the troy lectures: the advent of digital microscopy (business school edition)

The advent of digital

microscopy

Yves Sucaet, Wim Waelput,

Peter In’t Veld

Business e

dition

02-05-2023 pag. 2

Financial disclosure

• Yves Sucaet and Wim Waelput are co-founders and shareholders in Pathomation, an innovative company founded in 2012. The company strives to offer the most comprehensive software platform for digital pathology possible. The focus is on integration, scalability, and user-friendliness. Pathomation implements digital pathology in a variety of use cases and scenarios.

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Prelude

• In October 2016, I was honored at Troy University as one of its 2016 “alumni of the year” during the annual homecoming activities.

• In the following week, I gave several guest lectures in various departments across campus.

• This is the lecture as presented for the Business department on Thursday, October 20, 2016.

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Topics for today

• How did I get here?• Digital microscopy• Digital pathology• Companion diagnostics

PERSONAL BACKGROUND

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Who am I (education)?

• 1998-2000: Hogeschool Gent (BE)– BS Computer Sciences

• 2001-2005: Troy State University (US)– Exchange program

• Developed an interest in using ComS to help (molecular) biologists

– MS Biological Sciences• Research in yeast genetics with Dr. Christi Magrath (NSF fellowship)

• 2005-2010: Iowa State University– PhD Bioinformatics & Computational Biology

Education

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Who am I (professional)

Professional

• 2000-2001: Becton Dickinson• 2010-2013: HistoGeneX

• Section head Data Management & Bioinformatics

• 2012-now: Pathomation• Chief Technology Officer

• 2014-Q1 2017: VUB• Digital Pathology Manager

• 2016-now: HistoGeneX• Data scientist

WHAT IS DIGITAL MICROSCOPY?

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This is not it

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Digital microscopy on a budget

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Add a camera “port”

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Whole slide imaging (single slide)

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Hardware

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Whole slide imaging (clinical)

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Software

Very large

image!

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How big are these images?

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Who does this?

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But the problem is that they don’t talk to each other!

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What’s the solution?

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Digital microscopy at the VUB

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What does the Pathomation software look like?

(DIGITAL) PATHOLOGY 101

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What does a pathologist do?

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Tools for pathologists

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Digital tools for pathologists

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Unique Selling Proposition and digital (r)evolution

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Valorization of a biobank

• Without digital histopathology: • With digital histopathology:

I’m looking for breast tumor tissue

Does the sample contain cancer cells

Is it in situ or invasive?

Is it hormone-responsive?

I’m looking for breast tumor tissue

Does the sample contain cancer cells

Is it in situ or invasive?

Is it hormone-responsive?

Sure; glad to help

Just trust us

Just trust us

We don’t have that information

Sure; glad to help

Have a look at the HE

Have a look at the HE and the immunostains (p63 – calponine)

Have a look at the immunostains and the fluo

data (FISH)

Fidelity increases, confident about requests, investments pay off

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Market size

• Digital pathology is a $2 Billion market– That’s actually small (it’s a niche market)• GE is now dropping out of the race because of this!

• Medical imaging is a mature market– Annual growth of about 5%– Digital pathology: 14%

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M&A activity

THE ECONOMICS OF CANCER

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The cost of cancer drugs

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How do cancer drugs work?

• Rituximab, Rituxan: – monoclonal Ab that attacks CD20+ B cells– Leukemia, lymphoma

• Trastuzumab, Herceptin– Interferes with Her2/Neu receptor– Breast cancer

• Imatinib, Gleevec– Tyrosine Kinase Inhibitor– Chronic Myelogenous Leukemia (CML), Gastrointestinal

tumors (GITs)• Everolimus, Afinitor– HR+ (ER or PR), Her2 negative– Breast cancer

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To prescribe or not to prescribe?

• Expensive drugs only work in a subset of patients– Herceptin: 20-30% of early stage breast cancer

• Only to be used in HER2/Neu positive patients• Cost: $4,659 / month

– Affinitor: 35% of patients respond • Only to be used in Her2 negative, HR positive patients• Cost: $8,701 / month

– Ibrance: • Only to be used in ER positive, Her2 negative• Also for metastatic cancer• Cost: $10,677 / month

– Avastin + Erbitux• Triple Negative Breast Cancer (TNBC)• Cost: $5,551 + $11,862

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The need for personalized medicine

Cancer therapy

Resection

Radio

therapy

Targeted

Immune

therapy

Research

Chemotherap

y

% patients responding: 25%

20-30% patients benefits from ipilimumab

EpigeneticsCombinations

Lung cancer :EGFR - gefitinibALK - crizotinib

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So what do you do?

• Companion diagnostics are tests that are administered to assess what treatment is suited for a particular patient– Can save lots of resources (time, money), and therefore

lives– cDX is usually done on a (liquid) biopsy or resection

• Which means a pathologist is involved– Allows clinician to take shortcuts!

• Sometimes a 3rd line treatment can be opted for directly as a 1st line treatment

– Paves the way for personalized medicine• Get the right drug to the right patient at the right time • (at the right price for the patient and for society)

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How can digital microscopy help?

• In the future: Automatic assessment of stained slides– Decision support systems– Most importantly: help troubleshoot borderline

cases!• Today: Training the pathologist for make the right assessment– http://training.Pathomation.com

• Today: Facilitate discussion– Tumor boards, multidisciplinary oncological consults– Second opinions

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Decision support

Tumour

DOCTORS DON’T ALWAYS GET IT RIGHT FROM THE FIRST VISIT

But even so…

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What would you do?

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The cost of change in a diagnosis (Mark Priebe)

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The cost of change in a diagnosis (Mark Priebe)

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Number of cancer cases, estimated total cost

• 1.6 million new cases are identified each year with a 5% opportunity of improvement– 80,000 cases annually

• Saving resources on 80,000 cases at $30,000 per case– $2.4 Billion saving

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The stakes are high (loser)!

128B market cap / 83B market cap

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The stakes are high (winner)!

IN CLOSING

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This is a global market

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Potential customers, partners, and re-sellers

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Conclusions

• Digital pathology is ready for prime time– Education and training, – Research (including biobanking)– Clinical research and drug development

• Business opportunities abound– $2 B market size, $2.4B savings to be realized– Hardware: scanners can still improve a LOT– Software: needs to be more flexible, intuitive, user-

friendly (also programmer-friendly and MD-friendly)– Consulting: team up with MDs!

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Learn more about digital pathology

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Continue the conversation

• Email: yves.sucaet@gmail.com

Thank you for inviting me!