Bengaluru start-up strives to bridge the indigenous data gap in precision oncology

4baseCare has come up with a gene panel for the Indian population after extensive research. This, according to the start-up, would allow to provide more evidence-based and data-backed treatment for cancer patients in the country.

In February this year, Union minister for health and family welfare Mansukh Mandaviya, citing the Indian Council of Medical Research-National Cancer Registry Programme, told the parliament that the estimated incidents of cancer are rising in India.  

While there have been substantial advancements in the field of oncology and the treatment of the disease, keeping the cancer rate in the country below that of several others, several gaps persist including the need for increased clinical trial, high expenses associated with advanced treatments and so on. 

One such gap has been the reduced availability of data. Precision oncology, an advanced form of cancer treatment, tailors customised treatment plan for patients based on their DNA and genomic biomarkers. However, the existing genomic database comprises of data mostly on Caucasian population, putting non-Caucasian population including India at a disadvantage.  

4baseCare, a Bengaluru based start-up, aims to bridge this data gap and has come up with a gene panel for the Indian population after extensive research. This, according to the start-up, would allow to provide more evidence-based and data-backed treatment for cancer patients in the country. 

Background 

Hitesh Goswami and Kshitij Rishi, co-founders of 4baseCare, were previously colleagues at a drug discovery company. While Gowany worked as a research scientist for drug discovery, Rishi used to work on vaccines for cancer.  

The duo came together again in 2014-15 and a lot of conversations revolved around genomics and oncology.  

“Unlike in other diseases, genomics in oncology is much more mature, because cancer is the disease of the DNA. And the more understanding we get about any disease, we can fight it back better. We knew what was happening in the West in terms of how genomics was being applied in treatment, but in India, it was very basic at that time,” Goswami recollects. 

“In the West, people were using genomics for identifying the treatment for breast cancer. We wondered why we weren’t doing it in India.” 

Thus, they started talking to oncologists. Two challenges were identified in the process.  

One was the prohibitive costs associated with it as the tests were being offered by multinational companies. People couldn’t afford to spend lakhs for one test. 

Second was the data gap. 

“Most of these tests are based on data on the Caucasian population. The Cancer Genome Atlas (TCGA) is a global platform where a lot of genomic data on cancer is available. The majority of them is Caucasian. And most of the solutions that are developed are using that data,” Gowamy points out.  

It was clear to him and Rishi that for things to further advance in India, tests need to be done based on local research and data and they must be affordable. 4baseCare was registered in 2018 with this idea.  

Into research mode 

In 2019, the company raised its angel funding as well as was selected for the Illumina Accelerator Program which works with start-ups to develop breakthrough innovations in genomics. This made the start-up the first from Asia Pacific to be selected for the Program, says Goswami.   

“Illumina to genomics is what Amazon is to e-commerce. Being selected for the Program gave us brilliant exposure to giants in the field and how they work and access to scientists. We also had free access to their machines,” he notes.  

While Rishi moved to the U.S. for the Program, Goswami reached out to leading Indian hospitals and obtained access to their biobanks and tumour tissues.  

“And then we looked at something called whole exome sequencing,” Goswami notes.  

“One human cell has around 20,000 genes. And change in one or multiple of those 20,000 genes can lead to cancer. Our objective was to analyse the patient tumor tissue, find out which of these 20,000 genes have mutations or changes, and based on that make a panel which will allow us to study those changes.  

The team conducted research on more than 1,500 patients across 28 different cancer types for two years and identified around 1200 genes associated with pathogenesis and progress of cancer. 

“We found which gene is there and where in the gene the mutation is there. And that is our proprietary data,” Goswami says.  

Launch of indigenous panel 

In 2021, armed with about 10,000 GB of data, the company launched its panel called TarGT IndieGene. The team claims it to be the first gene panel in the country based on indigenous research.  

“The power of personalized medicine in oncology is just unlimited,” says Goswamy citing an instance from the early years of their research. 

“A pancreatic cancer patient was on standard chemotherapy for one year. Then the doctor decided to find out more information about the changes in the tumor and determine future treatment based on that. The sample came to us and we found that the tumor mutation burden (TMB) score was around 5.8. We told the oncologist that as per our data this was high TMB and suggested immunotherapy. This was in 2021. We had a call with the patient caregiver three months back. Still complete remission.” 

Apart from data from Indian population, the team has also included globally available information to the panel so as to not restrict the solution to just India. According to Goswamy, they are also getting samples from Iran, Latin America, Turkey, and so on.  

The tests would cost ₹15,000 rupees to three lakhs depending on the comprehensiveness of the test and the affordability of the patient. 4baseCare currently works with more than 300 oncologists across India and is expanding its operations to Philippines, Nepal and Dubai, given more than 50% of the global cancer incidences are from Southeast Asia and Middle east combined. Nearly 10 million new diagnoses are reported from this region every year, but the patients’ access to technology has been limited.  

Going forward 

According to Goswamy, the company would continue to do genomics research and innovation to refine the data further and make it more population-specific, the next step would be to add a layer of artificial intelligence and machine learning to it.  

“Even with the same mutants, the treatments and outcomes may not be the same. For example, many of us got COVID, but different people reacted differently. That’s because we are different people and our bodies metabolise differently. Our genes work differently,” he says.  

The start-up is planning to address this by creating a database of genomic digital twins.  

“As part of this, when a patient comes in, we’d collect information such as clinical information regarding metastatis, but also information regarding comorbidities, whether they have diabetes, heart problems, Alzheimer’s, Parkinson’s, symptoms before the diagnosis and so on. Then, when a new patient comes in, we would make a clinical genomic digital twin, digital twin of this new patient.” 

“This would be matched with other twins in the database to find out which other patients have the same clinical genomic attributes. Similar treatment might work for them even if their cancer types are different.” 

According to Goswamy the initial prototype for this is ready. However, he adds that the company makes no claims to cure the patient completely.  

“What we are saying is that when you take data-backed decision, you increase the probability of anything working. Currently we have limited data. What most hospitals and companies are not doing is learning from previous patients. And that is something that we are doing differently. We are not just a diagnostic company, but a precision oncology company which is working on diagnosis and data to personalise cancer care and better outcomes for patient.”

source/content: thehindu.com (headline edited)

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