“We provide targeted tests that help our physicians make judgments to influence their patients today,” says Tan, who is founder and CEO of Lucence. He refers to the discarded cancer cells as “sewage”, and explains that “the more you go through, the more likely you will find fragments that suggest the [condition of the patient].”
Lucence’s liquid biopsy test received the green light from the Ministry of Health in Singapore last year. It has conducted several hundred tests for patients across the country in both public and private hospitals. On Feb 7, it announced a partnership with IHH Healthcare-owned ParkwayHealth Laboratory, which will allow physicians to order Lucence’s liquid biopsy and genetic tests through the laboratory services provider. According to Tan, the test is now also available in Malaysia, Thailand and Vietnam.
Why liquid biopsies are ‘in’
The liquid biopsy test that Lucence runs is becoming more popular in the medical world. Its promises of non-invasive testing — it requires as little as 1ml of blood — and a 24-hour turnover have fuelled the growth of many new medical companies in the field. The global liquid biopsy market is expected to grow 23.4% yearly to reach US$2 billion ($2.6 billion) in 2022, according to Markets and Markets Research.
More significantly, liquid biopsies can detect tumours before patients show any symptoms — a boon for early-stage cancer detection. A Hong Kong-based study, Tan says, shows a 97% sensitivity rate for early-stage nose cancer detection. Research from Johns Hopkins University released on Jan 18 suggests that the accuracy rate for liquid biopsy in early-stage cancer detection varies widely across different types of cancer. The test scores more than 80% for ovary and liver cancers, but less than 40% for breast cancer.
For some patients, a liquid biopsy may be the only option. For instance, a lung cancer patient who is on blood thinners may not be able to undergo the procedures required for a tissue biopsy.
“The false positive rate is very low for liquid biopsies,” adds Tan. “If we see a signal in liquid biopsy, it is usually real. This lends the technique well to screening.”
Liquid biopsies have in fact been in commercial use for some time in the US and the UK. Incumbents Guardant Health and Personal Genome Diagnostics, both based in the US, sequence between 64 and 73 genes to look for the mutations found in various cancers. Recently, Hong Kong-based Cirina merged with Grail to ramp up early-stage cancer detection using non-invasive tests. Malaysia-listed Genting’s subsidiary Genting Bio Cellular has invested US$2 million in Singapore-based Nova Satra DX. The investment will be used to commercialise the latter’s liquid biopsy test for breast cancer.
Tan himself has raised an undisclosed seed round. Lucence also won $100,000 from SPRING Singapore in the Slingshot @ Switch competition, which last year awarded prizes of grants and workspace to start-ups with promising technology and business ideas.
“Asia accounts for 60% of the world’s population, and changing lifestyles and environmental factors in Asia are driving increasing incidents of cancer. [The liquid biopsy] has a strong advantage in its early and accurate detection of cancers pervasive in Asia,” says Lim Kaling, a private equity investor who has taken a stake in Lucence. “There is explosive potential in this area [in spite of the] competition. Tan is recognised globally for his ground-breaking discoveries in cancer research and is both a highly awarded clinician and a scientist.” Lim is also the non-executive director of Razer.
Differentiating factors
Tan is a trained medical oncologist and geneticist. His company has a clinic at Gleneagles Hospital that offers genetic counselling for cancer patients. He is also principal research scientist at the Institute of Bioengineering and Nanotechnology at the Agency for Science, Technology and Research (A*STAR), where he has overturned a decades-long assumption that cells in the blood of cancer patients are cancerous. They were in fact from supporting blood vessels. The breakthrough meant better understanding of the impact of cancer treatments that slow the growth of blood vessels.
Now, Tan is hoping to make a difference in the early treatment of cancer patients. The technology behind Lucence comes out of research that he had been doing at A*STAR. He subsequently decided to acquire the intellectual property rights and commercialise the diagnostics services. Tan transferred six IPs out of his A*STAR lab.
One factor that differentiates liquid biopsy firms is the choice of genes or DNA fragments used for screening. “There are certain genes that everyone understands are necessary,” Tan explains. “[But] every company will try to extend its capability by testing a wider range to refine its algorithm. The number of genes [to be tested] is driven by the decision that [can be made]. Today, we are limited by [the drugs available].”
Lucence scans for epidermal growth factor receptor cancer mutations, which are commonly present in patients with lung or colon cancer. These patients are likely to respond well to the anti-EGFR drug, tyrosine kinase inhibitor.
Currently, Lucence is also developing a multi-gene liquid biopsy test. This would allow the company to cover a wider range of cancers. Tan is tight-lipped about what the test can do, but says it may be available as early as a few months from now. Lucence intends to provide screening for up to nine types of cancer, according to its website.
The kit price for Lucence’s cancer test ranges from the low hundreds to over a thousand dollars. Only physicians can order the test. The amount of blood required varies. A nose cancer test requires 9ml of blood, while a lung cancer test requires 18ml. Lucence delivers the results within 24 hours. For urgent cases, Tan says results are possible within a few hours.
The road ahead
Liquid biopsies are not widely in use yet because the results vary greatly for different types of cancer. According to Tan, Lucence’s lung cancer test has a positive predictive value or sensitivity of 98%. Its nose test rates at 89%. So far, Lucence has done trials on over 150 samples for its nose cancer test and 400 samples for its lung cancer test. One of the largest liquid biopsy trials was conducted by Guardant Health, involving more than 15,000 patients.
Liquid biopsies are also subject to the same problems typical to blood tests in general, industry experts say. This could include overdiagnosis — the diagnosis of a disease that will never cause symptoms or death during a patient’s ordinarily expected lifetime. As the test is new, results are still deeply contested. A study by JAMA Oncology shows that Guardant Health and Personal Genome Diagnostics’ liquid biopsy cancer test yielded widely different results in the same set of patients.
Tan concedes that the field is still nascent. But that means there are still plenty of opportunities for a young start-up like his, he says. He plans to use his seed round of funds to set up Lucence’s Singapore operations, and grow its range of diagnostics services.
The cost for running a healthcare start-up can be very high. “The equipment can be the cost of a HDB flat,” Tan says. “And they have all the usual depreciation.” He also has to worry about the cost of running trials as he ramps up his diagnostics services. “[But] I see this as the only way our work can be delivered into reality to change things around me,” he says. “The only way you can do this is through a start-up, where you can scale a new test as quickly as possible into the real world.”
This article first appeared in Issue 817 (Feb 12) of The Edge Singapore
Subscribe to The Edge at https://www.theedgesingapore.com/subscribe
