Cancer And Startups - 7 Principles For The Next 10 Years

RockHealth supports digital health startups and their latest quarterly update suggests the VC dollars in the sector doubled and then doubled again. In other words, 2020 was a huge increase and doubled 2019 and 2021 looks to be ending as double of 2020. Our view at Tau is, as you might expect, that this increase is undeniably because of the pandemic. But what it did is accelerate long-standing trends and brought a much overdue awareness around the challenges and opportunities in healthcare. And that this is a permanent change i.e., even once covid recedes into the background the VC dollars in healthcare (both a reflection and a catalyst for creating more startups) will maintain this new baseline and grow steadily from there. One area especially that has attracted funders and founders is oncology. Tau is an AI-first fund and we fundamentally see a trifecta of more data + more computational power + improved regulation powering further developments around cancer. As such we see tremendous opportunities and are putting forth here the principles we believe in:

1) “Cancer” is a non-specific term that refers to many distinct entities

Cancer is heterogeneous. Less a nuanced diagnosis than a broad bucket, the term “cancer” encompasses many different etiologies, severities and progressions. Simply put, no two cancers are the same. Even two seemingly identical HER2-positive breast cancers can vary wildly by genetic makeup, driver mutations, and treatment responsiveness. It makes sense that we would encounter this variation between two separate individuals. Perplexingly however, variation additionally exists at the single patient level. Each cancer is composed of thousands of subpopulations of malignant cells that are constantly competing to gain dominance, and at two separate timepoints, John Doe’s cancer may look starkly unrecognizable. This is the reason why cancer therapies fail and relapse occurs. But why are we belaboring this point? More on this in a minute. 

2) Prevention is ideal, and we know it works. But like weight loss, it requires diligence

A healthy lifestyle can help stave off many types of cancer… shocker. We’ve all heard many tunes to this song: avoid smoking and tobacco, minimize processed foods and red meat, apply sun-block, get vaccinated against certain cancer-causing viruses. Importantly, there’s compelling evidence that fasting and calorie restriction can help “promote anticancer immunity” and cell regeneration. Strikingly, fasting can even amplify the efficacy of chemotherapeutics. Unfortunately, there is poor awareness of the cancer-related benefits of fasting in the general public for a variety of reasons – perhaps chiefly because fasting is impossible to monetize by pharmaceutical companies. 

3) From nuclear warheads to sniper rifles: the evolution of cancer therapy precision 

Chemotherapies and radiotherapy are nuclear warheads that eradicate any and all rapidly proliferating cells; this results in the classical hair-loss, nausea/vomiting, and immunosuppression. Over the last few decades, we’ve honed our arsenal to cause less collateral damage. Biologics (most commonly, antibodies that are highly specific to their targets) are the tip of this spear. Siddhartha Mukherjee beautifully outlines this (and much more) in his seminal book The Emperor of All Maladies. And thankfully, breakthroughs like CRISPR/Cas9 have further accelerated the pace of drug discovery.

4) Why reinvent the wheel? Hijacking the immune system

If evading and eradicating cancer is a high-stakes game of search and destroy, nature has provided the ultimate weapon: our immune system. In fact, in their quest for survival, most cancers develop mechanisms to elude and suppress the immune system. Many blockbuster therapies (ie. Keytruda) counter this deadly offensive by serving as “catalysts” for the immune system to a certain degree. You’ve probably heard of CAR-T cells (genetically modified “super” immune cells), another potent iteration of this theme. There are numerous challenges, from regulatory to long-term effects, that we need to understand before such techniques become widespread. At Tau we invest based on what we see as an achievable vision – make most cancers into a chronic disease within 10 years. Key to that is converting aggressive forms into indolent ones (e.g., prostate and thyroid, which are slow moving) and continue to increase survivorship with quality of life.

5) Early detection is the key to early treatment and saving lives

We see both cutting-edge computational techniques and traditional biopsies to be key. An example of the former: Iterative Scopes (full disclosure: Tau portfolio) uses computer vision to detect polyps that are potentially carcinogenic during a colposcopy. Today even the best doctors miss some of them because they are too small or hidden. An example of the latter: GRAIL (one of several contenders within the $168 billion“liquid biopsy” industry ) launched in Jun 2021 their test to detect DNA fragments, analyze them, and thus identify patterns associated with particular cancers. GRAIL was also in the news earlier since the FTC blocked in Mar 2021 Illumina’s attempt to acquire the company for $8B.

6) Where we’re headed: The Holy Grail of Precision Medicine

The premise of precision (previously: “personalized”) medicine is simple: tailor therapy to the specific genetic, proteomic, and phenotypic characteristics of any individual cancer. Every incremental development – from biologics and immunotherapies to diagnostics and liquid biopsies – brings us closer to this goal. But although research groups have maintained a breakneck pace of innovation, actual medical practice lags behind. Sequencing remains expensive, and hosting terabytes of patient biologic data is daunting. Nevertheless, we must push on. One day, we’ll be able to fine-tune therapy to target the varying treatment-sensitivities of different subpopulations within the cancer.

7) But be careful not to look “too hard”. The perils of over-treatment.

Antibody assays? Monthly ultrasounds? Why not get that full-body scan? There are startups in all of these areas and we believe their customers should use them with care. The average human likely has at least one cancerous cell at any point in time. You can bet on that. But incredibly, our immune system detects and eradicates over 99.9% of these threats. False positives and over-treatment can actually be worse than not doing anything.

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Co-authored this article with Kush Gupta, thanks also to Dr Vasu Divi for his feedback. Originally published on “Data Driven Investor," am happy to syndicate on other platforms. I am the Managing Partner and Cofounder of Tau Ventures with 20 years in Silicon Valley across corporates, own startup, and VC funds. These are purposely short articles focused on practical insights (I call it gl;dr -- good length; did read). Many of my writings are at https://www.linkedin.com/in/amgarg/detail/recent-activity/posts and I would be stoked if they get people interested enough in a topic to explore in further depth. If this article had useful insights for you comment away and/or give a like on the article and on the Tau Ventures’ LinkedIn page, with due thanks for supporting our work. All opinions expressed here are my own.