Helmy Eltoukhy’s Big Idea That Might Change The World

Scaling applies to people, not just companies — one has to keep learning new skills, on and off the job, to be able to continue adding value to hyper-scaling companies. Learning to hire, manage, lead, write, present more effectively are all necessary growth curves that young founders must dedicate time towards.

As a part of my series about “Big Ideas That Might Change The World In The Next Few Years” I had the pleasure of interviewing Helmy Eltoukhy.

Helmy Eltoukhy is CEO of leading precision oncology company Guardant Health, which he cofounded with AmirAli Talasaz over 8 years ago. Helmy is an entrepreneur and pioneer in the biotech industry. Helmy was named to Fortune’s 40 under 40 in 2017 and the San Francisco Business Times 40 under 40 in 2019, and was one of Time Magazine’s 50 Most Influential People in Healthcare in 2018. After receiving his PhD, MS and BS degrees in electrical engineering from Stanford University, he joined the Stanford Genome Technology Center (SGTC) as a postdoctoral fellow in 2006 to work on low-cost DNA sequencing technologies. During his doctoral studies and at the SGTC, he developed the first semiconductor sequencing platform and first base-calling algorithm for next-generation sequencing under several NIH National Human Genome Research Institute grants. In 2007, he co-founded Avantome to commercialize semiconductor sequencing to help speed up the democratization of high throughput DNA sequencing until its acquisition by Illumina in August 2008. At Illumina, Helmy was Senior Director of Advanced Technology Research, where he developed novel chemistries, hardware and informatics for genetic analysis systems.

Thank you so much for doing this with us! Before we dig in, our readers would like to get to know you a bit. Can you please tell us a story about what brought you to this specific career path?

It’s my pleasure, thanks for having me. I knew fairly early in my career that I wanted to dedicate my life’s work to pursuits that held high positive social impact. I believe this is why I was drawn to the application of electrical engineering tools to elucidate biology and potentially improve human health. As a doctoral student and postdoctoral fellow at the Stanford Genome Technology Center, I worked on low-cost DNA sequencing technologies that led to my co-founding of Avantome. The company was acquired by Illumina in 2008 and over the next few years Illumina made great strides in achieving an important milestone of reducing the cost of sequencing a human genome down to $1,000. While I was working at Illumina, I actually had an undiagnosed health issue that exposed me to the lack of tools that exist in the healthcare sector. It was this personal healthcare odyssey that led me to realize that physicians desperately need much more informative tools to be able to ask and answer the right questions regarding their patients. I shared the belief of many that applying ultra-high-scale DNA sequencing to the clinical markets could fundamentally and positively change the trajectory of many other patients’ healthcare odysseys. Cancer being a disease of the genome was certainly an area where DNA sequencing could make an enormous impact, if cancer could be found early enough and tracked in real-time. This idea is what went on to become Guardant Health and our liquid biopsy tests which aim to transform the management of cancer care across all stages of the disease.

Can you please share with us the most interesting story that happened to you since you began your career?

We first launched our liquid biopsy back in 2014. Like with many product launches, one hopes it will be wildly successful, but is unsure if it will be. We certainly believed that our liquid biopsy could make a difference in patient care, but were surprised to discover all the unexpected ways it could. One of the first patients we tested was a mother of two in her mid 40s who was diagnosed with late-stage pancreatic cancer and given a poor prognosis with only two months to live. She went to another medical center to get a second opinion and the physician ordered our Guardant360 liquid biopsy test. The test came back with genomic mutations that were not consistent with pancreatic cancer, so her physician ran a few more tests. They realized it was really ovarian cancer! This meant she was now a candidate for a common ovarian cancer chemotherapy. She was administered the therapy and had a fantastic response with her disease going into remission. This story highlights that sometimes just a little bit of additional information is all that’s needed to make a life-changing difference in the trajectory of a patient’s journey.

Which principles or philosophies have guided your life? Your career?

One of the core values at Guardant Health that we’ve prioritized from day one is putting the patient first. We try to imagine all patients as our own family members. In fact, we begin and end every all-company meeting with a reminder of this value along with a new patient story. Having dedicated myself to the cancer care space, like so many of my colleagues here at Guardant Health, I think this principle of putting the patient first has truly helped guide me in my life and career. This dedication to patients also guides how we think of social responsibility more broadly as a company, and for example, helped lead us to our next-generation sequencing based COVID-19 test which we developed to help during the pandemic, given our expertise, and we are now offering the test to select schools and underserved communities.

Ok thank you for that. Let’s now move to the main focus of our interview. Can you tell us about your “Big Idea That Might Change The World”?

What if a simple blood test could detect cancer across all stages of the disease, even earliest when it can be treated most effectively? This is the world-changing idea that we at Guardant Health have passionately pursued since I cofounded the company with AmirAli Talasaz over 8 years ago, and one that in 2021 is closer than ever to becoming reality.

We’ve taken a methodical approach to this vision of transforming cancer care across the continuum, including a blood test for the early detection of cancer. We adopted a beachhead strategy starting where the greatest unmet medical need exists, so we’ve focused first on advanced cancer where this need exists, and where the DNA that’s shed from a tumor into blood is easier to detect. Our company’s first blood test, or liquid biopsy, for use with advanced cancer patients, is easier, faster, and less invasive than traditional tissue biopsy, revealing the genomic mutations of a patient’s cancer to inform precision medicine, an increasingly essential branch of therapy that can be more effective and less toxic than traditional “one size fits all” chemotherapy or immunotherapy. Since then, Guardant Health’s liquid biopsy tests have been used by over 9,000 oncologists in over 150,000 samples to date. Last year our Guardant360 CDx test became the first FDA-approved comprehensive liquid biopsy for any advanced solid cancer, helping to overcome remaining skepticism about the technology and help set the stage for earlier cancer detection.

Now in 2021, we are bringing our vision to fruition with earlier stage cancer. We are launching the world’s first blood-only liquid biopsy test for residual disease and recurrence monitoring, Guardant Reveal, allowing oncologists to identify early-stage patients at high risk of recurrence who may benefit from adjuvant therapy, and who may benefit from continued monitoring to detect recurrent disease months earlier than current standard of care. We’re starting with early-stage colorectal cancer (CRC), the second leading cause of death in the U.S. and a disease where an estimated 10–30% of early-stage patients recur within five years. Our LUNAR-2 program is developing a multi-cancer blood test that will first focus on CRC, with our ECLIPSE trial planned to finish enrollment in 2021. This landmark study is one of the largest of its kind, enrolling 10,000 American men and women aged 45–84 for early colorectal cancer detection, and will be an important milestone in bringing to market a blood test that can detect early signs of cancer in asymptomatic people.

How do you think this will change the world?

A simple blood test to detect cancer at all stages of the disease has the power to change the world by increasing testing and screening rates which will help curb cancer mortality rates once and for all. There are barriers to traditional standard-of-care testing and screening modalities that a simple blood test, which is easier, faster, and less invasive, can help overcome. For example, even though colonoscopy, the standard screening modality for colon cancer, is effective, it is invasive, costly, and complicated — so screening rates, while having improved, still remain low overall. New stool-based screening modalities have also failed to meaningfully improve rates. The U.S. Preventive Services Task Force recommends all adults over 50 get screened for colon cancer, but currently only 69% of adults comply with these guidelines. A simple blood test can help improve these rates.

Cancer remains a leading killer globally. To truly curb cancer mortality rates, we must catch it earlier when it is most curative, and enable better testing across all stages of the disease to inform better treatments. The potential impact of liquid biopsy on human health is profound. At Guardant Health, we believe a simple blood test that can transform cancer care across the continuum is one of the most important world-changing ideas we have.

Keeping “Black Mirror” and the “Law of Unintended Consequences” in mind, can you see any potential drawbacks about this idea that people should think more deeply about?

To be honest, there aren’t many significant drawbacks to liquid biopsy. It’s a simple blood draw that is minimally invasive, especially when compared to other existing screening modalities, and can provide potentially life-changing genomic information that was not available to the oncologist prior to the testing. Unlike innovation in broad technology, in healthcare, you have the added barriers of clinical evidence, regulatory approval, reimbursement, etc. — so these systems make it harder to have Black Mirror scenarios, though don’t get me wrong they can happen in healthcare too.

Was there a “tipping point” that led you to this idea? Can you tell us that story?

Liquid biopsy has been around since the 1950s. What’s happened in the last decade has really been the tipping point. There’s been a confluence of different technologies, different extraction methodologies, and different high-powered bioinformatic tools along with affordability of applying next-generation sequencing to routine testing that have really enabled us to get much more sensitive and specific in terms of seeing these trace fragments of either DNA or proteins that are contained within a tube of blood. Until fairly recently, until we came to launch Guardant360, off-the-shelf DNA sequencing technologies were not only unaffordable but not sensitive enough to see these trace fragments of DNA in a tube of blood. Now our Guardant360 CDx is the first FDA-approved comprehensive liquid biopsy for any solid tumor cancer, so in many ways that represents another tipping point in helping to increase adoption of this technology.

What do you need to lead this idea to widespread adoption?

In healthcare, unlike broad technology, innovation is not enough. You have the added complexities of proving the clinical utility of your test to improve healthcare outcomes. This requires conducting the necessary clinical trials, amassing evidence, regulatory approvals, reimbursement, coverage, and so on. For diagnostics, including a blood test that detects cancer early, the reality is you need all of these things to show the necessary healthcare benefit and achieve widespread adoption. You really need to get the necessary clinical evidence to prove to oncologists that this improves upon the current standard of care or serves an unmet medical need. Once you do that, you need to make sure payers will cover the test. We have known this from the start and we’ve approached all of our products systematically with these barriers in mind. Our recent success in bringing to market Guardant360 CDx, the first FDA-approved comprehensive liquid biopsy for all solid cancers, and a test that is covered by many private payers and Medicare for all advanced tumors, has provided us with many important learnings as we continue to look ahead to bringing future products to market for more patients earlier in the cancer care continuum.

What are your “5 Things I Wish Someone Told Me Before I Started” and why. (Please share a story or example for each.)

1. Scaling applies to people, not just companies — one has to keep learning new skills, on and off the job, to be able to continue adding value to hyper-scaling companies. Learning to hire, manage, lead, write, present more effectively are all necessary growth curves that young founders must dedicate time towards.
2. Healthcare is harder than one even imagines given the complexity of payments, care delivery, and all of the various stakeholders that control a piece of the ecosystem. Over the last few years, we have made tremendous progress with payer coverage and have 200 million Americans covered for Guardant360, but there are is still more work to do until every individual is covered for the test.
3. Early adopters are different than the bulk of eventual users and they care about different aspects of the product, even in healthcare. Market research is often dominated by early adopters, which can lead to complex products that don’t resonate with 80% of users. Our reports have gotten simpler and simpler over the years by narrowing their scope to what truly matters for patient care.
4. It’s possible to fundamentally bring about breakthrough impact by focusing on simple things. In our space, undergenotyping is such a significant challenge, whereby as many as 80% of cancer patients aren’t being tested for basic therapies that are indicated in guidelines. Getting these 80% of patients tested would result in significant savings to the healthcare system and much better overall survival for cancer patients. This doesn’t need breakthrough innovation, but can happen through just more testing.

Can you share with our readers what you think are the most important “success habits” or “success mindsets”?

One success mindset that I think is important is intellectual humility. This is something that I, as well as many others here at Guardant Health, really take to heart. I think with innovation, it’s vitally important to have confidence, that audaciousness, that optimism and can-do spirit, but I think a challenge arises when this is not combined with intellectual humility — particularly when it comes to science and healthcare. For what we do, having respect for the complexity of biology and for learning from others is so important. Intellectual humility is a good thing.

How can our readers follow you on social media?

You can follow me on Twitter at @Helmy_L2K and you can follow Guardant Health on LinkedIn and Twitter at @GuardantHealth.