cancer but whose physicians are looking for the best way to treat it. “That is a fundamentally different test from what will be offered at Thrive,” Kafka says.
Thrive, along with competitors Freenome and Grail, are designing strategies for spotting the earliest signs of cancer in the blood, with the hope that such diagnostics will help doctors treat cancer before it grows and spreads. “The target audience here is the primary care physician and healthy people as part of routine annual checkups,” Kafka adds. “So the specificity, the avoidance of false positives, is crucial.”
Although Thrive just launched, CancerSEEK is already being tested in a research study of 10,000 women between the ages of 65 and 75 at the Geisinger Health System in Pennsylvania. The results of that study will help Thrive optimize the algorithms used in the test, says Christoph Lengauer, Thrive cofounder and chief innovation officer. “It is machine-learning based, and the goal is to continuously improve it,” Lengauer adds.
Thrive’s large initial round of financing will be partly used to support the Geisinger study. That study will give Thrive direction for registering its own CancerSEEK trial, which it needs to earn US Food and Drug Administration approval.
If CancerSEEK is approved, cost will be a major factor in its adoption. Thrive wants the test to cost hundreds, not thousands, of dollars. “We are in that zone already, so this is not a pie-in-the-sky thing,” Kafka says. That price point would place CancerSEEK between mammograms, which can cost a couple hundred dollars, and Cologuard, a genetic colon cancer test that costs $649.
“We are aiming to have this be part of your regular checkup, and that bar needs to be low for that to happen,” Kafka says.
Thrive will also face the challenge of helping doctors explain what the results of CancerSEEK mean. If the test says a person has cancer, there is still a small chance that they don’t. And if the test comes back negative for cancer, the test may have missed it, or the person could have cancer caused by mutations not included in CancerSEEK’s small panel of genes and proteins.
For this reason, Vogelstein says, Thrive is more than just a cancer company. “It is a preventative health company, because some of the biggest challenges are communicating results with patients.”