Early tumor screening giants have emerged, product iterations are rapid, looking for advantageous product strategies in the data age [2021 tumor early screening industry research report]

Core point of view

Judging from the growth trajectory of malignant tumors, early tumor screening is indeed expected to change the trajectory of life

In the period when strategy is king, there are only superior strategies for early tumor screening, and no absolute superior products.

Define strategies based on markers, economics of the technology platform, and functionality based on cohort data

Multi-omics and low throughput form a new trend in early tumor screening technology, and product data is king

The centralized business model has insufficient penetrating power, and direct 2C may become an end-game conjecture

1 The first overview and general remarks

1.

Change the trajectory, early tumor screening carries a market of 100 billion yuan

Early tumor screening refers to the screening of early cancer and precancerous lesions for target populations who are apparently healthy and have not yet shown obvious abnormal symptoms.

Unlike common genetic testing application scenarios such as auxiliary diagnosis and companion diagnosis, which target the clinical evaluation, diagnosis, or grading of tumors, most early tumor screening test results are negative.
In other words, proper early tumor screening is the basis for early diagnosis and treatment, which will help patients alleviate pain, improve prognosis, and even increase the cure rate.

Therefore, some people believe that early tumor screening is something that can really change the trajectory of life.

1.
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Long growth of malignant tumors

Generally, malignant tumors go from molecular cancer in the ultra-early stage to tissue cancer in the middle and late stage, which lasts more than 10 years.
During this period, the malignant tumor grows from a single cell to nearly one hundred grams of cancerous tissue.
With the accelerated expansion of the tumor shape and the continuous compression of the time span, it will go through three fission stages.
If it can be intervened during the best prevention period of up to 10 years and the best treatment period of up to 3 years, it will undoubtedly greatly improve the efficiency of the entire process of tumor diagnosis and treatment.

The latest global cancer burden data released by the International Agency for Research on Cancer (IARC) of the World Health Organization in 2020 shows that in 2020, there will be 19.
29 million new cancer cases worldwide, of which 4.
57 million new cancer cases in China, accounting for the global number of cases 23.
7%; In 2020, the number of global cancer deaths will be 9.
96 million, of which 3 million cancer deaths in China, accounting for 30% of the total global cancer deaths.
In addition, according to the latest data released by CA Cancer J Clin, malignant tumors have jumped to the first place among the causes of death among Chinese in 2020.

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The global cancer situation is grim

Ideally, the application scenarios for early tumor screening include medical institutions and third-party medical laboratories to carry out in-hospital testing services, direct contact with people at high risk of tumors for health checkups and convenient home testing for ordinary consumers.
At this stage, early tumor screening products are still in the early stages of commercialization, and are still mainly targeted at in-hospital patients and high-risk groups outside the hospital.

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"Funnel" heavy volume

From in-hospitals, health checks to homes, the number of people covered by early tumor screening shows a pyramidal distribution, gradually increasing from top to bottom.
Behind this, there are two key points worthy of attention.

First, from the supply side, in my country, the medical system dominated by public medical institutions can hardly meet people's medical and health needs.
Some medical projects with low operation difficulty and low risk should be carried out in an orderly manner, and tumors should be screened early.
In it.

Second, from the demand side, compared with the sick people who have already experienced symptoms, the larger seemingly healthy people regularly exclude the possibility of illness, which corresponds to a greater effective demand.
As people's awareness of pre-health management continues to increase, under the general trend of consumption upgrades, this part of the demand is highly monetized.
If we calculate that there are about 4.
5 million new cases of malignant tumors each year, the number of people who need early tumor screening will be ten times that.

2.
Introduce the old and bring forth the new, early tumor screening will condense innovative vitality

Generally speaking, the methods used for early tumor screening mainly include traditional detection and liquid biopsy.
Among them, the traditional detection methods mainly include tumor marker detection, medical imaging examination, and endoscopy.
Liquid biopsy is a concept corresponding to tissue biopsy.
It is a more cost-effective early tumor screening solution that has evolved with the emergence of a large number of new technologies in the field of precision medicine.
Liquid biopsy takes non-solid biological tissues as samples for sampling and analyzes tumor-related analytes, such as circulating tumor cells and circulating tumor DNA.
In recent years, how to effectively transform relevant scientific research results to fill the gaps in disease prevention, screening, and treatment has become the focus of the entire precision medicine industry.

Traditional test VS liquid biopsy

Traditional testing methods have many shortcomings in the process of early tumor screening.
Taking colorectal cancer as an example, there are three types of internationally recognized clinical screening technologies for colorectal cancer: fecal occult blood, colonoscopy, and FIT-DNA detection technology based on molecular testing.
Occult blood in the stool and digital examination cannot detect early adenomas.
The blood cancer detection index (CEA) of routine physical examinations is low in sensitivity and cannot detect early bowel cancer variant signals.
It is unrealistic to require colonoscopy for all people over the age of 50.
In the urban cancer early diagnosis and treatment project in 2018, the acceptance rate of colonoscopy was only 15.
3%.
Insufficient compliance among high-risk groups with no obvious symptoms.
It is necessary to explore screening technologies and programs suitable for my country's national conditions to improve the specificity of CRC high-risk groups and the detection rate of colonoscopy.

Among the various new detection methods, liquid biopsy is considered to have the most potential.

First of all, the objects of liquid biopsy are liquid samples such as blood, urine or feces.
The sampling is simple, which can significantly reduce costs and reduce patient trauma and risks.
Second, compared to medical imaging and endoscopy, which can only examine tumor lesions at a specific site each time, liquid biopsy is easier to achieve simultaneous coverage of multiple tumors.
Third, liquid biopsy is easy to operate, fast in detection speed, and can repeatedly obtain samples for high-frequency monitoring.

In addition, malignant tumor is a heterogeneous disease.
Liquid biopsy can reflect the complete picture of tumor genome.
While reducing the deviation caused by tumor heterogeneity, it can also reflect the dynamic changes of tumor development in a timely manner.
Use tumor molecular markers to detect mutations, deletions, rearrangements, methylation, amplification, and insertions in the tumor cell genome in the early stages of tumors (stage I, II), so as to provide early diagnosis, prognosis and treatment methods for tumors The choice is provided with instructions.

Tumor Early Screening VS Aided Diagnosis

However, the liquid biopsy tumor early screening solution also has its problems.
For example, the function positioning is not clear enough.
Since most early cancer screening products are still in the early stages of the industry, and a clear industry map has not yet been formed, it is difficult for many industry professionals to accurately describe the difference between early cancer screening products and tumor-assisted diagnostic products, and it is easy to confuse the two.

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Clarify the boundaries of early tumor screening

In fact, as can be seen from the above figure, there is a significant difference between early tumor screening products and auxiliary diagnostic products.
This difference will be even more obvious when compared with more mature disease diagnostic products in clinical applications.

In short, for early tumor screening products, clinical guidance, diagnosis, and intervention are indispensable.

First, it has clear clinical guidance significance, and the test results must be approved by clinicians and experts;

Second, there is a simple method of diagnosis, which can clearly tell the patient what to do next and what may be done;

Third, there are feasible clinical interventions to provide patients with rapid treatment or relief programs.

Good wind depends on strength

In recent years, the market with huge potential for early tumor screening based on liquid biopsy has always been a hot spot for domestic and foreign genetic testing research and manufacturers.
Guosen Securities Research Report quoted data showing that with the accelerated growth of tumor detection applications and paid population coverage, the global NGS tumor market will show a compound annual growth rate of 27%, which is expected to reach 75 billion US dollars in 2035.
Among them, early tumor screening is the largest one, which is estimated to grow at a compound annual growth rate of 75%, covering a population of 150 million.

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2020~2021 Domestic Cancer Early Screening Financing and Industry Progress

The above figure simply counts the capital and product progress of liquid biopsy tumor early screening companies that have received financing in 2020.
As of the end of March 2021, the corresponding companies that have completed at least one round of financing in 2020 have completed the construction and verification of the technical model of early tumor screening products, and realized the commercialization of service capabilities.
More than half of these companies have entered the B round and the later mid-to-late entrepreneurial growth stage.
Burning Rock Medicine, Genetron Health, and Nuohui Health have been listed one after another; more than half have carried out prospective clinical studies of various scales, but only Nuohui Health The commercialization of the product has been realized.
In other words, the early tumor screening business of domestic mainstream manufacturers has begun to generate cash flow, but the ability to scale is limited.
In this process, external capital provides a key force.

3.
Strategy is king, early tumor screening refers to medical health

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From the previous analysis, it can be seen that if tumor early screening products are to achieve sufficient market penetration, it is very important to have the ability to directly serve the C-end population.

The main application scenarios will be transferred from medical institutions and physical examination institutions with relatively limited ceilings to With greater potential for health management, the 2C model has gradually shifted from being a subsidiary of the 2B2C model to one of the mainstream models that go hand in hand.
This is our guess at this stage of the end of early tumor screening.

It is true that the essential characteristics of a health testing product will inevitably change from the outside of the hospital to the inside, and then from the inside to the outside of the hospital.

Right now, end users are relatively low in willingness to actively substitute due to the unification of operating habits and testing standards.

In fact, whether it is fighting in medical institutions and medical examination institutions, or in an innovative model that integrates insurance companies, communities, and the Internet into the rules of the game, tumor early screening manufacturers are all anchoring the most intensive user scenarios.

In an era when strategy is king, further optimizing product strategy, positioning opponents, and building competitive barriers are urgent tasks.

The above is an excerpt from the main content of the report.

The first overview and general remarks

1.

2.

3.

The second technical path of early tumor screening

1.

2.

3.

Chapter 3 Compliance Strategies for Early Tumor Screening

1.
Retrospective and prospective clinical studies locate the function of early tumor screening

2.
Preemptive deployment and forward-looking trials of large queues are the mainstream strategies

3.
Three key points of high investment, high risk, and prospective clinical research

Chapter 4 The Business Model of Early Cancer Screening

1.
From the laboratory to the terminal, the last mile of early tumor screening

2.
Leveraging on the B-side network, the penetration of the centralized model is insufficient

3.
The final conjecture of early tumor screening: directly serve the C-end crowd

Chapter 5 Typical Cases of Early Tumor Screening

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