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In a crowded field of cancer diagnostics companies looking to detect relapses earlier, Foresight Diagnostics thinks it has a more sensitive approach. On Thursday, it received more than $58 million to test the theory.

Even after successful cancer treatment, regular imaging can be a source of anxiety for patients — and a clear scan doesn’t necessarily mean a patient won’t relapse later on.

“I work with a number of physicians and they recurrently say what they hate the most is telling a patient, ‘As far as I can tell you’re cured, but the statistics tell us that over the next two years you have X percent chance of relapse,’” Foresight CEO and co-founder Jake Chabon said.

Scientists are now looking to the bloodstream for small DNA fragments from tumors called circulating tumor DNA (ctDNA) to learn more about a patient’s cancer, including whether it has come back. A handful of companies exist in this space, including Exact, Adaptive, Natera and Haystack Oncology, which accepted a $300 million buyout offer from Quest Diagnostics this morning.

Some approaches involve tracking single nucleotide variants (SNVs), or single base changes in cell-free DNA molecules that can tell scientists whether the fragment came from a tumor cell. However, the process is akin to searching for a needle in a haystack, according to Chabon.

“You could have a million healthy cell-free DNA molecules and then just a single tumor-derived molecule,” he said.

Add in what co-founder Max Diehn calls biological and technical background noise, and the task becomes even more of a challenge. Benign SNVs can obscure the presence of tumor-associated SNVs, and artifactual mutations can be introduced during the DNA sequencing process.

Foresight aims to cut through some of that noise for a more sensitive readout by looking for phased variants, or multiple SNVs found on a single sequencing read. The approach has allowed them to detect ctDNA at levels below one part-per-million, according to Chabon. The team has read out results suggesting superior sensitivity in diffuse large B-cell lymphoma patients who have experienced recurrence compared to SNV-based approaches, and took data to AACR earlier this month also suggesting sensitivity gains with its solid tumor recurrence test in non-small cell lung cancer.

Foresight unveiled a $58.75 million Series B round led by Foresite Capital, with participation from Civilization Ventures, Bluebird Ventures, Pear Ventures, Agent Capital, Stanford University, and The University of Colorado Healthcare Innovation Fund. The funds will be used to pursue FDA clearance for PhasED-Seq, support real-time patient testing and further development in solid tumors. Chabon declined to comment on a regulatory timeline.

“We want to expand our evidence generation efforts for solid tumors as well. But ultimately, the big picture, we want to bring it to patients,” Chabon said. “Getting this incorporated into the guidelines and into routine clinical use, that’s the primary goal.”

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