Haystack and a needle: a look at the smaller liquid biopsy developers

With yesterday's data on Guardant's colorectal cancer screening liquid biopsy disappointing, it is worth looking at the smaller players in the cancer blood test segment. A new one of these, Haystack Oncology, emerged last month with an impressive $56m series A round. The group is working on a test for minimal residual disease – recurrent cancer caused by cells left after tumour resection. It is not alone among smaller developers in pursuing this setting; C2i Genomics, Burning Rock, Neogenomics and Invitae also have MRD tests. Otherwise the private groups are largely geared towards screening for individual cancers, whereas the smaller listed firms are working on tumour-agnostic screens as well as other settings, such as monitoring response to treatment. But there are perils here. The only one of these smaller companies to have gained FDA approval for a liquid biopsy is Epigenomics, which suffered badly after its test was denied reimbursement – at one point it looked like it would have trouble continuing. However, after a few rounds of refinancing it is now working on a new version of its colorectal cancer screen. The tables below are divided into private, venture funded groups and smaller listed companies.