Since the beginning of this year, the entire team of Qihe Technology has been very busy. The 2018 "CSCO-臻 and Oncology Precision Therapy Forum" jointly organized by the China Society of Clinical Oncology (CSCO) has spread all over the country, following the first in Shenzhen in May. After the station started, the Chengdu station meeting was the second period they held.
In the past two years, NGS-based cancer clinical testing service competition has entered a fever. Everyone hopes that this technology will enter the clinic as soon as possible, and can provide patients with real-time, accurate medication guidance, efficacy testing, prognosis, and drug resistance reasons, and assist in accurate treatment.
From investor to entrepreneur
Prior to founding this company, Du Bo had done research and management of drugs and made investments. In general, from graduation to work, he has not left the field of life sciences, and has accumulated a lot of experience and contacts in this field, providing a basis for later entrepreneurship.
In 2010, Illumina reduced the cost of sequencing to $1,000 and the industry was boiling. At that time, Du Bo was exposed to the field of NGS, and the advancement of technology is bound to bring great value. New methods may subvert our perception of disease.
"It has the potential to change the diagnosis of the tumor." Du Bo told the arterial network in an interview. The clinical application of NGS will lead people to re-recognize cancer from a deeper molecular level, and new methods may subvert our perception of disease.
“At the time, I felt that this was a very important market,†Dubo recalls.
Among his core teams, there are medical experts who have been working in the clinical-scientific research field for more than 10 years, and also have business management talents who have been engaged in the marketing of oncology drugs for many years in the world's top pharmaceutical companies. "Technology is progressing very fast. What's more important is how to quickly turn these things into reality and become diagnostic products and methods that patients can use." Du Bo said that in this field, he has done a lot of new things. explore.
In March 2018, the National Cancer Center released the "2018 China Cancer Report" (China's cancer statistics generally lag behind for 3 years, so this latest data released in 2014) shows that the number of new cases of malignant tumors in 2014 was 380. Forty thousand cases (2.114 million males and 1.69 million females), on average more than 10,000 people were diagnosed with cancer every day, and 7 people were diagnosed with cancer every minute.
The incidence of lung cancer ranks first in the country, with an annual incidence of about 781,000, followed by gastric cancer, colorectal cancer, liver cancer and breast cancer. Lung cancer and breast cancer are the first among male and female morbidity rates.
Clinically, a diagnosis of cancer usually requires a needle biopsy, which is traumatic and imposes a heavier physical burden on the patient. Not only that, the biopsy takes a part of the tumor tissue, there is tumor heterogeneity, so it can not accurately represent the entire tumor tissue. If the tumor is small, the puncture is also difficult to handle.
During the sampling process, the liquid biopsy is convenient and non-invasive, and it can also break through the limitations caused by tumor heterogeneity in tissue biopsy, representing the overall characteristics of the tumor.
The imaging methods commonly used in oncology often only judge the location of the tumor, and it is difficult to accurately determine whether it is benign or malignant (some experienced doctors can also directly judge according to angiography, but this The method relies heavily on the doctor's personal experience).
The emergence of targeted drugs and immunological drugs has brought tumor treatment into a new era. But a technology is not likely to solve all problems, whether it is a targeted drug or an immune drug, it is not effective for everyone.
The same drug does not necessarily have the same effect on patients with the same cancer. The molecular diagnostic technology based on NGS let us know why. Even the same cancer has different subtypes, corresponding to different mutation sites; anyway, if different cancers correspond to the same mutation site, patients may also adapt to the same drug. This is the classic "umbrella test" and "basket test" in precision medicine .
Not just treatment, liquid biopsy of ctDNA and CTC is also possible for early screening of tumors. This is of great value for the treatment of late tumors.
Not only that, because the liquid biopsy is less invasive, easy to sample, and can represent the entire tumor state, this technology can also be a powerful tool in the process of tumor treatment and monitoring after treatment.
It can be said that liquid biopsy subverts the modern medical understanding of cancer, but also subverts treatment, bringing more hope to doctors and patients.
JP Morgan predicts that the global market for liquid biopsy in 2020 will reach $23 billion, and Goldman Sachs predicts that the US liquid biopsy market share in 2020 will be $14 billion. Guosen Securities predicts that in 2020, the number of cancer patients using liquid biopsy in China will reach 5 million. According to the 50% penetration rate and the frequency of use of 4 tests per year, if the price of each test is 2,000 yuan, China 2020 liquid The biopsy market will reach 20 billion yuan.
On this basis, the value of liquid biopsy is not only the tumor diagnosis itself, but also commercial value and social value.
“1+Nâ€, multi-dimensional product to achieve comprehensive evaluation of tumors
Based on the established ctDNA extraction and quantitative detection technology platform, Yanhe Technology has built a platform for solid tumor concomitant diagnosis, prognosis assessment and drug guidance technology based on non-invasive detection in China, including lung cancer, colorectal cancer, liver cancer, esophageal cancer, Detection of pancreatic cancer such as endometrial cancer, ovarian cancer, and cervical cancer.
"In addition, 臻 and not only do non-invasive blood testing platforms." Du Bo told the arterial network, in addition to blood testing, they also established a technical platform for tissue testing.
Image courtesy of Yuhe Technology
Du Bo believes that in order to achieve a comprehensive assessment of the tumor, it must have a multi-dimensional evaluation method, which requires the company to invest a lot of time and energy.
In the process, Qihe Technology has also carried out a variety of new attempts, such as immunotherapy, targeted therapy and adjuvant diagnosis of radiotherapy and chemotherapy.
In the true sense of disruptive innovation, in addition to innovative technology, an environment that enables it to grow upwards is also very important. Du Bo revealed that Qihe Technology has done a lot of work on the quality control and medication guidelines.
At present, all blood samples on the NGS technology platform will be tested for EGFR, and the double-edged calibration of the NGS platform and the ddPCR platform will ensure accurate detection of medication guidance.
How NGS can help clinical tumor detection
So, in the end, how does this technology help clinical cancer diagnosis and treatment?
“This industry is very special, both application and exploration.†Du Bo said. On the one hand, they need to collect and organize existing information and data; on the other hand, they also need to constantly explore new information and evidence.
He explained to the arterial network that the tumor itself changed rapidly and the corresponding treatment plan was also changing. According to news reports, in 2018, a patient who had stage IV breast cancer and had been transferred to the whole body was completely cured. This was completely unimaginable in the past. “This success is not an accident. This trial has also been proven to be repeatable,†he said. “We are going to use existing, well-defined evidence to help patients with treatment. But at the same time, we also use these tests. Work with your doctor to explore the new combination of treatment and diagnosis."
Liu Lunxu, deputy director of Huaxi Hospital, told the arterial network: "Comparative to solid tumor tissue biopsy, the sampling of liquid biopsy is much less difficult, and it is like checking a blood routine for patients."
For doctors, liquid biopsy is a powerful tool for the treatment process and prognosis prediction. Liu Lunxu told reporters: "It can reflect the surgical situation on many levels, such as whether the tumor is removed, whether there is any metastasis after surgery, and even predict the survival of the patient."
The biggest significance of this process is to guide doctors to take medicine. Based on these mutations, it is predicted which patient will respond better to which drug. “A lot of research shows that this is valuable in the treatment of cancer. But there are still many rules in this field that need to be explored,†he said. “Overall, the future is very promising.â€
How is this technology working in the clinic?
As a surgeon, he has a more personal experience in the clinical value of liquid biopsy.
The first is reflected in the accuracy of treatment. "Whether it is medical treatment or surgical treatment, the choice of treatment options is more accurate than before." Liu Lunxu said. In surgical procedures, which patients are suitable for surgery, the extent of surgical resection, and how to accurately locate before and during surgery, liquid biopsy gives quantifiable indicators. Before that, most of them relied on imaging or personal experience of doctors.
Image courtesy of Yuhe Technology
“In surgery, the main problem with liquid biopsy is to get the fastest, maximum recovery in the smallest trauma conditions, while at the same time achieving the longest life span,†he said.
The other part is reflected in new treatment options such as targeted therapy and immunotherapy. Liu Lunxu told the arterial network that advanced tumors that were previously incompletely treatable may have a marked improvement in taking these drugs, and some patients may even survive with long-term disease.
However, not all patients are eligible for these drugs, and some patients develop resistance after a period of medication. If a new mutation is detected by the test after the patient develops resistance, the mutation has a drug that can be used. Then, although the patient's condition has recurred, but through the genetic test to find a new drug, you can continue to use the drug to survive.
"In this case, a disease that was dangerous and fatal in the past can slowly become a chronic disease." He added, "The effect of treatment has improved a lot now."
"Of course, there are still some tumors that we have not yet overcome," he continued. The condition of each tumor patient is different, and the mutation of each cell in different tumors may be different. A drug that does not cover patients of the same cancer.
"Some patients may have commonality, they can apply the same drug. But now the precise treatment is accurate to a class of people. In the true sense, our goal is to be accurate to each patient and achieve individualized and precise treatment." Liu Lunxu Said.
Due to the high degree of inhibition of the tumor, there is a high probability of conversion or new mutations during the treatment. "So if you want to solve the tumor problem truly and completely, I want to make customized drugs and treatments for each patient in the future, in order to cope with the situation of the disease." Liu Lunxu said.
He revealed that in this respect, Huaxi Hospital has also done a lot of basic application research, including tumor immunity and tumor microenvironment. "Immunotherapy is another major direction in precision treatment. But this is only the beginning," he said.
Explore while applying
It is understood that Qihe Technology and Huaxi Hospital have already carried out research cooperation on clinical exploration of genetic testing, including NGS-based treatment prediction, medication guidance, survival prediction and so on.
And Hehe Technology itself is also doing a lot of cutting-edge exploration. In addition to the precise treatment of non-small cell lung cancer, which is currently in the forefront, they have also studied the immunotherapy of solid tumors such as digestive tract tumors.
"Some patients have a very good prognosis after taking the drug, and some patients are progressing faster than without drugs. We have explored these phenomena," Dubo said. These cases are very high in patients with digestive tract cancers, up to 20%. In other words, this part of the patient accelerated the death after taking the medicine.
"This situation requires a lot of screening, and we have done a lot of research, especially in the data accumulation," Du Bo said.
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