I had the pleasure to interview Dan Rhodes, PhD, Co-founder and CEO, Strata Oncology. Dan is co-founder and CEO of Strata Oncology. Previously, he was Vice President of Oncology Strategy at Thermo Fisher Scientific (Life Technologies) where he led cancer sequencing product development and companion diagnostic partnerships. Before that, Dan co-founded and was CEO of Compendia Bioscience, a cancer genomics data company, acquired by Life Technologies in 2012. Dan holds a PhD in Bioinformatics from the University of Michigan.
Thank you so much for doing this with us! Can you tell us a story about what brought you to this specific career path?
In 1999, I was a junior at the University of Michigan, sitting in a molecular biology lecture on microarrays and measuring the expression of all 6000 yeast genes in a single experiment — when a light bulb went off for me: I realized that with technology, we were really transforming biological science into a data science — a big math problem.
This idea was incredibly appealing because math had always been my real passion. Although I was gifted at math, at the time, I was on a medical path, having been admitted into medical school. So it was in this moment that I realized that I could incorporate my interest in health and biology with my passion for data and mathematics. Luckily for me, the field of genomics, and cancer genomics in particular, was beginning to emerge as a new field along with a new discipline called bioinformatics, the intersection of biology and data software mathematics.
The next summer I pursued my newfound interest by working in a cancer genomics laboratory using microarrays and data analysis to study kidney cancer. I loved it. I felt that I was bringing the best of my abilities to one of the biggest problems that faces humanity, cancer. I had a lot of fun writing software algorithms and doing data analysis to try to better understand cancer, so that we could inform better diagnostics, better treatments and ultimately better outcomes for patients with cancer.
Can you share the most interesting story that happened to you since you began leading your company?
More than twenty years later, this has been the only thing that I’ve worked on my entire adult life, understanding the cancer genome and leveraging that knowledge and understanding to improve patient outcomes. It’s really been the mission of my entire career.
You are a “healthcare insider”. Can you share 5 changes that need to be made to improve the overall US healthcare system? Please share a story or example for each.
1. Universal Healthcare
We must make sure that all individuals are covered. Without adequate access to services, it’s very challenging for individuals to take the necessary steps to properly manage their own health — whether from a preventive perspective or in managing a chronic condition.
2. Lifestyle Medicine
We need to focus more on what Dean Ornish calls “lifestyle medicine” — diet, exercise, stress relief and community. More directly, on the food front, I believe if Americans transition to a whole foods, plant-based diet, that would result in a marked decrease in a number of diseases, dramatically reduce our spend on healthcare and dramatically improve our healthcare outcomes.
3. Value-based Medicine
We need to transition from fee-for-service medicine to value-based medicine. I think this is underway, but we need to compensate hospitals and physicians and pharma for positive outcomes, not necessarily for the number of services that are performed.
4. Universal Basic Income for All Americans
Part of the health outcomes problem is related to income inequality and the reality that some people don’t have enough money, or have barely enough money, to get by, let alone live a healthy lifestyle. This really needs to be addressed so we can prevent diseases from occurring in the first place. One idea that I am a fan of, that the Democratic presidential candidate Andrew Yang is a proponent of, is a universal basic income of a thousand dollars per month for all Americans. While this isn’t enough to take someone out of poverty, it is enough to supplement a family with two minimum wage incomes, with additional funds to spend on healthy living. I am not sure this is a solution, but it’s one that I’m supportive of trying.
5. Focus on Cancer
I’ll focus on cancer, which is the number-two overall killer of Americans, but the number-one killer of what I’ll call young Americans, those in their 40s, 50s and 60s. I think we are in the midst of a number of cancer breakthroughs, but it will be critical to really maximize the impact of those breakthroughs. Comprehensive molecular profiling of patients’ tumors and defining molecular indications for therapies, as opposed to tissue-based indications, will maximize the benefit of these new therapeutic advances and improve outcomes for patients with cancer.
What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)
This is this is my second time at company building, so I benefited from learnings from the first time around.
The first thing I wish someone told me was that this is going to take longer than you think. Actually, I think several of my investors and advisers told me this. So, maybe it’s that I wish I had listened and built a longer-range plan. I suffer from over-optimism in some cases. I think it’s important to paint a picture and rally a team around a common near-term vision, and in my view, even if it takes an extra year longer, so long as you get there, that’s the important piece. For investors and other stakeholders, that’s not always a shared belief.
Two, it’s going to cost more than you think. Early on, I had a pretty lean plan to build out this company, but until you get into it, all of the moving parts required for success aren’t always clear. So, in addition to taking longer than you had hoped, it’s going to cost more than you had hoped.
The moral of this interesting story is that with a just cause that multiple stakeholders believe in, things often take longer and are harder than you anticipate in the near term. But in the long term, with that just cause and that network of stakeholders who share a common purpose, you can often exceed your expectations. Time is just the piece that is not always in your control.
In our case, we set out to test one hundred thousand patients as part of the Strata Trial, an ambitious initiative to screen patients’ genomes and match them to a portfolio of clinical trials. This is a huge number of patients, and success requires participation across a large network of health systems.
Back in 2016, after we made this announcement, we were early in partnering with health systems, and it turned out to be a harder and longer process than we had anticipated. As months went on, as we continued partnering discussions and working through contracting, we began to question just how feasible this ambitious trial was.
We were so excited when we had our first health system contracted and received our first tumor samples for genomic profiling from the University of Alabama, that we actually framed the FedEx package and have it hanging on the wall.
Now, three years later, the network is twenty-five health systems big and we are routinely testing more than 100 tumor samples a day, so we have reached this scale that we dreamed about. But there were certainly some moments of doubt early on as building out the network was taking longer and was harder than we had anticipated.
Can you share with our readers about the innovations that you are bringing to and/or see in the healthcare industry? How do you envision that this might disrupt the status quo? Which “pain point” is this trying to address?
Despite significant advances in precision medicine, including new drugs that target mutations or other genetic drivers of cancer, new therapies that target and reactivate the immune system, and amazing technologies like next-generation sequencing for molecular profiling, by and large drugs are still approved one tumor type at a time, usually with “tissue based” indications. We are just beginning to see the first of what we call molecular indication drug approvals, where drugs are approved not by tissue type, but by the underlying genetics or biology of the cancer. Unfortunately, though, this is the exception and not the rule.
What Strata Oncology brings to the industry is a platform for efficient and rapid molecular indication drug development. We are assembling a very large clinical and molecular database to help inform new potential molecular indications for biologically-defined sets of patients who are likely to respond to a therapy. We are working on the discovery side. But even more importantly, we are also working on the development side.
We have created a network of large health systems across the U.S. These health systems have standardized comprehensive molecular profiling of their entire advanced cancer patient populations, such that together, as a network, we can conduct really transformative clinical trials. In these trials we select patients for enrollment, not by the tissue for which their cancer arose, but by the mutations or the gene expression patterns of their tumors.
This is a very important and disruptive shift for the industry. By seeking molecular indications, we can often drive far superior outcomes, which means smaller clinical trials and faster drug approvals. Also, these molecular indications open market opportunities for drug companies by enabling the treatment of patients outside of that first or second cancer type in which responses are observed. Patients can be treated across all tumor types provided the genetic or biological profile is correct. Of course, it is a major advance for cancer patients. By driving drug approvals by biology instead of tissue, patients who have rare tumors or tumor types outside of the initial improved indications can now access these therapies and have the potential for significant benefit.
Thank you! It’s great to suggest changes, but what specific steps would need to be taken to implement your ideas? What can individuals, corporations, communities and leaders do to help?
As individuals, we can focus more on a healthy lifestyle. I’d recommend reading Dean Ornish’s book, Undo It. I think companies, schools and communities can focus on a whole foods, plant-based diet, as well as education on the benefits of healthy diet, exercise, stress relief, etc.
The bigger, systemic issue in the US comes from 1) income inequality, and 2) the incentives within our healthcare system. We need to reduce our income inequality through government policy, so I personally support candidates for the president and Congress who believe in taking significant steps to address income inequality in the US. I think that’s what, ultimately, is going to have the biggest impact.
As far as health system structure goes, as I mentioned, I think we are in the midst of a transition toward value-based care. It’s upon healthcare leaders, healthcare providers, and companies in the health care arena, to devise solutions and to work with payers to pay for those solutions in terms of healthcare outcomes, and not in terms of services performed.
What are your favorite books, podcasts, or resources that inspire you to be a better healthcare leader? Can you explain why you like them?
I mentioned one book that was inspirational to me, the book Undo It by Dean Ornish.
What makes your company stand out? Can you share a story?
While there are a number of companies in the cancer genomics and precision medicine drug development spaces, what separates Strata Oncology from our competitors is our very clear focus on bringing new medicines to molecular indications, expanding the use or optimizing the use of medicine, based on molecular profile.
Unlike other molecular diagnostics companies, for us, testing is just the means, it’s not the end. The end is a remarkable treatment outcome for a patient. We spend an enormous amount of energy combing through our clinical and molecular data to devise new treatment hypotheses and then work with biotech and pharma companies who have therapies that we predict may have significant benefit in new patient populations. We are likely one of the few companies that takes this holistic approach across all types of cancer. We ask ourselves questions such as, what are the best new treatment hypotheses for which we can facilitate testing and ultimately new indications, either for existing drugs or new drug approvals? Which ones can we help facilitate? I think this holistic approach is unique to Strata Oncology, and what sets us apart.
To illustrate how we stand out, the work we have done in immunotherapy is a good example. Some immunotherapy biomarkers have been published on, for example PD-L1 immunohistochemistry and tumor mutation burden (TMB), and most next-generation sequencing assays offered by diagnostic companies today are measuring those markers to inform the use of immunotherapy. But we felt these existing markers are likely not sufficient because they are not identifying all potential responders to immunotherapy in a relatively specific way.
We went into the data that we have amassed both from molecular profiling and clinical outcomes and searched for new biomarker patterns for immunotherapy response. We identified that both existing biomarkers, PD-L1 and TMB, did have some predictive capacity, but we also identified a novel predictive signature that combines both PD-L1 and T-cell infiltrate in a single predictive measure.
We didn’t stop there, though. We went and partnered with a company called Arcus Biosciences to test their PD-1 drug in this novel, Strata-identified molecular indication, and we now are working together on a prospective trial enrolling patients who are biomarker positive and are outside of existing indications for PD-1 therapy.
Our hope is that this trial will demonstrate a new biomarker to find indications independent of tumor type that are responsive to PD-1 immunotherapy. Our best case scenario would be to advance a new drug approval in this indication to help the tens of thousands of patients who are not getting immunotherapy today but may have sensitive tumors, enabling them access the medicine via this new drug approval.
How can our readers follow you on social media?
Thank you so much for these insights! This was so inspiring!