Copied from here: https://xconomy.com/national/2019/04/03/aacr-2019-roundup-no…
Take aways: Guardant in the lead, but Resolution Bio’s test uncovered more information. Guardant’s vision and roadmap sounds compelling.
Full text follows:
Guardant Health (NASDAQ: GH) is one of several companies with a blood test to help doctors prescribe drugs based on the genetic profile of a patient’s diagnosed tumor. Data at AACR showed that the test, called Guardant360, could be an alternative to tissue-based biopsy for newly diagnosed lung cancer.
Also at AACR, a smaller firm called Resolution Bio presented data that its test uncovered more “actionable” information about patient’s lung tumors than Guardant360.
So-called liquid biopsies, which genetically profile a patient’s cancer or flag its return after remission, are becoming more established by the day. While access to the tests and understanding their results has caused concern, Medicare has begun covering their costs.
Developers like Guardant are also aiming for a bigger target: Screening tests that find cancer before a person develops symptoms. As does its well-funded rival Grail, Guardant wants eventually to deliver a screening product that only requires a blood draw. It is following a cautious roadmap, as Xconomy described when Guardant’s effort, dubbed Lunar, was unveiled three years ago.
Only recently, Guardant made Lunar available to drug companies and researchers. It’s not close to being an on-the-ground diagnostic tool. Guardant first wants to show that Lunar can characterize previously diagnosed tumors. It took a first step in that direction with a small study in colon cancer unveiled at AACR. It’s extremely early days, as Vantage pointed out. Of the 105 patients in the study, only 25 had early-stage cancer. It is those patients, ultimately, that Guardant and its rivals want to detect. The earlier a tumor is treated, the more successful the treatment could be. The trick will be to make cancer screening as accurate as possible, because screens that give false results can do far more harm than good.
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Reading the poster, it seems like Resolution Bio(RB) has a better product. But that’s what a product poster should do. http://www.resolutionbio.com/publications/AACR2019_DFCI_Fusi…
It also seems odd to me at how low the identification rate is for GH.
They boast 77 out of 282. Which is better than 60 out of 282 for a tissue based testing. It seems like GH has a 27% diagnose rate, but it could be for a specific mutation and that not all 282 of the patients have these specific mutations.
https://www.fiercebiotech.com/medtech/guardant-s-blood-test-…
To add further confusion between the two documents is that they reference the mutations differently between the two studies. RB puts a lot of reference to allele frequency, while GH never once mentions it in their studies. I have no idea if allele frequency matter or not. RB sample size is really small and raises the success rate of GH to 44%.
If any one has expertise in the medical field, it would be enlightening to further understand liquid biopsy.
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They boast 77 out of 282. Which is better than 60 out of 282 for tissue-based testing. It seems like GH has a 27% diagnose rate, but it could be for a specific mutation and that not all 282 of the patients have these specific mutations.
Not all 282 patients have those actionable mutations. In that study, only 48 mutations were discovered by both tissue-based NGS and Guardant 360. Tissue-based testing is the current standard. But liquid biopsy clearly can identify more patients that have targetable mutations.
RB puts a lot of reference to allele frequency, while GH never once mentions it in their studies. I have no idea if allele frequency matter or not.
Allele frequency is one of the most important parameters in sequencing test. The higher the allele frequency, the more sensitive the test is. In this RB poster, they focused on gene translocations, which are much more challenging to detect than other more common types of mutations such as point mutations and small insertion/deletions. Their result showed that RB is superior to GH to detect these translocation events.
I think liquid biopsy will play a significant role in cancer management and prevention, but the competition is fierce and the barrier to entry is not that high.
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“I think liquid biopsy will play a significant role in cancer management and prevention, but the competition is fierce and the barrier to entry is not that high.”
I finally had a conversation with my brother in law, who is one of the head pathologists at Cedars Here in Los Angeles.
Basically his view is that there are so many researchers around the world, many even at Cedars attempting to come up with all sorts of testing using liquid biopsy. At Cedars they are presented every week more and more research, researchers from around the world presenting their latest findings, that it’s literally changing by the day. So even if a test comes out that claims to be the best most thorough at finding cancer cells, a week later it can be surpassed, and another week that can be surpassed. That eventually one or two of the big pharmaceutical companies will buy up the most innovative research and most likely end up at the top.
For me, I have been down this biotech road before and it’s always been for me a complete crap shoot that I’ve many times ended up on the wrong side of.
I’m tempted to buy a very small position in GH as a roll of the dice, but only if it really takes a nose dive in stock price. Otherwise just too much of a gamble for my taste. I don’t see any moat here.
Chris
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I’m tempted to buy a very small position in GH as a roll of the dice, but only if it really takes a nose dive in stock price. Otherwise just too much of a gamble for my taste. I don’t see any moat here.
I’m also a pathologist and agree with you that there is not much moat here. As the first mover, Guardant Health may enjoy a few years of advantage. Other companies will catch up soon. It is also possible that clinical laboratories in medical centers will be able to perform the tests in-house in the future.
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