DeciBio had the pleasure of interviewing Canexia Health’s SVP of Business Development, Brady Davis. We interviewed Brady to understand how Canexia Health and Project ACTT (Access to Testing and Treatment) are leveraging Canexia’s tech transfer platform and liquid biopsy test, Follow IT, to bridge the gap between the Canadian cancer community and molecular testing during the COVID-19 pandemic.

Could you go over the liquid biopsy landscape in Canada and how the pandemic has influenced it?

There is no coverage of liquid biopsies through provincial health policy in Canada. But even though it is not covered, there is definitely a growing momentum. A lot of key opinion leader oncologists believe liquid biopsy is a less invasive and potentially better way to find the right treatment for their patients. As for health policy and regulatory & reimbursement, people are looking to liquid biopsy as a next generation move, and they believe that it is a necessity. Each province looks at data a little bit differently and being able to build the evidence to support coverage in the different provinces is a critical part of Project ACTT, which is the Digital Technology Supercluster project that we recently announced.  We're aren’t alone in this push either, there are a multitude of other players in this space that are looking at the advantages of liquid biopsy.

How do you see Canexia Health’s position relative to some of the U.S. leaders like Guardant or FMI?

We are encouraged by the progress and the adoption of liquid biopsy that several of those companies are generating. We have a model that is all about democratization and decentralization of cancer testing. Our belief is that testing can be done and should be done locally, it reduces turnaround time. But it is hard for many organizations to bring this type of testing online in their community. To execute on a plan where you are bringing testing to the local setting, you need a depth of experience in, and knowledge of, how to develop and validate that assay, and get a usable clinical report out of that information. Those are not trivial things to do. People find it difficult to move forward with implementing testing in-house. Our tech transfer models provide all of the critical components and create the right environment to actually implement a solution in-house very quickly. We then continually update and support your lab so you don't have to revalidate. You, as a lab, can focus on the patient and what your lab really needs to do.

It seems like the pandemic has created a scenario to really prove liquid biopsy use for therapy selection even though oncologists really prefer to use tissue samples first. So do you think that there's going to be a long-standing change or new normals post COVID-19 in regards to how liquid biopsies are used?

Yeah, that's a really interesting question and it will be a really great debate over the next few years. We will be able to look back 7-10 years from now and actually see how it played out. NIPT is an interesting example of how that whole model played out. You can reduce the risk for pregnant women by doing a less invasive test, and still uncover and identify risk factors. Similarly, we're looking at a less invasive and less risky approach. If you're doing a tissue biopsy then you have to come into a hospital, it cannot be done at a remote blood collection facility or even at the home. Blood will be a much easier way to collect that data and provide people the right targeted therapies with an earlier turnaround time. Liquid biopsies can help people that are at risk during this pandemic and still allow them to get on the right targeted therapy, which is incredibly important.

It would be great to just talk about Project ACTT and understand the Digital Supercluster’s intentions and Canexia’s role within the project. How are Canexia and Project ACTT poised to address lapses in cancer care created by the pandemic?

Project ACTT was built specifically in response to COVID-19 in order to help cancer patients avoid potential risks like hospital visits. It also is intended to help hospitals have space to provide critical care to COVID-19 patients. The pandemic in Canada alone has delayed at least 100,000 surgeries. In some regions, as much as 30% of these are for cancer-related surgeries. The pandemic has had a significant impact and will continue to have an impact as hospitals battle backlog and prepare for a second wave and flu season. Project ACTT is led by Canexia Health in partnership with Queen's University, AstraZeneca Canada, Eastern Ontario Regional Laboratory Association, Genolife, and others. These are high-quality partnerships providing the expertise needed to execute on this plan, as well as funding to offset the cost of testing so patients don't have to pay. We want to make sure that patients have equal access to this type of testing across all of Canada. There are also specific partnerships focused on digital innovation and allow us to integrate with EMRs through APIs and use advanced AI / ML to improve sensitivity of the test. It's not just about the COVID-19 response to cancer patients -- it's also about continual improvement for this technology to benefit cancer patients over time, through increased service access and digital innovation.

How will this real-world data that's going to be generated be used? What are some of those ramifications or changes that Canexia is hoping it drives with that initiative?

We will be testing at least 2,000 patients across the country in urban and remote areas and that's really important. Equal access to diagnostics is really important to us. Getting Follow It, our enhanced ctDNA minimally invasive test, into remote, urban, and rural areas will generate initial health economics data. A critical component of this project is bringing that data together in order for health policy leaders to evaluate and hopefully approve liquid biopsy as a reimbursed and covered benefit. Ultimately, the aim is to make this life-saving technology available to Canadians even after the pandemic. Collecting real-world data is not trivial so our partnerships are going to be really important to this effort.

Just to clarify, is the genomic data itself being linked to patient outcomes? Is that data going to be used to drive any research initiatives or leveraged in other ways?

ACTT is funded by the Supercluster and we have a conjunction of academic and research partners engaged, so this data will be accessible and usable by these partners. Ultimately, we want to see it available to everybody if it can advance care, but we are definitely looking at this to drive significant outcome improvements and collecting those outcomes that will support strong research in the future.

What is the future of Follow IT and how is it going to develop to meet the demands of cancer care during this pandemic and then beyond? Will it grow beyond breast, lung, and colon cancer?

Yes. One of the objectives of Project ACTT is to extend Follow IT to a broader range of tumor-based cancers in early 2021. Follow IT and Canexia Health are still young, but we have a lot of R&D behind us. We have been commercial for a couple of years so there will continue to be significant advancements over the next few years as we continue to grow this organization. We've built a clinically focused molecular test specifically for those who want to really bring the technology in-house. We've made it extremely easy.The faster you can get an individual on targeted therapy, the better their outcomes are likely to be. Local testing can really reduce turnaround time down to a few days. Improving the speed with which you can get a test and a report is going to be an area of continual innovation for us. The distributed model is also a critical kind of differentiation in advancement. Part of the tech transfer we enable is cloud-based bioinformatics support on the report so you don't have to have the bioinformatics expertise in-house. Our machine learning and AI capabilities continue to look at improving the sensitivity, as well as looking at ways that we can enhance the test.

From experience, the lack of bioinformatics or the personnel to process the data is a huge barrier to adopting complex tests, especially in the community setting. It's great to hear that this vision is to cut out that pain point and enable more sites to have access to the greater genomic data.  

We agree. A majority of cancer patients are treated in their communities. Building out in-house capabilities and delivering that support, that's really the focus for Canexia Health.

You mentioned the potential of bringing testing outside of the hospital, so where do you see testing moving? Is there enough feasibility to start offering at-home testing for cancer patients?

There is a specific amount of blood that we need to collect. Can that be done from the home? Sure, if the phlebotomist or the phlebotomy organization has the capabilities to do that. We think we will see the market go there. If cancer patients can really be de-risked and can have blood drawn from the home that would be ideal. There are no real technical or inherent biological roadblocks to this happening. It is really more of the services piece, of who's available to go out to those homes and collect the blood sample. Right now, there are a lot of labs that are able to collect blood and are less crowded with people, which in itself is less risky than exposing cancer patients to hospitals during this pandemic. Getting to the home is something that would be very advantageous and ideal. At some point hopefully, we can get there.

What can we be excited about for Canexia Health in the next year or two?

On top of rapid scaling of deployments, we'll continue to see advancement in AI / ML and building algorithms to improve our test sensitivity and to expand the range of cancer types and coverage.I think you'll see more excitement around reimbursement in value-based care models.A lower cost but highly sensitive test that can be used as a triage prior to a larger more expensive test can be extremely advantageous in value-based care. If we're showing a significant reduction in cost but similar outcomes, that is going to be a very positive movement.I also think partnerships with pharma will be a growth area. They want to get their valuable targeted therapies to patients who are in communities where they're not doing molecular diagnostic testing and so they're not currently able to access targeted therapy. We have a model that can help get molecular diagnostics out to every single community in a very rapid fashion.Monitoring is another area. We have already discussed how valuable liquid biopsy can be for rapid treatment selection, but how do you monitor for recurrence and resistance? Follow It could be used very well to support a strong monitoring component in treatment. That is a very innovative area for us to move into.Globally there are also a lot of organizations that aren't necessarily ready for a large panel and that would like to look at a smaller, more clinically focused panel that can be customized relative to clinical trials in their specific areas of need. That's something that we can do very well.

I know Canexia Health recently went through a rebrand. What were the drivers for this change?  

It traces back to what I said about the community. Contextual Genomics was a great name to convey putting context around a clinically focused molecular test. But as we started to build on this decentralized testing model, it became clear that our work is really about connecting cancer diagnostics to communities. This connection is critical. It's really about building that ecosystem and that support infrastructure to enable equal access to molecular diagnostics across the world. That's really the key component behind the name change to Canexia Health, and what we wanted to articulate about what we have built, are building and our passions as a company.

Broadly speaking, what do you think the world of “digitally-augmented” molecular diagnostics will look like in 10 years? In 20 years?  

I think we’ll certainly see the advancement of multi-modal data integration and the impact of bringing so many types of data together to improve outcomes – both from research and clinical perspectives. This will further enable us to deliver care in more minimally-invasive and more virtual ways, in a world we know is becoming more and more vulnerable to pandemics.At the same time, over the last decade, we had hoped to see cancer Dx and treatment improve outcomes, and that’s happened in some areas. But we haven’t seen cost go down. It’s actually going up. That’s where our mission really comes in – we believe we must help reduce cost of care while improving outcomes, and we must make access to cancer diagnostics available to all patients – not just those who can afford it. Canexia Health has really been purpose-built with this in mind.Brady Davis has more than 25 years of leadership experience in the life sciences, healthcare, and software fields. His previous roles have included vice president, market development and strategy at DNAnexus, head of strategy and market development for Illumina focused on informatics, and head of healthcare strategy and business development at Oracle. He currently serves on the board of directors and advisory boards of multiple non-profit organizations, including the Cancer Informatics for Cancer Centers (Ci4CC), Global Alzheimer’s Association Interactive Network, Muscular Dystrophy Association, and the University of Washington Center for Commercialization.

Reuben Schleiger  |  ASSOCIATE

Reuben has experience with strategic assessment and market analysis engagements spanning the LBx continuum. He has a particular interest in how early detection, MRD, and monitoring technologies will change how cancer is treated by detecting cancer when it is curable and fine-tuning treatment options along a patient’s treatment journey. Connect with him on LinkedIn or email him at schleiger@decibio.com.Disclaimer: Companies listed above may be DeciBio clients and/or customers

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