January 26, 2024
OncoHost’s CEO Is PROphet-ic About His Diagnostic’s Potential To Transform Care
Original source here.
Medtech Insight spoke to Ofer Sharon, CEO of OncoHost, about his company’s PROphet platform, proving a diagnostic’s ability to improve cancer survival, and the slipperiness of involving oneself with pharma.
There have been multiple systemic innovations that have improved how we treat non-small cell lung cancer (NSCLC). First came targeted therapies in the 1970s and 1980s and then immunotherapies, which first entered the market roughly a decade ago. More recently, surgical robots have enabled better nodule removal.
Despite these, lung cancer is still the number one cause of cancer death worldwide.
Ofer Sharon, CEO of OncoHost, believes that more attention should be paid to how treatments are delivered and for whom.
Speaking to Medtech Insight, Sharon explained that, currently, when a patient develops metastatic lung cancer, between “20% and 40% of patients benefit from current first-line treatments.
”This leads to two problems. Patients waste time – that they do not have – receiving ineffective therapy and payors waste money – that they do not have – delivering infective therapy.
Sharon explained that PROphet analyses more than 7,000 proteins found in a patient's plasma, deciding whether their make-up more closely mimics what would be found in a responder, or a non-responder.
The proteins of interest – which indicate a patient would not respond – are called “resistance associated proteins” (RAPs).
“We essentially count how many overexpressed RAPs a patient has. If a patient has many, they get a PROphet negative report. If they only have a few, they have a PROphet positive report,” he explained.
Proving the clinical benefit of a test like this is usually very difficult. The diagnostic provides a yes/no answer as to whether a singular therapy should be delivered, but that the therapy itself does all the heavy lifting in survival metrics – both progression-free and overall.
But PROphet further stratifies patients, allowing clinicians to make much more informed decisions on their behalf.
“What we do with PROphet is improve the resolution of existing treatment guidelines. Physicians don’t like differentiating from these, so we offer more personalized treatment choices with demonstration of the potential to improve overall survival, without asking them to do anything off-label.” – Ofer Sharon
Results of a 545-patient study, published in the Journal of Clinical Oncology, showed that PROphet help certain patients avoid chemotherapy (PD-L1 ≥ 50% with a PROphet-positive result), thus sparing them from its toxic effects. Also, other patients (PD-L1 ≥ 50% with a PROphet-negative result) experienced an almost tripling of overall survival thanks to the indication of immune checkpoint inhibitor chemotherapy.
“What we do with PROphet is improve the resolution of existing treatment guidelines. Physicians don’t like differentiating from these, so we offer more personalized treatment choices with demonstration of the potential to improve overall survival, without asking them to do anything off-label,” Sharon said.
Most advanced diagnostic tools make use of genomics.
And Sharon said that, at least for the time being, most will continue to do so. He explained that those looking to use proteomics face many challenges that would never be an issue with genomics.“
The issue with proteomics is the huge variability between patients. The ability to pinpoint the exact relevant signal pathways and the directionality of proteins are also problems,” he said. “Genomics, by comparison, is very clear cut – it answers a yes/no question.
”However, genomics’ simplicity is its core weakness. Sharon said that genomics can only tell us information about the “potential” of something happening and that, especially in the real-time monitoring of disease, it comes up short.
“We take a simplistic approach to cancer mutation. Genomics can find mutations in say 80% of cells in the primary tumor – but it tells us nothing about the metastases,” said Sharon. “I really think proteomics is going to play a much bigger role in the future.
”Ultimately though, Sharon said that a “multiomics” approach will be what Oncohost – and medicine in general – moves towards.
“Once we can compare a tumor’s microenvironment with what we see in plasma, with what we see in the genes, and what we see elsewhere, we’re going to get a much better picture of cancer,” he said
Past precedence has dictated that diagnostics should only be awarded a small fraction of health care budgets, despite their impact on almost every patient pathway.
Simultaneously, payors want diagnostics to deliver more and more and their needs vary geographically.
Sharon explained that NSCLC treatment varies country by country. In the US, monotherapy is the preferred approach. In the UK, combined therapy is used “from the get-go,” with other European countries taking similar approach, depending on the value proposition.
Regardless, PROphet “takes existing guidelines and improves their resolution,” and thus should appeal to payors internationally.
“My joke is that pharma always loves companion diagnostics and translational medicine in phases I and II. But when they get to phase III, the boardroom doors open up and the gray suits walk in. They're dealing with the commercialization and want the largest possible market.” – Ofer Sharon
The price OncoHost is able to charge will be constrained, however. Sharon pointed to similar offerings from the likes of Foundation Medicine and Guardant, saying that their products typically have a list price of around $5,000, but the negotiated end purchase price can be much lower.
Turning to commercial partners to look for higher prices could prove difficult. Sharon noted that pharmaceutical companies, which often bankroll entirely new diagnostics, can be slippery.
“My joke is that pharma always loves companion diagnostics and translational medicine in phases I and II. But when they get to phase III, the boardroom doors open up and the gray suits walk in. They're dealing with the commercialization and want the largest possible market.”
However, he believes that pharma needs companies like OncoHost if the next cohort of drugs are to be a commercial success.
“For example, in immunotherapy, there are 6,000 ongoing trials. If only 1% succeed, there are still going to be 60 new treatments – how will clinicians decide between them? That is the value of Oncohost,” Sharon explained. “If a pharma company purchased us today, they’d shelve our platform, but if they choose to buy us in 5 years, we will be used as a companion diagnostic.”
Either way, Sharon is not afraid to say that he is already thinking of Oncohost’s exit.
He said the company will apply the PROphet platform to other tumor types in the future – making it a much more attractive proposition to both those in the pharma sector, and the next generation sequencing sector.
The latter, he said, is “rapidly consolidating,” with its players already feeling a competitive squeeze. OncoHost, therefore, represents a “very appealing target for those looking to improve their capabilities."