By Arunima Rajan

In a tete-a-tete with Arunima Rajan, Vidya Veldore, who leads clinical operations at 4baseCare, talks about the company's focus on solving the challenge of making genomic profiling accessible and affordable for Indian patients.

Can you give us an overview of what 4baseCare does and its primary mission in precision oncology?

4baseCare is a precision oncology company leveraging advanced genomic technologies to provide personalised cancer care. We aim to democratise precision oncology by making genomic profiling and personalised treatments accessible and affordable for cancer patients, particularly in developing regions like India.

We empower oncologists to make more informed treatment decisions, empowering patients, too. We also ensure patients receive therapies tailored to their tumours' unique genetic makeup for the best treatment outcomes.

What does "bridging the genomic data gap in cancer care" mean in practical terms, and why is it vital for Indian patients?

It means addressing the lack of population-specific genomic information crucial for tailoring cancer treatments. It involves collecting and analysing genetic data from diverse populations to better understand the unique mutation profiles and cancer characteristics within these groups. Most existing genomic data is derived from Western populations, meaning treatments and biomarkers—like those used for immunotherapy or targeted therapies—are often based on information that doesn't fully apply to patients from other regions, such as India, South Asia, or Southeast Asia!

Could you explain how 4baseCare's flagship test, TarGTIndiegene, differs from other cancer genomic tests on the market? What unique insights does it offer for Indian patients?

Target IndieGene is an indigenously developed gene panel based on our understanding of cancer-causing driver/pathogenic alterations across 28 different cancer types from more than 3000 cancer patients across India. From the conceptualisation, design, development, validation, and launch of the panel for routine clinical testing, it has all been implemented and functional at 4baseCare laboratories in India. Because of its indigenous development and service, it has been cost- effective and able to reach a more significant number of cancer patients with low/medium economic strata.

The Indian government has recognised this test as one of the TOP 75 products for the Make In India, Made in India Initiative.

This panel also detects other significant genetic changes for both treatment and research. The test examines 1212 different genes, covering a wide variety of genetic alterations, including common, rare, and even newly discovered gene changes. It also looks for important indicators that can help guide immunotherapy treatments, such as tumour mutational burden (TMB), microsatellite instability (MSI), and PD-L1 expression. These insights are vital for identifying personalised treatments that could be more effective for individual patients.

What are some of the main challenges in developing precision oncology solutions specifically for the Indian population, and how is 4baseCare addressing these challenges?

One of the biggest hurdles we face is India's genomic diversity. The genetic makeup of Indian patients is rich and varied, yet it's vastly underrepresented in global genomic datasets. Most cancer research today is built on Western data, but treatments designed for those populations don't always work as effectively for Indian patients because of these genetic differences.

Another challenge we face is the lack of awareness. Many patients and even healthcare providers in India need to be fully aware of precision oncology's benefits. Integrating genomic testing into routine clinical practice is still slow, and many oncologists continue to rely on traditional treatments for various challenging reasons, as we mentioned earlier.

Can you share some examples of how 4baseCare's genomic testing has improved treatment decisions or outcomes for cancer patients in India?

One such case involved a patient with non-small cell lung cancer (NSCLC) who was not responding well to traditional chemotherapy. Using our TarGT Indiegenegenomic panel, we identified a RET mutation in the patient's tumour, a known actionable target. Based on this result, the oncologist switched the patient to a RET inhibitor, a targeted therapy designed to address this mutation. The patient responded remarkably well, with significant tumour shrinkage and improved quality of life. Without the genomic insights provided by our test, this personalised treatment option might never have been explored.

Another example comes from a breast cancer patient who had initially been placed on standard hormonal therapy. Our comprehensive genomic profiling revealed a BRCA1 mutation, indicating that the patient could benefit more from PARP inhibitors, a class of drugs particularly effective for patients with BRCA mutations. After adjusting the treatment, the patient showed improved outcomes, with better disease control and fewer side effects.

How has being part of the Illumina Accelerator program benefited 4baseCare's research and development efforts?

Illumina is a global leader in genomics, and through this partnership, we gained access to cutting-edge sequencing technology and expertise that has accelerated our ability to deliver advanced precision oncology solutions. We recently welcomed Francis deSouza to the 4baseCare Advisory Board. Francis is a Silicon Valley tech veteran and former CEO of Illumina; he has brought in over 30 years of leadership experience in genomics, technology, and healthcare. This collaboration opened doors to a broader network of industry connections and collaborations, which has been vital in accelerating our validation processes and expanding the reach of our solutions.

What are your thoughts on the current state of precision oncology in India compared to Western countries? Where do you see the most significant opportunities for improvement?

The current state of precision oncology in India is undoubtedly evolving, but it still has a long way to go compared to Western countries. Precision oncology has been more fully integrated into routine cancer care in places like the US or Europe due to better infrastructure, broader access to genomic testing, healthcare insurance supporting genetic testing, and a strong culture of clinical trials and research. In India, we're still in the early stages of adopting these technologies on a large scale, and several challenges remain. One of the most significant gaps is the lack of population-specific genomic data. Most precision oncology strategies in India have been based on research from Western populations, which doesn't always translate effectively to Indian patients because of the genomic diversity here.

Overall, the future of precision oncology in India is promising, but there's a lot of work to be done. The most significant opportunities lie in building local genomic data, making solutions more affordable, and integrating precision oncology more deeply into clinical practice through education and research.

With the recent Series A funding, what are 4baseCare's key priorities and expansion plans for the next 1-2 years?

Collaborating with hospitals, research institutions, and pharmaceutical companies in Nepal, Bangladesh, and the Philippines remains a cornerstone of our growth strategy. We will strengthen our partnerships both within India and internationally to bring the latest advancements in precision oncology to our patients.

Over the next 1-2 years, we will launch a series of educational initiatives, including workshops, webinars, and training programs for oncologists and clinicians, to promote the adoption of genomic testing in cancer care. We plan to expand our laboratory infrastructure, enhance our bioinformatics platforms, and build a stronger team of experts across genomics, oncology, and data science. Our goal is to ensure we can manage larger volumes of data and samples while maintaining the highest standards of accuracy and quality.

With Series A funding from Yali Capital and our esteemed Advisors on board, we will be able to expand our reach, accelerate innovation, and ensure that more cancer patients can benefit from precision oncology.

How is 4baseCare working to make its genomic testing more accessible and affordable for cancer patients across different socioeconomic groups in India?

For Indian patients, if we look at a biomarker that's often used to guide immunotherapy treatments, like the Tumor Mutation Burden (TMB), FDA guidelines suggest cancer patients with a TMB score greater than ten are thought to be more likely to respond well to immunotherapy drugs. However, recent research, including an article in the Science Journal by Rodrigo Pérez Ortega, highlights a significant issue: TMB score misclassification occurs in 37% of Asian and 44% of African patients. This means that many patients from these populations might be prescribed expensive immunotherapy drugs which cost between $2,000 and $4,000 per dose—without actually benefiting from the treatment, as well as toxic side effects.

Our in-house research has revealed similar trends in Indian cancer patients. For instance, in pancreatic cancer patients, we found that 40% of patients have a TMB score above 10, while in gastric cancer, every second patient may have a score above this threshold. However, the 10-point TMB score in thyroid cancer is highly significant, as only about 5% of patients reach that level.

This data shows that a universal TMB score of 10 might not be the best standard for determining which patients should receive immunotherapy. Instead, what's needed is a population-specific approach that takes into account the TMB score distribution in different cancer types across different populations. Without this tailored approach, we risk wasting valuable resources and failing to give patients the treatments that will work best for them.

Can you discuss any ongoing research collaborations or partnerships 4baseCare has with academic institutions or hospitals in India?

TarGT™ Indiegene cancer panel was generated under the guidance of specialists from Illumina as a part of the Illumina accelerator program. The development was a massive multicentric one involving scientists and oncologists from leading cancer research institutes and hospitals, including ACTREC, AIIMS, Tata Memorial Hospital, Fortis, and Shankara. Over 1,500 individual patient tumour profiles were analysed to identify mutations in DNA (Whole Exome) and RNA (Whole Transcriptome) across 20,000 genes. The ab-initio approach employed in developing of TarGT™ Indiegene not only provided insights into the existing mutational landscape, predominantly characterised in Caucasian cohorts, but also identified novel biomarkers that are rare and specific to the Indian population.

What do you envision as the future of precision oncology in India over the next 5-10 years? What role do you see 4baseCare playing in shaping that future?

I see precision oncology becoming a core part of cancer care in India over the next 5-10 years. We'll likely see genomic testing integrated into routine cancer diagnosis as costs decrease and more hospitals adopt it. This will enable targeted therapies that are more effective, with fewer side effects because treatments will be matched to the patient's genetic profile. I also see greater access to targeted therapies and immunotherapies as more pharmaceutical companies enter the Indian market with cost-effective options. And with early detection becoming more common, we'll be able to identify high-risk individuals before cancer develops, shifting from treatment to prevention. As AI and big data become more integrated, we can analyse genetic profiles more effectively, helping oncologists make faster, more accurate decisions. And with a more robust focus on clinical trials, India could become a hub for precision oncology research.

4baseCare's Bold Bet: Democratising Genomic Profiling to Transform Cancer Care in India