MiRXES eyes fuss-free early cancer tests; road ahead not easy

Singapore

IMAGINE if early-stage cancer testing was as fuss-free as taking a Covid PCR test or a blood test.

Homegrown startup MiRXES is hoping to bring such "liquid" cancer tests into our homes in about 5 to 10 years' time. If this dream pans out, a simple blood test could be able to detect all types of cancers at an early stage - when it is easier to treat and possibly cure.

MiRXES has since developed one test - a PCR-based blood test kit for gastric cancer, which has been approved by Singapore's Health Sciences Authority.

The Singapore-based company, which is heading towards a public listing, is working to develop similar test kits for lung, colorectal, liver, breast, pancreatic and ovarian cancers. It is also trying to improve accuracy for its gastric cancer test kit to 92 per cent, chief executive Dr Zhou Lihan told The Business Times.

But even so, the road ahead is not an easy one. In order for a shift to happen, the company will need to find better ways to bring these tests to homes or clinics. It will also need to develop digital tools to engage patients. Regulators, insurers and medical bodies will need to be onboard. Data security and privacy is paramount.

Financially, MiRXES is on good footing. The company in July raised a US$77 million funding round on the back of renewed investor appetite for scientific innovation during the pandemic. It is now weighing a route to the public markets, either through a Hong Kong initial public offering or a US special purpose acquisition company, showed previous reports from BT, quoting sources. This could allow it to tap further funds for growth.

The A*star spinoff, which last year repurposed its labs and technology to help manufacture, distribute and sell Covid-19 PCR test kits, posted S$61.6 million in revenue for the year ended Dec 31, 2020, 17 times the S$3.6 million it recorded a year earlier.

Singapore is MiRXES's largest market, contributing 66.1 per cent - over S$40.7 million - to revenue. Indonesia is its next largest contributor at 11 per cent. Net profit for FY2020 stood at S$20.4 million, reversing from a net loss of S$3.5 million in 2019.

Dr Zhou reckons the company is in a "good position" to acquire smaller companies in the preventive healthcare space. He is hoping to pad up MiRXES's digital and physical infrastructure such that at-home-testing could one day be a possibility.

Right now, the company does not have the internal capabilities for point-of-care-testing, said Dr Zhou. That means that it still cannot bring these tests directly to the patient at clinics or even homes without the need to send a sample to the laboratory.

"That's one major front we're looking at. It's the coupling of having a wide variety of cancer tests, more accurate testing and a way of making these tests more accessible to patients that will eventually allow us to present a holistic business model.

"As much as possible, we don't want to reinvent the wheel. If someone has done some early research, we want to get in on that either through acquisitions, partnerships, or joint ventures," he added.

MiRXES is able to detect cancer mutations through these tests because it takes advantage of the fact that telltale traces of cancer - like microRNA fragments from tumours - are often present in the blood.

Because these blood tests are not invasive, they can be easier to repeat periodically or even at home in the future, potentially detecting the disease as early as possible and allowing treatments to be adjusted accordingly.

These kits serve as a complementary test to gold standard biopsies or screening tools instead of a surefire diagnostic tool, similar to how Covid-19 antigen rapid tests are used right now.

That also means people might not have to solely rely on invasive tumour biopsies or endoscopies to screen for early-stage cancer - which can be uncomfortable, expensive or even somewhat risky.

The company's test kit is able to detect gastric cancers - prevalent in Asian countries like Japan, Korea and China - even in early stages.

According to its website, its test kit has sniffed out 87.5 per cent of stage I gastric cancers and 89.5 per cent of stage II gastric cancers in clinical validation, possibly improving the chance of recovery for patients.

But such test kits also might be tricky because patients could be given unnecessary treatments or have needless anxiety in the case of a false positive.

Dr Desmond Wai, a gastroenterologist with over 20 years of experience in treating patients, noted that for most countries outside of Japan and Korea, periodic gastric cancer screening is not a recommended practice yet.

"Even breast cancer and prostate cancer screening are controversial, as screening itself may lead to false-positive results, unnecessary investigations or a biopsy."

Furthermore, for a new screening test like MiRXES's gastric cancer kit GASTROClear, it is unknown what action should be done for false-positive or false-negative results.

"For other screening modalities like a pap smear and fecal occult blood testing, the pathway has been well mapped up," said Dr Wai.

For now, Dr Wai is "certainly not" ready to give up testing via biopsies yet. Many doctors might feel the same - biopsies are still considered the gold standard everywhere.

But he added: "It is a good study, a new technology that may lead to a breakthrough in cancer management.

"For it to be recognised by professional bodies, government health ministries, and insurance companies as a cost-effective method, more studies and maybe lobbying will be needed."

• Garage is BT's startup vertical. Read more news, analyses and opinions at bt.sg/garage.