Primed with experience from their stints in bluechip research-driven companies like Piramal Lifesciences and GE Healthcare, two researchers turned entrepreneurs set out to solve two major challenges in oncocare: bringing advanced precision oncology technologies to India and reducing the price of such tests.
Still in its early days, yet onco-tech platform 4baseCare promises to cut the cost of genomic-based tests to at least 1/4th of the current costs. Incorporated in May 2018, the company bagged funding from reputed investors as well as the Government of Karnataka and has an advisory panel of scientists and oncology surgeons. It is reportedly the first company from the Asia-Pacific to be selected by global genomics leader Illumina for their Illumina Accelerator 10th funding cycle, to develop advanced genomics-based applications to personalise the treatment of cancer patients based on Indian population-specific genomic markers. With partner hospitals in 13 locations and a lab in Delhi, co-founders Hitesh Goswami, CEO and Kshitij Rishi, COO, 4basecare give more details of their entrepreneurial journey, business model and strategy to Viveka Roychowdhury
How is 4baseCare different from other digital/medtech start-ups? How does it work?
4basecare is a precision oncology company developing solutions using technologies like Genomics and Digital Health technology to personalise patient care in oncology.
There are multiple differences between 4basecare solutions and the other medtech/ digital health startups
The primary difference is 4basecare’s strong focus on oncology (unlike others who want to use the same solution across various care segments, thereby limiting the scope of personalisation). The 4care app has been designed under the guidance of both oncologists and cancer patients to specifically support them in their fight against cancer.
Another major differentiator is that unlike other companies who either focus on genomics or on digital health tech, our solution utilises a combination of both the technologies to provide personalised recommendations towards patient care.
How did you as founders get the idea to build such a platform? Why did you choose oncology?
As founders, we have deep expertise from research to retail marketing in both genomics and healthcare.
During our research days in Piramal Lifesciences, Hitesh was a part of the team working towards identifying novel therapeutics in cancer, diabetes and inflammation. Kshitij was a part of the vaccine development team working on the development of nano-particle based vaccines for cancer.
Post this, Hitesh got involved in genomics and in 2011 founded a company which was providing genomics-based services to various academic and private organisations across India and Asia. During this time he was able to understand the applicability of genomics across various stages of drug development and also the current acceptance of these technologies in the clinic
Kshitij did his MBA XLRI and had always been excited to continue working in the field of healthcare and life sciences. Prior to starting 4basecare, for close to five years, he was a part of the GE Healthcare’s Education Team in India where he enabled the development and execution of various pieces of training related to imaging for various healthcare stakeholders including the cardiologists/ oncologists etc. This also helped him in understanding the current healthcare ecosystem of the country.
It became exceedingly clear to us that there is a large need of bringing the advanced precision oncology technologies to our country where every year there are more than 1 million new cancer patients diagnosed. The objective would be to increase the affordability of these technologies through innovative solutions so that more and more patients are able to benefit from the use of the same.
Also, we realised that just like DNA (code of life) there are 4bases (A-T-G-C) of Cancer Care ecosystem which supports cancer patients, viz: Allied Care (psychologists, nutritionists, NGO’s, etc.), Technology (Genome Sequencing, Digital Technology, AI, Gene Editing, etc.), Global Research (Cancer Researchers, Cancer Drug Discovery companies, etc.) and Clinical Care (Oncologists, Hospitals, etc.).
All these four bases work towards the benefit of the cancer patients, but unfortunately as of now, they work independently, in silos. 4baseCare was established with a vision to bring all these 4bases on a collaboration platform and work together to bring about a positive impact on cancer care and outcomes. We envision to achieve this through collaborative and applied research with the use of advanced technology like AI, machine learning and genomics.
How have you been funded so far?
In terms of cash investment, the company has raised close to $230,000 until now.
This includes angel investment of approximately $80,000 from Dheeraj Jain, a leading Indian angel investor and Lalit Wadhwa, an angel investor and businessman, as investors and promoters.
Along with this, as a pre-seed investment, the company recently raised $100000 from First-In-Venture – US-based investment firm. In addition to this 4basecare won Elevate 2019 with a grant amount of $50000 last August.
Apart from the cash investment, 4basecare is the first company ever from the Asia-Pacific region to be selected by Illumina accelerator for their 10th Funding cycle (https://sapac.illumina.com/science/accelerator.html). The selection has entitled the company to be able to launch a massive R&D project which would be worth approximately $1.5 million in terms of the sequencing and scientific expertise being utilised from the program.
What will be the business model, the roll-out plan/strategy?
4basecare generates revenue through its in-house genomics test panels.
We have already launched our TARGET portfolio and Germline test portfolios. TARGET Stands for (Tumour Associated drug Response by Genomics Testing).
Our TARGET portfolio allows a better understanding of an individual’s disease through deep molecular profiling of the tumours and provides precision therapeutic options generated through detailed bioinformatics and clinical analysis.
Our flagship and one of the most affordable tests available in this segment is TARGET-Focus – a focused 352 gene test to identify gene variants in well studied known tumours biomarkers which are associated with FDA-approved and/ or NCCN guideline-recommended treatments and clinical trials. TARGET-Focus reports help the oncologists in identifying actionable and targetable mutations to provide the right treatment guidance. The test identifies known mutations in tumours which includes SNV’s, In-Dels, CNV’s and other genomic signatures like Tumour Mutational Burden (TMB) and Microsatellite Instability (MSI) in the same report, all of which would have otherwise taken multiple and expensive tests to be done.
TARGET – Focus is a validated test with high sensitivity and specificity to detect low-frequency genomic alterations. Our interdisciplinary team of cancer researchers, bioinformaticians and data scientists uses in-house developed custom algorithms which includes complex mathematical and statistical models for in-depth curation and correlation of published scientific findings and clinical research to provide the most updated and best treatment recommendations.
In addition to TARGET Focus we have:
TARGET exome which provides comprehensive coverage of all the coding region of the complete genome, profiling > 20,000 genes.
Target IO provides a comprehensive analysis of biomarkers associates with the treatment sensitivity and resistance to immunotherapy treatment.
Target Lung provides comprehensive profiling of lung molecular
markers using multiple technology platforms which includes Next Generation Sequencing (NGS), FISH, PCR and IHC. Use of parallel technology allows us to quickly eliminate negative test results and accelerate the molecular profiling of positive biomarkers for quick treatment decisions.
Our Germline portfolio (including Germline+ and Germline++ tests) enables patients and their family members to understand if there is a hereditary cancer risk to the individuals which helps them to bring the necessary changes to their lifestyle and identifying screening needs.
Along with this 4basecare is committed to enabling the research community working in precision oncology and is working to establish various national and international collaborations on this front. The objective if these collaborations are to help the researchers in developing optimal solutions for the underserved
How do precision oncology and targeted therapies work for cancer patients? What is the difference in terms of quality of life, survival benefits etc?
We are in the era of personalised medicine where a one-treatment-fits-all approach is replaced by personalised treatment. Targeted therapies or treatment based on comprehensive profiling of cancer markers allows a better understanding of an individual’s tumour and provide precision therapeutic options based on the extensive research that is happening across the work in this front.
A genomic test like TARGET could be used to identify genomic changes that may be targetable with specific therapies.
A tumour test may be done to determine if a tumour has certain features (genomic variation or variants) indicating that the cancer is more susceptible to treatment with a specific therapy. The results are based on in-depth curation and correlation
of scientific findings published in peer-reviewed scientific journals and clinical studies. The advantage of doing this test is that, if primary or first-line of therapy is not yielding satisfactory results, the doctor has immediate access to patient’s genomic test results, which might provide a substitute and personalised therapy options based on specific mutation and changes associated to patient’s tumour sample. Immediate access to such test results saves precious time and gives an opportunity to doctor to immediately employ substitute therapy which might yield much better results and better treatment outcomes.
Personalisation of treatment and targeted therapies not only is known to have positive clinical outcomes with improved survival rates but also leads to lesser toxicity/side effects thereby improving the overall quality of the life for the patients.
More details on the mode of action of these therapies can be found in the following link: https://www.cancer.net/navigating-cancer-care/how-cancer-treated/personalized-and-targeted-therapies/understanding-targeted-therapy
How can genomics and technology make cancer care more accessible and affordable in India?
This is a macro-economics based question. There has been some research which does suggest that in terms of the use to these advanced technologies, through the life cycle of the patient, the targeted treatments help in overall cost saving and a better lifestyle for the patients. Along with this, at 4basecare we are also doing our bit towards the same.
Unlike the west, precision oncology is still in its infancy in India. However, a lot of work has to be done in terms of creating awareness and make it a standard of care. There are two major challenges:
Limited availability of data from Indian population: Currently most of the genomics tests available (including our portfolio of tests) are based on data available from the Caucasian population. We need more genomics data from Indian population. At Illumina accelerator, we are generating whole-exome and Transcriptome data of >1000 cancer patients tumour tissue to develop Indian population-specific gene panel, IndieGene. In fact, this would be first of its kind population-specific multi-gene panel developed for molecular profiling of patient tumour tissue. Data generation for IndiGene panel is underway at Illumina and we expect to launch the test at the start of Q3.
The high cost of genomics test: One of the major challenges in widespread clinical adoption of precision oncology in India is the high cost of genomics-based test. Currently, a comprehensive panel of 300+ genes would cost anywhere between Rs150,000 – 250,000. As a company, our highest priority is to address this issue and come up with strategies to make these comprehensive tests available at least 1/4th of the current costs and we are confident of achieving it. We are setting up a separate fund under our CSR activity which will allow us to further subsidise the cost of the tests for the patients who cannot afford to take the test. As a company, we have built a patient-first culture in our DNA and we see patients as our partners and beneficiaries and not as our customers and we want to make sure that not even a single patient is denied better treatment because of financial constraints. We would ask people from government, industry, NGOs to join hands with us in our fight against cancer because, Together, We Beat Cancer!!
The COVID-19 pandemic which has forced a lockdown has brought remote consultation at the forefront. Will this sustain post the pandemic, with bandwidth issues in India etc?
There were two challenges why doctors and patients both were hesitant in terms of adopting digital technology for the consultation:
Fear of misdiagnosis and medico-legal issues: Physical consultation even for symptoms such as common cold has always been a preference for both patients and doctors. The reasons being, firstly, physical consultation is a standard of care and secondly, it reduces the chances of misdiagnosis and thereby any complicated medico-legal issues.
Legacy change: Adopting to digital technology means learning using applications and digital platforms to access medical reports digitally and scheduling video calls. There are challenges not just in terms of learning how to use an application but also dependency on the availability of high-end internet and features available on a smartphone/computer.
However, recent guidelines by the government (Medical council of India, NITI Aayog, etc) give doctors comfort to practice digital consultations. We have surely seen an increase in the adoption of digital technology for digital remote consultation because the current COVID-19 situation has forced both patients and doctors to change their conventional ways and adapt to a new convention. And surprisingly, it is having a positive impact as doctors are able to consult more patients in the same amount of time, and also patients are getting the comfort of avoiding the traffic and travel specifically limiting their exposure under the current vulnerable situation.
Also, the Digital India initiative from the government and great startup initiatives like Jio has allowed the infrastructure today to support digital consultations.
In addition to genomics, 4basecare also uses digital technology to personalise cancer care in oncology. We have developed 4Care digital healthcare platform which aims at driving patient care through improved patient-doctor engagement, easy medical record management and a robust patient support system. Apart from the much-needed video consultation feature which is coming handy in the current time a clear differentiator of our platform is the specific focus on oncology. One of the major challenges in virtual consultation is getting access to the right reports from multiple reports uploaded by patients. 4Care platform allows patients to securely store and manage all their medical records (medical reports, prescriptions and medical bills). All the documents are encrypted and stored on a secured cloud platform. The medical records are stored in a structured format using unique onco-tags and in a customised onco-specific consultation timeline manner which allows doctors to quickly summarise the case and conveniently access the reports.
In terms of the long term use, we believe the current situation has primed both doctors and patients in using digital technologies for some of the interactions and these changes are bound to stay for at least the consultations where a physical consultation might not be needed (eg. case reviews, follow-ups, or second opinions). Specifically, we believe that since a large number of the patients in India are dependent on out-of-pocket payments with limited insurance coverage, use of these digital consultations will empower them to approach doctors of their choice without worrying about the geographical distances.
How do you see the future of digital healthcare platforms in India? Have privacy, data confidentiality issues been addressed suitably? Where does insurance fit into digital health?
Digital health is the future and (during) this time of the pandemic, globally both patients and doctors are realising how much they will be reliant on digital health platforms in the times to come. You will see a phenomenal increase in the adoption and implementation of digital health strategies by governments and healthcare organisations.
As for data security, unfortunately, in India, we still do not have stringent data privacy laws, which is a huge concern for both patients and doctors. Having said that, this can be managed by referring to and implementing standards in the west and following the well-established HIPAA security laws and GDPR guidelines for data protection.
What is the next milestone for 4basecare?
We give a strong impetus to R&D and will be continuously innovating to develop and bring affordable precision oncology solutions for cancer patients so that we are able to support more patients with these advanced technologies.