Gimme the Light, Just Gimme the Light
A Q&A Session with Lightpoint Founder and CEO, Dr. David Tuch
Lightpoint’s intra-operative molecular imaging and sensing technologies are designed to detect cancer in real time during surgery. They are a technology leader in precision-guided robotic cancer surgery. They have been developing miniaturised imaging and sensing tools for advanced intra-operative cancer detection. Their mission is to improve the lives of people with cancer by transforming the efficacy of robotic surgery. They have recently been granted FDA regulatory approval in the US; a huge boost and validation of their promise and potential. We sat down with Founder and CEO, Dr. David Tuch, after his recent relocation to Boston, to find out more about his company.
(Interview questions submitted by our Verve Venture Partner, the amazing Dr. Irina Babina).
Dr. Tuch, can you, in your own words, describe what your company Lightpoint does exactly?
Lightpoint Medical develops and commercialises medical imaging and sensing technologies to help cancer surgeons find cancer during surgery, particularly for minimally-invasive robotic surgery. We are addressing the pressing medical need that cancer surgery has a high failure and complication rate because surgery often misses cancerous tissue or removes more healthy tissue than needed. Today, the only way surgeons have to detect cancer during surgery are sense of touch and naked eye. By giving surgeons a tool to detect cancer during surgery, Lightpoint is aiming to improve the success rate of surgery, reduce complications, and improve health outcomes for cancer patients.
What was the driver behind developing this technology?
Early in my days at Massachusetts General Hospital, I was struck by the enormous medical need for better tools to detect cancer during surgery. The problem is very challenging because any solution needs to be accurate, robust, rapid, and cost-effective. Lightpoint was founded on the vision that molecular-targeted surgery using cancer-seeking imaging agents could address this challenge.
How are you progressing?
Since founding 6 years ago, the company has made enormous progress. We have achieved regulatory approval, clinical data, and sales for our first product; expanded into multiple cancer types; and are looking forward to launching our robotic laparoscopic probe. The robotic laparoscopic probe has generated a lot of excitement as more surgery is moving towards minimally-invasive robotic surgery.
The Google AI team trained an algorithm (named Lymph Node Assistant, or LYNA) to spot the features of tumours that have metastasised, which as you of course know are notoriously difficult to detect. The results have been phenomenal; the firm’s deep-learning tool was able to correctly distinguish metastatic cancer 99% of the time. What is your take on the influx of technology into the cancer detection field and are you, or could you use the images that are produced in LightPoint as sort of a training data set for AI?
I think AI will play an increasingly important role in digital pathology by augmenting human pathologists but not replacing them. For example, AI could be used to triage cases for the pathologist or to direct the pathologist’s focus. In principal, we could use AI to train our systems but to date we have focused on direct approaches due to the difficulty AI has generalising to real-world data and the inexplicable black-box nature of AI algorithms. Longer term, in surgical applications, we continue to be interested in the potential of AI for remote proctoring, skills assessment, and situational awareness.
There seems to be a split on how far precision medicine has come. Some argue that gene-specific treatment and prediction has made significant progress (23andMe signed a $300m deal with GlaxoSmithKline to develop personalised drugs, starting with treatments for Parkinson’s disease), others claim the sheer number of genetic factors that can cause cancer make it very difficult to pinpoint a cause and develop a pinpointed customised cure. What are your thought on precision medicine?
Precision medicine is a transformative advance, particularly in oncology drug development, but the examples of approved drugs with companion diagnostics are limited. Key challenges for precision medicine are pricing and reimbursement which are starting to be addressed through value-based healthcare models. It remains to be seen to what extent precision medicine can be applied beyond single mutation biomarkers.
Why is the UK doing so well on Med-Tech devices?
The UK MedTech sector is doing well for a number of reasons including a very strong research base, ready access to NHS physicians, and abundant early-stage equity and grant funding. Scaling businesses in the UK is more challenging however due to a conservative and relatively small home market and the lack of growth financing. These issues are getting a lot of attention from the NHS and policy-makers and I have seen the environment improve considerably over the past several years. If I were to found Lightpoint again tomorrow I would not think twice about founding it in the UK.
Some tissues are easier to image than others, in terms of accessibility and tissue density- will the device be limited to certain types of solid tumours?
The device is applicable wherever the imaging drug is indicated which includes a wide number of solid tumours. Strategically, we are focused initially on prostate and lung cancer surgery which is where we see the greatest medical need and health economic benefit.
What about relatively small tumours, where dye uptake would be reduced?- will this technology only apply to high-grade tumours?
Studies have shown high performance of the imaging drug even in small tumours. The fundamental detection limit is a topic we are still investigating. It is important to mention though that the goal is not to find every micro-metastasis since those are controlled by post-surgical chemotherapy and radiotherapy. Rather the surgical goal is to achieve clear margins and remove clinically relevant disease.
Have any attempts been made to reduce surgeon’s bias in trials? Some surgeons are more aggressive with excision margins, and in studies where margins were evaluated, they may have been deliberately generous.
Variability among surgeons, not necessarily bias, is a major challenge for clinically validating surgical technologies. The standards and practices differ considerably across countries and even within hospitals. There are a few studies showing that surgeon variability is one of the largest factors in surgical margin status. In our studies, we tend to have a local and a centralised definition in order to accommodate local definitions but also have a consistent standard definition.
In terms of amending clinical pathway- Will special measures need to be implemented to protect staff from radiation? Will extra training need to be provided to staff? How much extra time will this add to a routine surgery?
Our technology is based on radio-guided surgery. No special measures are needed to protect the staff from radiation. This was very important in evaluating and developing the technology as we did not want there to be any change at all the clinical workflow. The radiation exposure to staff is very low and comparable to the background radiation from natural sources. Radio-guided surgery is used routinely for a number of non-targeted procedures so staff are generally familiar with the method. We provide training to the surgical staff. Our aim is to substantially reduce the procedure time by allowing surgeons to avoid removing the extensive tissue that is done routinely today.
Do you see this technology being used NHS-wide? There are numerous hurdles to NHS implementation- what is the current status? Or will it be aimed predominantly to US and EU market, where it is more flexible?
In the fullness of time, we certainly see our technology being used NHS wide. Independent economic research has shown our technology to be highly cost-effective which is a key criterion for NHS adoption. The US and continental EU are larger markets but it is also critical to do well in one’s home market.
What are you future plans for Lightpoint? Do you see it incorporated into a larger suite of technological solutions (robotics for example) or as a stand alone aid to surgeons?
We will be launching our robotic probe for prostate cancer surgery, followed by lung cancer surgery. Our system is compatible with robotic as well as non-robotic systems. Surgical decision-making will always take into account of range of inputs such as patient history and pre-operative and intra-operative imaging. As a result, we do not see our technology existing in isolation but rather in bolstering the real-time information available to the surgeon.
What about depth?
We can control the depth sensitivity to between ~mm and ~2cm]
Sounds amazing, we cannot wait to see the progress that Lightpoint make in the future and we are so impressed by the resilience and robustness of the company through such a difficult period where clinical trials were delayed, and cancer treatments rescheduled indefinitely. We wish you all the best!
Wassim Matar is the Managing Partner at Verve Ventures, an early stage VC Fund out of London, Boston and NYC. They are currently deploying their first fund. Verve invested in Lightpoint’s Series B and C.