America, a land of plenty – plenty of land, plenty of food, plenty of crazy politicians and plenty of start-up funding.
Grail, a company formed by sequencing giant Illumina in Jan 2016, recently obtained a hefty $900 million in Series B financing, after already obtaining $100 million in Series A. Grail aims to screen for cancer mutations in circulating tumour DNA (ctDNA) from blood samples via next-generation sequencing (learn more about this booming field in Sensitive Detection of ctDNA). The money came from several large pharmaceutical companies, Johnson & Johnson purportedly with the largest investment followed by others such as Bristol-Myers Squibb, Celgene and Merck. Interestingly, Bill Gates and Jeff Bezos from Amazon has also invested in Grail, together with the venture arm of medical distributor McKesson, China-based Tencent Holdings, and Varian Medical Systems, a radiation oncology treatment and software maker from Palo Alto.
This is the biggest start-up financing deal in biotech by a long-shot, the largest deal in 2016 went to Human Longevity, Craig Venter’s company that raised $220 million in series B. Another one that came somewhat close was RNA company Moderna Therapeutics, which raised $450 million in 2015.
Grail plans to carry out “high-intensity sequencing” on blood samples from vast numbers of people to detect circulating tumour DNA at early stages, essentially in people not showing any signs cancer, as a means of early detection to enable better treatment. This is an especially challenging feat, given that ctDNA makes up < 1% of circulating DNA found in the blood. But there are some hints that Grail is sitting on promising data sets that have turned skeptics into believers.
There are concerns that testing healthy people for cancer might yield false positives that could subject people to unnecessary and potentially dangerous testing procedures and treatments. This was the case for the Prostate-specific antigen (PSA) test used to screen men at risk for prostate cancer. It turned out that PSA testing did not significantly reduce mortality of men with prostrate cancer but did increase the harms associated with the accompanying treatments and tests, some of which are pretty nasty such as urinary incontinence and erectile dysfunction.
So Grail had better be sure the sensitivity and accuracy of their predictions are full-proof as cancer treatments are not exactly pleasant. They seem to be taking it seriously, judging from their embarkation on an ambitious trial called “The circulating cell-free genome atlas study” where they will recruit more than 10, 000 participants – 7000 newly-diagnosed cancer patients of multiple solid tumour types who have not undergone treatment, and 3000 healthy volunteers. The trial is already recruiting and is projected to be completed within 5 years by Aug 2022, with a primary outcome measure available by Sept this year. Grail hopes to detect shifts in cancer stage severity as they perform their tests over time. How accurately their tests reflect other clinical readouts would give appropriate proof of its reliability. Likely, more trials involving more patients would be necessary to determine if this form of testing is full-proof and whether it may even replace tissue biopsies as a gold standard in cancer diagnosis.
Grail has even drafted plans to make their form of testing available to the medical community by 2019, subject to experimental results. An incredibly ambitious timeline, so its no wonder they need the big amounts of cash to drive it through. Jeff Huber, a former Google Exec, is Grail’s new CEO. His wife Laura died of colorectal cancer, so his new job also fulfils a personal mission. Other members of the team include other former employees from Illumina and Google, including Verily CSO/founder Vikram Bajaj. The Google Life Science company Verily have recently received a similarly outstanding investment of $800 million from who would have guessed, Singapore Temasek Holdings.
The scale of investment in America seriously dwarfs that found in the European biotech scene. Despite conservatives highlighting a potential bubble in US biotech and Trump’s anti-pharma sentiment that may signal a potential decline in available funding, one cannot deny that the lofty research goals being currently undertaken, can only yield an incredible expansion of scientific knowledge. In my opinion, science is expensive, and the more money you have, the more science you can do. They key thing though, is to make sure its good science!