This Entrepreneur Is Changing the Face Of Cancer Treatment In India Dr. Manjiri Bakre is the founder of OncoStem Diagnostics, a Bengaluru-based start-up that has developed a test to help women with a certain kind of breast cancer be diagnosed and given the right kind of treatment.

Breast cancer is the most common cancer in women in India. Accounting for 25-32 per cent of all cancers in women, the mortality rate post-treatment is 60 per cent, compared to as much as 89 per cent in the United States. The numbers, to put it simply, are disappointing and an entrepreneur based in Bengaluru is trying to change that.

Dr. Manjiri Bakre, who has a postgraduate doctoral degree in cell biology, is the founder and chief executive officer of OncoStem Diagnostics, a start-up that has developed a test to help women with a certain kind of breast cancer be diagnosed and given the right kind of treatment.

One of her earliest encounters with breast cancer was when a friend during her PhD years was diagnosed with the same. Bakre says the friend felt the tumor herself, went to the doctor and since it was diagnosed early, got it removed. Thereafter, as did everyone, that friend went on her post doctoral fellowship, which was in Israel.

That's when the cancer relapsed, and spread to multiple organs. "It was so sudden; we really tried to help her by sending her for various therapies, even non-traditional ones but nothing helped," she says.

The sudden demise of this friend got Bakre thinking about why, despite early detection, so many patients like her are unable to survive.

"If the tumor is five centimeters or ten centimeters large and has spread to nearby organs, then you understand that the patient has a limited lifespan but when the tumors are small and detected early, typically, such patients should be doing well."

Why OncoStem

While Bakre was thinking about those whys and working on a solution, a company in the US had come up with a similar test.

However, the biggest differences between patients there and in India is that the former are mostly postmenopausal women and because they have much better insurance schemes with regular, annual checkups, the tumors are also very small when first detected.

"When the patient is elderly and diagnosed with a smaller tumor, the biology is different; our patients are younger and and we don't have great programmes of insurance," she says.

Compared to those in the west, Indian women are also more likely to have triple negative breast cancer, which is considered to be a more aggressive type.

Breast cancers are classified based on biomarkers that are proteins present on the tumor cells. If a patient's tumor has three proteins: estrogen receptor, progesterone receptor and human epidermal growth factor receptor 2, they are called triple positive patients while their absence makes one a triple negative patient.

"The hormone receptors are really key determinants of how the disease will progress; in the universe of breast cancer patients, if the patient's tumor has hormone receptors they do well," says Bakre.

OncoStem's first and currently only test is for hormone receptor positive patients. This test is only valid for early stage breast cancer patients, that is, for those at stage one and two.

With the tests, patients are certified into low recurrence or high recurrence categories and the treatments are done accordingly.

"Majority of Indian patients are getting treated with chemotherapy, even in early stage hormone receptor positive cancer, which is supposed to be a less aggressive form of the disease. To really save the excessive chemotherapy, we decided to develop a test which would suit our population,"

The idea was to cut down on chemotherapy, as the side effects are often enormous.

Another point where the company is different from others, according to her, is that theirs is a protein-based test while the others are gene-based. The company has a machine learning-based algorithm which gives the risk of cancer recurrence. Bakre claims the test is 95 per cent accurate.

The biomarker analysis process is patented while in her own terms, the ML-based algorithm is a "trade secret".

Challenges Along the Way

Bakre incorporated the company in 2011 but it took six-seven years to develop the test and eventually go to market.

A major reason for such a long process was that they needed to do a five-year follow up. The patient base in India is huge but the system isn't organized enough to keep the follow ups going.

How the company managed to sustain over the period of time when they were developing the test and not making any revenue was through investor money. In the very early days, they received $1 million in seed funding from Artiman Ventures, an early stage Silicon Valley-based venture capital fund.

The biggest challenge, however, has been to work with hospitals, she says. Given that there are multiple layers to convince and explain the test to, it takes a lot of time and that's something investors are unable to understand. She feels a lack of clarity in terms of guidelines is also an issue that elongates processes.

On VC funding still not going much into the healthcare space, Bakre says, "entrepreneurship is like bringing up a child; at every stage you have different issues, you cannot be like I have given you seed funding and that's enough, you have to think of the entrepreneur in the next stage."

Bakre feels that their kind of work requires a lot of patience from the side of the investors and a lot more than what many of the now well-known tech start-ups began with.

"Our kind of work is not like you can buy a laptop and start working out of a coworking space," she jokes.

In 2017, the company raised $6 million in a Series A round led by Sequoia Capital.

Plans Going Forward

Currently, the test is prescribed by 180 doctors across India and the company works with 15 hospitals, of which 12 are in India.

Bakre says the company is looking to touch the lives of about 1000 patients in the next one year and build from there. According to her, the way to reach the masses is through insurance schemes such as Pradhan Mantri Jan Arogya Yojana.

"Because the majority of the chemotherapy costs for cancer patients are given by the government and so if 70 per cent don't need, it is saving about INR 750 crore per year, just on the cost of chemotherapy."

The test costs INR 60,000 to one patient and the strategy of working with government hospitals, and treating low-income patients is to provide discounts as the volumes go up.

"If the numbers go up, our costs will come down, and then we can work on reducing the price of the test," says Bakre.

In terms of new offerings, OncoStem is now working on developing a test for triple negative patients as well as something for patients of ovarian cancer.

The ultimate goal, though, she says, is to work with pharmaceutical companies and help develop treatments for the patients being diagnosed.