Pushing boundaries in cancer diagnosis

Dr Ravi Gaur, COO, Oncquest Laboratories in a candid conversation with Prathiba Raju talks about how Oncquest lab’s advanced diagnosis has brought in precision, affordability in cancer diagnosis in India

How is molecular hematology and surgical pathology services is evolving in India. Oncquest Laboratories has a special focus on molecular oncology, can you tell us how  have you evolved and progressed in the field?

Established in 2000, Oncquest Laboratoriesis known for its excellence in molecular diagnosis and its core competence in cancer diagnosis. Its key business areas include molecular diagnosis (oncology and infections ), advanced diagnosis, general pathology and microbiology, hospital lab management, clinical trails, and R&D. With over eighteen years of experience under its belt, Oncquest has established itself among India’s largest cancer diagnostic networks. It is a College of American Pathologists (CAP) and National Accreditation Board for Testing & Calibration Laboratories (NABL) accredited centre, with a core focus in Molecular Pathology and Surgical Pathology Services. The logistic capabilities and Pan-Asia geographical spread, makes Oncquest an ideal associate for all clinical activities in India and neighboring countries.

Oncquest utilises the experience and expertise of trained scientists and pathologist to provide clinicians an incisive diagnosis to identify the disease process at the fine point of differentiation. Recently, it has extended its arms in the areas of Companion Diagnostics and Pharmacogenomics which has encouraged greater penetration of personalised medicine into the Indian healthcare market. This is a way towards the future epicentre of the much technological advancement in healthcare.

What are the latest trends within the diagnostic market in India, particularly in cancer diagnostics?

Looking at the current data, the combined healthcare spending in the major influential countries across the globe is expected to reach $8.7 trillion until 2020 while in 2015, it was USD $7 trillion. And, the healthcare industry in India is one of the fastest-growing sectors worldwide; in fact, the experts expect it to reach $280 billion by 2020. The expenditure on R&D in the healthcare industry in India is increasing by the passage of time as more and more Indian healthcare companies, especially pharmaceutical, are collaborating with foreign companies. Today, India is able to attract high capital investment in the industry’s advanced diagnostic facilities as it’s the prime choice for high-rated diagnostic services and medical equipment.

As the lifestyle-related diseases are increasing at an alarming rate, people are being health-conscious and aware of life-threatening diseases like cancer, for which effective treatment is not guaranteed. This has led to an increased spending on cancer detection and diagnosis by consumers. Therefore, the demands for accredited cancer diagnostic centres as well as home-based diagnostic services, as a recent trend, continues to spur. Secondly, we see a rise in technological investments, which is immensely benefiting hospitals, diagnostic centres as well as R&D facilities and education for improved diagnosis facilities and services.

Oncquest is more  like a multi-platform pathology service provider what’s your core focus, how will you expand it further?

We are planning to come up with precision diagnosis, nephelometry, and immunofixation to further broaden our service spectrum. Though we have strong presence in New Delhi, Bangalore, Chennai, Chandigarh, Coimbatore, Hissar, Mumbai, Hyderabad, Jalandhar, Ludhiana, Indore, Patna, Pune, Panchkula, and Surat, we aim to get Pan-India presence. We are also looking forward to creating a vast and effective network of hospital laboratories management services in international markets, particularly in Bangladesh, Nepal, Sri Lanka, and other adjoining countries. Oncquest has tied up with almost all leading cancer hospitals pan India. As of now we have 38 independent labs Pan-India and we will be adding 25 more labs within the next two years.

What is your take on PPPs  in diagnostics market space?

Public-private partnerships (PPP) have the potential in bringing innovation into the healthcare sector. Both public and private sectors can leverage the strengths of each other in terms of resources, management, expertise, knowledge, and skills that would meet the public needs. The government can partner with private healthcare service providers for working on specific contractual projects where the responsibilities of designing, construction, financing, and maintenance etc., can be managed by private hospitals using their adequate resources and medical expertise.

Why do you think Indian market is important for cancer diagnostics, what are your plans for the next five years?

We see the rise of technological investments in the healthcare infrastructure, which is immensely benefitting hospitals, diagnostic centres as well as R&D facilities and education for improved diagnosis facilities and services. In fact, the cost-efficient and competent technologies in cancer diagnostics facilitate the creation of new drug testing laboratories and hence, the discovery of breakthrough therapies to treat cancer such as immune-oncology and adoptive cell transfer-based treatment.
In light of the growing importance of preventive healthcare, Oncquest is focused on building exclusive tie-ups with experts in the fields of genetic testing to bring newly specialised as well as general health-related tests to India. We are also working on bringing the best and most advanced technologies available in oncology, cardiology (cardio genomics), infertility, prenatal, infectious diseases, metagenomics and genetic testing to India.

What are new advanced assays which are being offered and why do you think Oncquest is preferred to when it comes to BCR/ ABL &MRD(minimal residual disease) testing?

BCR/ABL testing with International Scale reporting – helps in the diagnosis and monitoring of Chronic Myelogenous Leukemia (CML) and few, though rare Acute Lymphoblastic Leukemia (ALL). Both these cancers affect the mature blood cells and their precursors in the bone marrow; Chronic Myelogenous Leukemia and certain types of acute lymphoblastic leukemia are caused by the product of abnormal BCR-ABL gene fusions.

We perform over 60 per cent BCR/ABL testings and 70 per cent MRDs testings across India. The reason is Oncquest has a highly skilled team of doctors and scientists, trained in most advanced technology-driven platforms and geared up to deliver with globally accepted quality norms. Team Oncquest is well integrated with clinicians and patients to provide final and correct diagnosis which can help the clinicians in designing personalised and target based therapy, early diagnosis and its recurrence. Today, Oncquest is well known for providing final opinion for complex medical cases.

What are the latest cutting-edge technologies adopted by Oncquest laboratories?

Oncquest offers one of the largest test portfolios especially molecular oncology, in exploratory and end-point biomarkers, genomic services and surgical pathology. Its specialised services cover over 1500 advanced technology based assays spl based on Next Generation sequencing, Rt_PCR & Multiplex PCR, Digital droplet PCR , ten colored Flowcytometry , Immuno Histochemistry ,Advanced Bone marrow assays, infertility assays ,automated microbiology & ELISA’s ,immunology etc., comprising screening, early and final diagnosis, monitoring and prognosis.

Oncquest is a preferred partner of global pharma companies and CROs (Contract Research Organizations) for clinical trials (Phase I – Phase IV). The lab also provides Patient Support Programme, clinical trials, and validation study on patients to bring down the cost of diagnosis and treatment along with prominent epidemic study.

Acknowledging the pathology space, the centre offers almost entire spectrum of biochemistry, immunology, hematology, clinical pathology and microbiology helping in clinical diagnosis, prevention, prediction, early diagnosis, monitoring and much more. Today, it has a state-of-the-art Molecular and Clinical Diagnostics Referral Laboratory, with a national footprint of over 36 laboratories, 250 collection centers and 1400+ service associates across India and South East Asia.

Oncquest Laboratories has launched many new advanced assays and technology-driven platforms for the first time in India. With rapid advancement and availability of new technology, many more new assays are now being offered including the NGS-based assays for better and focused tumor profiling, liquid biopsy for very early diagnosis of cancers, and Minimal Residual Disease (MRD) in leukemia. The recently launched tests include final diagnosis of cancer on tissue, FISH-based assays, Bone marrows for Myeloma and blood cancer – leukemia, and cytogenetic testing for haemat malignancies.

. The centre is continuously improving its TAT (Turn Around Time) and technical platform with an aim to transform the healthcare space. These advanced assays have helped researchers, clinicians and patients to understand molecular basis of cancer and plan more specific and successful target based therapies.

What is your opinion on the Ayushman Bharat programme,  which offers free diagnostics facilities?

Ayushman Bharat is a good initiative by the central government, it’s success depends on the implementation of it at the town level, we are sure the policy makers must have thought about it. The new programme will help in the improvement of the healthcare infrastructure in both the urban as well as rural areas. Diagnostic services should be made accessible to all whereas the investments should be made on health IT systems. Patient-care, as well as the affordability of good healthcare services, is a challenge for the government today. To deal with this, the focus can be laid on the PPP to speed up the strategic planning towards upgrading healthcare facilities and implementation process at a larger scale.

What are the main challenges in the diagnostic industry ?

The challenge the industry faces are the neighbourhood diagnostic labs, which have opened like barber shops. There are no regulations or set of guidelines to open a lab. I would not say all neighbourhood labs are bad certain pathologists owned labs do good work, but there are a lot of labs which are owned by technicians which do not have any adherence to quality. They use Korean and Chinese made test kits which are of cheap quality and offer tests at low cost. For the last three years the diagnostics industry is not able to increase the MRPs and the structured labs suffer. Public should understand that structured labs are giving accurate results and they adhere to strict quality mechanisms.Due to such low cost neighborhood diagnostics in the last three years structured labs have not increased their MRPs. Only about 25 per cent of the diagnostics industry is captured by structured diagnostic labs, which does a business of about Rs 4000 to 5000 crores rest is with the unstructured neighbourhood labs, which also includes hospitals which have their own integral labs but we don’t have a data on hospital labs. I hope the neighbourhood labs can be phased out gradually if the policy makers strictly implement the Clinical Establishment Act.

How cost effective are your tests and how do you balance quality and affordable price?

Oncquest is a preferred partner of global pharma companies and CROs (Contract Research Organizations) for clinical trials (Phase I – Phase IV). The lab also provides Patient Support Programme, clinical trials, and validation study on patients to bring down the cost of diagnosis and treatment along with prominent epidemic study. We develop the test in-house which are present in the international market so this helps us in cutting the cost of the testing. For example for a EGFR ( epidermal growth factor receptor ) testing of lung cancer will cost almost ` 20 to ` 18,000 in US but we offer it for ` 6000 in India, it is fully validated. People trust us and most of them approach us for the end diagnosis, as our tests are accurate.