In India, cancer treatment often follows a standardised approach, bucketing the treatments based on the stage and type of cancer. However, the West adopts a rather nuanced strategy with genome research to understand the exact type of cancer within a certain stage and type and administer targeted therapy, thereby hitting a higher recovery rate.
Hitesh Goswami and Kshitij Rishi founded the Bengaluru-based oncology precision startup 4baseCare in 2018 to introduce a similar approach to treating oncology patients in India. Recently, Infosys Innovation Fund invested close to $1 million in the leading precision oncology firm. They were also the past winners of the Karnataka government’s ‘Elevate’ initiative that supports innovative early-stage startups.
A few months ago, deep tech-focused venture fund Yali Capital led a Series A funding round and raised $6 million.
Genome Technology for Targeted Care
In an exclusive interaction with AIM, co-founder and CEO of 4baseCare, Goswami, explained the methodology behind cancer treatment. Previously, cancer treatment was uniform. All patients received the same therapy based on the cancer type and stage, and individual differences were not considered in treatment plans.
Goswami said that today, lung cancer stage-2 and stage-3 patients are subgrouped into 12 to 15 categories; each requiring distinct treatments as therapies effective for one group may not work for another and could even cause adverse reactions.
According to him, sequencing one human genome took around 15 years and $3.2 billion. Now that the Human Genome Project has concluded, Goswami believes the procedure can be done at a cost of $100 for a genome in a couple of years.
Notably, genome testing for oncology has grown rapidly in India. What stood at 5,000-6,000 tests in a year in 2019 has now touched 2 lakh. Goswami estimates that the market will easily hit 3 lakh tests.
India has its Own Struggles
While the results help in targeted care for cancer patients, precision oncology in India faces key challenges, including limited awareness among oncologists in tier-2 and tier-3 cities, who often rely on traditional chemotherapy. Many patients are also unaware of advanced targeted therapies.
Further, when effective drugs are identified, they are often unavailable in India. This becomes a cause for frustration among both patients and doctors. Affordability also remains a key challenge as treatments like immunotherapy cost ₹2.5-₹3 lakh per cycle and require multiple rounds.
“Although many pharma companies are running a lot of patient support programs where they give free access to a certain extent to some drugs. But overall…it is very expensive,” Goswami pointed out.
With increased awareness and reduced costs, the method is expected to become more accessible and be adopted in the coming years.
Analysis of Gene Fusions across functional categories and cancer types using 4basCare’s study. Source: 4baseCare
AI at Play
4baseCare has been adopting AI for a number of its use cases, including data interpretation, where it uses AI models to get the right insights from the huge amount of data it generates.
“So, right now, we are telling patients and doctors that you can look at your applications and see what you can work on. The next level that we are working on is directly giving the recommendation, best recommendation, best three recommendations in terms of application,” Goswami explained.
The startup has also received a grant from the Indian government to develop 3D cell models of tumour tissues in a lab setting. These models are used to test the effects of various drugs on the tumour, and the data collected from these experiments is being used to train an AI model to predict which treatments are most effective for specific types of patients.
In addition to this, the startup is working on a novel concept referred to as the CG Twin, which stands for clinical genomic digital twin of cancer patients. The method involves integrating a patient’s clinical and genomic data into a comprehensive profile. This system will allow doctors to compare a new patient’s profile with a database of similar patients, known as twins, and by analysing these matches, doctors can access insights about similar patients’ treatments, outcomes, and risk factors, thereby enabling a more personalised and informed treatment plan based on real-world data and previous cases.
“We have done close to 15,000 plus tests now, and we have actually developed a machine learning algorithm, which has been trained in 15,000 patients to build this twin model,” said Goswami, who looks to build a future which will be more evidence-based and outcome-based decisions rather than an empirical way of providing treatment.
CG Twin is already being tested by doctors and is slated to be released in the upcoming months.
Notably, the concept of digital twins in healthcare is gaining traction. Several healthcare platforms have used NVIDIA’s Omniverse to build a simulated environment of patients to help understand and administer more efficient treatment.
The Mission Continues Amidst Struggles
Co-founders of 4baseCare Hitesh Goswami and Kshitij Rishi
Goswami explained that the unique name of the startup is inspired by the four bases of DNA – adenine (A), cytosine (C), guanine (G), and thymine (T) – and the four pillars of cancer care – allied care, technology, global genomic research, and clinical care.
“What we realised is that these four bases or these four pillars are working in silos. So, we wanted as a company to bring all these four bases together just like the four bases of DNA to provide cancer care,” he said.
Notably, 4baseCare has partnered with well-known hospital chains such as Apollo Hospitals, Fortis Healthcare and Tata Memorial Centre.
The journey has not been an easy one, with the startup having faced a fair amount of funding struggles. “When you’re talking about genomics, genomics-driven data and all, there was a lot of apprehension because genomics is something new. And, it is something that’s not easy for everyone to understand.”
Goswami even recounted how they had to withstand “a hundred noes” before one “yes”, something that is a common reality for many founders in deep tech. However, eventually, things have a way of falling into place. “You need that one yes from the right people to believe in your vision, and I think that’s what we got with Yali and with Infosys.”
Above all, the biggest motivation for Goswami and his team, which has close to 200 members, comes from the profound impact their work has on cancer patients.
Goswami believes that seeing patients, once suffering from salivary gland cancer, cancer-free because of their recommendations is what keeps them motivated.
“The whole team, right from the logistics team who picks up a sample, I tell them, ‘Guys, you have no idea which sample you might pick up, and that will change the whole family’s life. So right from every level, someone is somehow impacting a family which they don’t even know. So that has kept us going, and…it’s a very exciting journey,” Goswami concluded.
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