Battle for Honor? No, it's a battle of life and death
——Preface
Yan'an, 1937.
In the classroom of the Anti-Japanese Military and Political University, the instructor is teaching dialectical materialism.
One lesson was later compiled into a management book - "The Theory of Contradiction".
One of them reads:
"If there are many contradictions in any process, one of them must be primary, playing a leading and decisive role, while the others are secondary and subordinate"
The most important thing is the sentence at the end:
"If we grasp this main contradiction, all problems will be solved"
Today, we will talk about MRD, and we will also focus on this idea.
- The business form of oncology NGS
- What is the contradictory background of MRD?
- Why is MRD the solution?
PS: This article is only a personal point of view, if you are offended, please open your face in the message area.
01 "Diagnosis" and "Drug Sensitivity"
If we classify tumor genetic testing, there are actually two categories:
- One is "diagnosis"
Its value lies in "prompting" a certain disease, such as early screening/auxiliary diagnosis, or cross-border t/mNGS is also in this category.
The size of the testing market for this type of product is as follows:
Among them, the "user base" of the horizontal axis is closely related to the user perception of the disease, and the "penetration" of the vertical axis is closely related to the complexity of disease diagnosis.
- One is "drug sensitivity"
Its value lies in guiding the "selection" of drugs, such as the well-known companion diagnostics.
The size of its inspection market is also the combined area of the horizontal and vertical axes:
The "user base" of the horizontal axis is linked to the incidence of the disease, while the "penetration rate" of the vertical axis is determined by the complexity of drug selection.
For more than 10 years, the core business of the oncology NGS industry has been companion diagnostics – or "drug sensitivity".
All previous product iterations, whether large panels, small panels, tissue tests, or blood tests, are all cut into this fixed cake.
The biggest crisis of this "highly concentrated" business is that:
Whether it's the horizontal or vertical axis, the initiative is not in the hands of the oncology NGS company.
Everyone eats the dividends of drug development.
And the dividends will always be eaten up one day.
02 "Fading Dividends"
After the previous post () was sent, a friend asked me why it couldn't be the third case:
Let's become bigger and stronger together and create brilliance.
I said I wanted to too, and it wasn't hard to do:
As long as the market as a whole can maintain rapid growth, then all internal contradictions are just small episodes.
But alas, this one really doesn't.
Back to the picture above.
Over the past 20 years, the complexity of drug selection has been driven by "drug targets".
——Non-small cell lung cancer is undoubtedly the most representative model in the middle, expanding from one EGFR to nearly ten targets today.
But again, take NSCLC as an example:
How long have we not seen new targets emerge?
Yes, the buried mine finally exploded
——As drugs encounter bottlenecks in the breakthrough of new targets, the growth of the tumor NGS detection market has stagnated.
MRD was born in such an industry background.
03"New Quality Productivity"
Since its birth, MRD has carried the expectation of "becoming the hope of the whole village".
And if you want to be the hope of the whole village, you have to come up with hard goods
-- Staying in the "dynamic monitoring" of "you can do without you, you can do it with you" is not promising.
MRD, eventually, must also become a "drug susceptibility" test.
This is what we have repeatedly mentioned before: answering the four quadrants.
If you carefully touch these four quadrants, especially the upper left and lower right, I believe everyone can quickly reflect the difference between it and companion diagnostics.
MRD is not to "cut the cake" in the original testing market, but to create a new market by extending the vertical axis.
What's more valuable is that the driving factor of this part of the longitudinal axis is not the drug target.
MRD itself is the driving factor that lengthens the longitudinal axis (Sugar Girl reminds: it doesn't have to be medicine, but it can also be chemical/radiotherapy).
——For the first time, the initiative is in the hands of the oncology NGS industry.
04 "Unity is Strength"
"Everyone gathers firewood and the flame is high"
How high the longitudinal axis of MRD can be made also depends on how many partners are supporting it.
In a market for "antimicrobial susceptibility" testing, in addition to the testing company itself, there are three parties: doctors, patients, and pharmaceutical companies.
In this regard, "pharmaceutical companies" are a very important force.
In the MRD quadrant, if you want to make a ranking of the willingness of drug delivery companies:
- The upper left is 3 points - the use of drugs has been added;
- The lower left and upper right are 1 point - strengthens confidence in taking drugs;
- The lower right is -3 points - reduces the likelihood of medication;
That's why we pay so much attention to clinical trials like ATLAIR and DCIPHER.
As the instructor advised:
"To unite all forces that can be united"
05 "Who Holds the Bull's Ear"
MRD is the first time that the oncology NGS industry is expected to take the initiative in the vertical axis.
Although there are differences in the industry between infection and tumor, there is a high probability that the truth is still the same.
However, the right to define MRD will not be equally distributed to all players in the industry.
Under the current mainstream route of "baseline detection + customized loci", there is no "standard answer" for MRD
- MRDs of different companies cannot be simply equated except for sharing a category name.
"The same sample, you get ctDNA+, I get ctDNA-, this doesn't naturally show who you and I are"
Unless, unless, we have one person who proves that their results are consistent with the final clinical significance.
Yes, the battle for the definition of MRD is a test of the ability of each company to operate its clinical programs
- Design a good clinical trial, promote it, and get the desired results.
Five-star general MacArthur said:
And whoever can take the first to win the right to define will be ready.
06 "Challenges and Hopes"
A generation has a long march of a generation.
The new MRD species naturally has its own challenges.
For example, the issue of registration in China seems not simple, but it is actually very difficult.
And if the registration has been stuck, or the short-term "me worse" because of the lower registration difficulty and steals the home, you may have to face the dilemma of "Oreo vs Ollie".
Of course, if there is a day, at least it means that the MRD category has been done.
For an industry that is currently stuck in place, this is a good thing.
"Bitterness comes to an end, all the way to the sun and waiting for the flowering period"
At the very least, August is something to look forward to.
(ENDS)
Source: Funny fat man is one in a million