Under the Microscope: AOA Dx
Why Avestria Invested in Early Ovarian Cancer Screening Startup
In this series, we explain why we invested in our current portfolio companies. In the process, we hope to highlight the white spaces in women’s health and the life sciences — as well as the people, products, and companies working to fill those gaps. The name “Under the Microscope” refers both to our extensive due diligence process and our investment focus on healthcare and the life sciences.
Note: Some content from this article was excerpted in a June 28, 2021 article in Forbes about AOA’s seed round and technology. You can find the full article here.
On June 14, 2021, CNN anchor Christiane Amanpour revealed that she, like “millions of women” around the world, had been diagnosed with ovarian cancer. “I’m telling you this in the interest of transparency,” she said in her on-air announcement, “but, in truth, really mostly as a shoutout to early diagnosis.”
Early diagnosis of ovarian cancer, as Ms. Amanpour noted, dramatically improves the survival rate. When detected early, 70 to 90% of ovarian cancer patients live more than five years after their diagnosis — but only 20% of ovarian cancers are found early. Previously believed to be an asymptomatic “silent killer”, recent large scale trials show that over 90% of women experience symptoms — such as bloating, fatigue, and pelvic pain — and vast majority seek medical intervention. However, with many of the symptoms are attributed to other causes and the lack of an accurate test, the cancer is typically not diagnosed until Stage 4: a point at which it has already spread — or metastasized — to another part of the body, and the five-year survival rates drop to under 20%.
As of 2021, about 21,410 women will receive a new diagnosis of ovarian cancer and about 13,770 women will die from it: numbers that are set only to rise in the coming years. By 2035, new cases are predicted to increase 55% and deaths by 67%.
In addition to the emotional and physical burdens placed on individuals who have been diagnosed, there’s a significant financial cost. Ovarian cancer is the second most expensive cancer to treat in women (second only to brain cancer) and the average cost of care in the first year after surgery is approximately $100,000. While the median out-of-pocket cost is around $3,000, that price tag is still high enough that it can cause women to delay or alter their care.
Early diagnosis is one of the best remedies to these costs, but current standards of care often can’t detect cancer early enough or accurately enough. As of today, women who present with ovarian cancer symptoms receive a transvaginal ultrasound to identify and assess any masses and a blood test that looks for elevated levels of CA-125, which measures a protein associated with ovarian cancer. If the ultrasound identifies a pelvic mass, the woman can remove it via surgery; in fact, up to 10% of women undergo surgery for a suspected ovarian mass. However, as a 2014 Kaiser Permanente study reported, out of the total 1363 women studied who had an ultrasound that revealed an ovarian mass and out of the subsequent 204 who underwent surgery without a second ultrasound to confirm, only six (2.9%) had malignant masses. CA-125, meanwhile, presents only in 50% of stage I ovarian cancers and in 75–90% of patients with advanced cancer — but also in cases of non-Hodgkin’s lymphoma, benign ovarian cysts and endometriosis among others so neither is its presence a guarantee of cancer nor is its absence a guarantee of being cancer-free.
AOA’s non-invasive blood test offers a new, accurate, and non-invasive approach to early ovarian cancer diagnostics.
The company is developing a non-invasive blood test for early ovarian cancer detection that aims to increase the early detection rate from 20% to 75% and subsequently reduce ovarian cancer costs by approximately 20%, deaths by 50%, and the chance of recurrence from 94% to 14%. Called Akrivis GD™, AOA’s test detects circulating tumor gangliosides, which are molecules found primarily in body fluids and tissues, including tumor tissue. Two types of gangliosides — are both specific to ovarian cancer and present across all stages (including relapse) and subtypes, and, by detecting whether the targets are present, AOA’s Akrivis GD™ test can determine whether or not a patient has cancer.
Already, the company has performed a retrospective proof-of-concept study using both tissue and serum from 87 ovarian cancer patients to compare Akrivis GD™’s ability to identify patients with (a measurement called sensitivity) and without cancer (a measurement called specificity) correctly to CA-125’s. In all cases Akrivis GD™ produced results with high sensitivity and specificity and outperformed CA-125. CA-125 not only failed to diagnose 30–40% of the patients with early-stage cancer but also generated a high number of false positive results. The company’s next step is an expanded 350 patient retrospective trial, which is currently ongoing, followed by prospective-patient clinical trial to compare Akrivis GD™’s results against those of tissue biopsy.
We invested in AOA because of its potential to transform the diagnosis, treatment, and survival rates of ovarian cancer patients. Ms. Amanpour herself has already demonstrated the positive health outcomes of early diagnoses; since she was able to catch her cancer early, she could receive necessary care, including surgery and chemotherapy, right away and could even return to reporting after a four-week absence. Through AOA’s Akrivis GD™, we believe that an increased number of patients will also have a chance to catch their own cancer early — and to experience the subsequent life-saving benefits that result from AOA’s accessible and accurate early ovarian cancer diagnostic.
At Avestria Ventures, we look for early-stage women’s health and female-led life science companies with products or technologies that improve healthcare quality and/or access, lower costs, induce clinical or behavioral change, are evidence based, have scalable commercialization plans, and have a sustainable competitive advantage. Know one? Contact us via our website, LinkedIn, or Twitter.
