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Lessons from AmirAli Talasaz, Guardant Health, building a leading precision oncology company to IPO
AmirAli Talasaz, co-CEO and co-founder of Guardant Health, a leading precision oncology company focused on helping conquer cancer globally.
Welcome back to the Pear Healthcare Playbook! Every week, we’ll be getting to know trailblazing healthcare leaders and dive into building a digital health business from 0 to 1— this week, we’re also joined by Eddie Eltoukhy, bio partner at Pear VC and formerly Head of Business Development at Senti Biosciences.
This week, we’re super excited to have AmirAli Talasaz, co-CEO and co-founder of Guardant Health, a leading precision oncology company focused on helping conquer cancer globally.
Founded in 2011, Guardant Health is focused on helping conquer cancer through the use of its proprietary blood-based tests, vast data sets and advanced analytics. Guardant’s solutions include treatment selection, recurrence detection and early detection of cancer. The Guardant Health oncology platform leverages capabilities to drive commercial adoption, improve patient clinical outcomes and lower healthcare costs across all stages of the cancer care continuum.
Through multiple rounds of private financing, Guardant Health raised over $500 million from investors including Sequoia, Khosla, Lightspeed, OrbiMed, and Softbank, and Pear! and Guardant completed a successful IPO in October 2018.
Prior to founding Guardant Health, AmirAli was a Senior Director of Scientific Research at Illumina and was a technology lead at the Stanford Genome Technology Center. He also graduated from Stanford with a PhD in Electrical Engineering.
If you prefer listening, here’s the link to the podcast!
AmirAli’s entrepreneurial path from biotech founder to acquistion to Illumina, and back to founding Guardant
Early days from combining biotech and engineering: AmirAli decided against going into medicine when he was a high schooler, but life brought him back to biotech from an engineering perspective. In 2001, AmirAli came to Stanford for his PhD in electrical engineering, especially in the field of telecommunication circuit design.
Amir’s first venture: Before Illumina, he founded Auriphex Biosciences, which focused on purification and genetic analysis of circulating tumor cells for cancer management. The technology was acquired by Illumina in 2009.
Starting his career in Illumina: He shares that the telecommunications field was collapsing at the time, but was introduced to the head of Stanford Genome Technology Center, Ron Davis, a professor in genetics and biochemistry, as well as his primary advisor in the same department. He was passionate about clinical impact and community health, and soon after finishing his PhD, started his career at Illumina.
Founding Guardant Health with Helmy: At the time, Illumina was evolving from a technology and service provider into a clinical provider. As it became more clear that it would be a long transition, and AmirAli decided to leave and start Guardant Health alongside co-founder, Helmy Eltoukhy, who he also met at the Stanford Genome Technology Center. Guardant’s early vision was to bring interesting genomic technologies into patient care in the clinical setting, especially in the field of oncology.
Guardant Health’s core is to find different biomarkers in blood samples for broader applications within oncology
Guardant’s vision from day one was to create a simple blood test during a wellness check-up that would diagnose a patient with cancer as early as possible. The science of finding oncology biomarkers in blood samples has been around since the late 1940s, and people have known about tumor-associated biomarkers since the late ‘80s, but there was a technology gap in finding these rare biomarkers and analyzing them.
“It looked like Mission Impossible from the perspective of many key opinion leaders in the field to marry next-generation sequencing technologies with finding these biomarkers in blood in the field of oncology, since those biomarkers are very rare.
That's the typical story of startups— when applications are big and the technology is missing. If you can put innovation on the table to fill those gaps, the market opportunity will present itself.”
Taking the risk to build Mission Impossible - you will get a hundred no’s but a few yes’s and true believers
“When you get into a field of potential big needs but with a technology gap, there will be a lot of naysayers. Maybe that's natural and should be expected for all entrepreneurs. It takes a set of entrepreneurs to take the risk: some of them will fail, and some of them will succeed to show that it wasn’t Mission Impossible, and with technology and a great team, we can figure that out.”
Guardant started with a technology stack based on a few biomarkers that they soon realized would 1) not meet the clinical requirements of their field in terms of accuracy and 2) lacked the ability to scale.
They needed to change quickly as a small team without a lot of funding, and ended up deciding to pivot the tech stack entirely. They didn’t pivot from the original vision, but pivoted to a new tech stack with more long term product market fit.
AmirAli shares that just like the original tests Guardant had launched, there are still doubts about many of Guardant’s new product initiatives.
“You need to believe in your vision; you need to have the appetite for risk taking because nothing is guaranteed. Nobody has a crystal ball. But based on some division and the feeling that you have for technology and science, you're going to place some bets… Those naysayers would always just stay on the sidelines. But the entrepreneurs who are going to take the risk are going to redefine the future.”
Real innovation takes iteration: The first product failed, but it took many iteration cycles to make it work
The team went through several innovation cycles to try and marry sequencing technologies to blood-based testing in oncology— and the first effort didn’t work. After a few months, AmirAli shared they had to pivot very quickly to a totally different technology stack, which finally resulted in a working product.
In healthcare, it’s important to count on KOLs, advisors, and network experts to find product market fit
In the early pre-commercial days, AmirAli shares that they mainly counted on advisory groups, KOLs, and people in their network to guide them. Once the product hits the field, you can learn a lot from the market. AmirAli believes that the best way to figure out product market fit is to put something on the market as soon as possible (of course, meeting the minimum quality bars required with regards to patient safety).
Guardant’s biggest strength, turnaround time, was based on market feedback
AmirAli shares that one of Guardant360’s biggest strengths is its turnaround time of under a week, which was a feature made completely based on market feedback. They invested significantly in this initiative and adjusted their operational stack. Even almost 8 years post-launch, their competitors typically have a turnaround time twice as long. There are some features that you’re only going to be able to understand better when customers get their hands on it.
Profile your early adopters and offer white glove services to your first customers
Guardant went through the classic early adopters to mainstream adopters cycle — AmirAli warns the audience not to jump into the mainstream audience too quickly. Their team focused on profiling their early adopters: Who are the people more receptive to innovative technologies? Who are the people who are stakeholders impacting payers to cover this test? Who are the stakeholders in guideline committees?
They offered white glove services to these physicians and incorporated their feedback when it came to adjusting the product. Once they got regulatory guideline inclusion and reimbursement wins, product adoption was clear.
To increase market share and product adoption, focus on generating clinical evidence and creating an even stronger customer experience.
The most important differentiator for Guardant was having a complete feature test set that could analyze a broad range of biomarkers. For the biotech market, AmirAli shares that the building blocks of a good company are strong technology, clinical evidence, provision from payers, endorsement from regulatory bodies, and strong customer experience.
To generate clinical evidence, AmirAli shares that Guardant sponsored studies as well as leaned on investigator-sponsored studies (different cancer centers) to show their tests were adding value to physicians’ practices. Now there are around 300 papers that offer evidence supporting Guardant’s products.
In terms of customer experience, a physician needs to have a good experience using Guardant’s tests in terms of interacting with salespeople, customer service, and the logistics of blood draw for the patient. Ordering the test and reporting delivery should be as easy and seamless as possible.
“That's a typical journey you have to go through in clinical diagnostics: take the test, generate evidence, deliver a great prescriber and patient experience, and then the guideline committee will endorse it.”
Guardant’s expanded product offerings from seed to IPO:
Guardant started by offering blood tests for advanced cancer patients. They launched their flagship product in 2014 called Guardant 360®, a comprehensive blood test that looks for relevant therapy selection biomarkers in advanced cancer patients. Instead of getting genomic information through biopsy tissue, you can get biomarker information through a simple blood test. Today, Guardant360 is in 60 countries globally with over 11,000 oncologists in the United States using it for over 250,000 cancer patients.
Guardant launched Guardant Reveal™ two years ago for cancer survivors, to see if the cancer has recurred. Its current indication is in colorectal cancer, which is the second leader of cancer related deaths in the US, and will expand soon to other cancer types.
Just a few weeks ago, the team launched a brand new test called Shield™, which effectively finds early colon cancer signs with a simple blood test in healthy individuals, especially for people who are not complying with any kind of colorectal cancer screening programs. Other products include tests in response to therapeutic intervention as well as tissue biopsy tests.
The field has changed dramatically in the last decade, and now with more endorsement from guideline committees, many more people will have access to these blood tests.
Guardant Reveal, the test that tracks patient relapse, is in the process of entering guideline documents. The team also believes it will be the first FDA approved, Medicare covered blood-based cancer screening test.
Build a dynamic organization that’s open to evolution, but keep as much of your early team with you as possible.
AmirAli has seen Guardant grow from two to over 1500 employees, and he shares that the most important lesson has been to make sure you’re ready for the next chapter. Don’t worry too far into the future, but make sure you’re ready for what’s next. He shares that your organization should be dynamic, learning from what has been successful so far but understanding what changes are required to scale.
AmirAli believes that having early employees who continue to scale with the company can be extremely beneficial. You can bring in external people at different levels and resources to help them, but avoiding huge changes in staff is important.
“It’s evolution. Evolution is true in biology, true in organization too. In order to be a better fit, based on internal and external factors, you need to evolve.”
How Guardant scales to IPO
Building governance committees and Designated Responsible Individuals for accountability
In the early days, AmirAli shares that making decisions and communicating decisions was much simpler. At the stage Guardant is now, the vast majority of decisions are made by the executive management team after being run through several layers:
Governance committees have broad oversight over the product development phase gate.
For corporate level initiatives, AmirAli shares they want to have only 1-2 people in charge in terms of accountability. Even if it’s a cross functional effort, there’s a Designated Responsible Individual (DRI) for that initiative that has the authority to deliver on it.
This culture of accountability goes deep in the organization, even when it comes to knowing who’s responsible for a simple decision.
Invest in a good network of trusted people around yourself, and pass your torch
To prepare for the next chapter at the executive level, AmirAli shares that a mentor and a network of trusted people were highly helpful.
The type of mentor can change based on the stage you’re at, from serial entrepreneurs in the early days to more seasoned leaders at later stages. Crowdsourcing and gathering experience adds a lot of value, as well as finding information through other resources like books.
“Invest the time to make sure you have a good network of trusted people around yourself. Make sure you talk to them, learn from their experience, and if you're dealing with issues, ask them. Vice versa, offer help to other people.”
Future bets on how AI can contribute to screening early diseases, drug discovery and more and a ripe environment for favorable health policy
AmirAli shares that at a government level and global scale, there are some interesting cancer initiatives in progress. The US has the Cancer Moonshot program and globally, there’s more attention towards preventative medicine and reducing mortality in the EU. He believes that globally, health policies are trending upwards to define a better future for cancer patients.
In terms of the healthcare field at large, AmirAli is excited about how AI can contribute to redefining healthcare. It’s applicable for screening early stage diseases, drug discovery, synthetic biology, remote carrying, etc. He believes Guardant’s technology stack is not ready for it but there’s a lot of opportunities for the right entrepreneur with the right tech stack to bring AI into healthcare.
Guardant’s first tagline was ‘Conquer Cancer with Data’ and they kept the tagline because they continue to believe in it
AmirAli shares that each product helps inform the next. For example, Guardant360 data and insights informs their cancer screening product. Based on some of the biomarkers from early stage cancer patients, they’re better understanding which pathways to look at and which clinical indications interfere with their results. Machine learning and AI is going to play a huge part in understanding the biology better, and as a result, improving Guardant’s products.
At its core, Guardant is mission driven, and the patient comes first in every decision. Every board meeting and all-hands meeting even after IPO starts with a patient story.