
Grail: Pan-cancer blood screening test for circulating tumor DNA - fitzwatermellow
http://www.grailbio.com/
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eganist
Disclaimer: medicine isn't my background, so the following comment could be
partially or entirely groundless.

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So I just took a crack at the concept PDF and the rest of the literature on
the site, and there's nothing that I can find which mitigates the risk of
flagging a slow-growing or self-regressing tumor as something worthy of
attention.

I say this because mammogram recommendations were only recently changed due to
the potential adverse health risks stemming from treating tumors which might
never progress to a severity warranting treatment [1] as well as tumors which
might spontaneously regress [2]. If some of the newer oncology theories
suggesting high tumor occurrence and anti-cancer immune responses are correct
(my google-fu didn't help me here, so someone else might want to help me with
the source), then as a result of Grail, you might start having a bunch of
people freak out and undergo unnecessarily heavy treatments for tumors which
might otherwise never become cancerous.

That said, I could be entirely wrong, and I wouldn't be surprised if they're
specifically working on mitigating this risk as one component of making this
screen viable.

[1][http://www.webmd.com/breast-cancer/features/new-mammogram-
sc...](http://www.webmd.com/breast-cancer/features/new-mammogram-screening-
guidelines-faq?page=2)

[2][http://archinte.jamanetwork.com/article.aspx?articleid=77344...](http://archinte.jamanetwork.com/article.aspx?articleid=773446)

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johntb86
I guess the difference is that mammograms tell you that there's some sort of
tumor, while sequencing the blood can give a better idea of what's wrong with
it. If you know what oncogenes it has then hopefully you can figure out how
it's going to progress.

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riahi
Mammograms/other imaging also tell you where the tumor is.

Until we have perfect chemotherapy, local treatment with surgery and radiation
will remain standard of care. To perform those, you need to know where the
tumor is.

I find the utility of this test will be in monitoring for recurrence, perhaps
reducing the standard every 3 month restaging examinations; however, once it
starts going up, you'll need advanced imaging again to see if it's local or
metastatic recurrence.

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greggman
Whatever happened to this which as supposed to also detect all cancers for
$0.01 per test at > 99% accuracy?

[https://www.ted.com/talks/jack_andraka_a_promising_test_for_...](https://www.ted.com/talks/jack_andraka_a_promising_test_for_pancreatic_cancer_from_a_teenager?language=en)

~~~
w1ntermute
Exactly what anyone with some common sense should have expected as soon as the
hyped-up news reports and media appearances began[0]:

> George Church of Harvard University, one of the expert judges for the 30
> Under 30 project and one of the fathers of next-generation DNA sequencing,
> reviewed the paper and thought that many of the key claims that had been
> made of Andraka’s sensor – for instance, that it was 168 times faster,
> 26,667 times less expensive, and 400 times more sensitive than existing
> technologies – may not hold up, or at least require more work to be proven.
> I sent the paper to five more top scientists, who reviewed it, for the most
> part, anonymously. Most saw holes and said the results did not match the
> glowing accounts reported, well everywhere.

0: [http://www.forbes.com/sites/matthewherper/2014/01/08/why-
bio...](http://www.forbes.com/sites/matthewherper/2014/01/08/why-biotech-whiz-
kid-jack-andraka-is-not-on-the-forbes-30-under-30-list)

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jerryhuang100
i am surprised that neither in their job opening, or exec board or advisory
board there's someone with specialization in gov regulation or legal matters
(except an opening for dir. of IP).

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untilHellbanned
Lots of scientist prowess except the CEO. Not ideal.

~~~
xiaoma
From your comment it's not quite clear if you feel it would be ideal to have
fewer scientists or for the CEO to be a scientist, but I'm guessing the later.

A couple of years ago while promoting his book in the south bay, Peter Thiel
spoke about his experience with scientist-lead biotech companies: "While
engineer-lead companies are sometimes poor in terms of business sense,
scientist-lead companies tend to be _catastrophic_ ".

~~~
dekhn
Not sure I agree with Thiel. Amgen, Genentech, Intel all had scientist-CEO-
founders. There is a subset of scientists who tend to be excellent CEOs.

