30 Customers Interviews

Performed by CureTip
1. Product Description
Our product is a recommendation service for physicians-oncologists
prescribing target drug therapy for cancer patients based on their DNA sequence of
mutated genes. It helps a clinician to solve the most difficult problem of different
cancer cases - to choose an appropriate drug for the particular patient.
Cancer is a rather serious problem nowadays. In USA malignant neoplasm is
the main cause of death (25%), even higher than rate of death in case of
cardiovascular diseases (17%). But cancer is not a one disease, it includes a wide
spectrum of different types (from gliomas and lung cancer to gastrointestinal and
genitourinary cancers). All of them have different causes and thats why each
particular type of cancer needs an individual approach for diagnostics and
treatment. Our product provides prediction about efficacy of different existing
drugs action on particular target that is mutated in individual patient. Generally, it
looks at mutations of certain target and chooses the drug for it that works better
than others. However, not all types of cancer are treated by acting on certain
molecule and not all proteins are targeted by several different drugs. Therefore, we
have to find our beachhead market, which fits our technology best, inside some
type of cancer. To understand, what is the right way to narrow the cancer market,
we interviewed our primary customers - clinical oncologists.
2. Interviews

We started sending e-mails to different oncologists all around USA. More

than 200 e-mails were sent to oncologists from different cancer centers in Boston,
Baltimore, Stanford, Philadelphia, Texas, etc. More than 25 oncologists agreed to
fill out the survey, speak with us by phone or meet and speak personally. One of
them was even a president of Dana-Farber Cancer Institute Edward J. Benz Jr.!
The group of oncologists was pretty diverse. It included specialists from different
areas of expertise, such as: lung cancer (9 responders), genitourinary cancer (5
responders), leukemia (4 responders), etc. The oncologists were from 35 to 75
years old, and they were preferentially males. They all had MD degree, but some
of them had more research experience than clinics.
Our interviews pursued 3 main goals:
1. To find appropriate markets of cancer target drug therapy, where the
problem we are solving is a pain point of end users, who find existing
solutions insufficient;
2. To identify if potential markets we chose have enough resources to use our
product (as it uses some input data);
3. To identify the end-user profile that is the most appropriate for our product.
3. Beachhead market
From our interviews we found that 2 main types of cancer that are treated
with target drug therapies are lung and kidney cancers.
In case of lung cancer there are several main targets but there are dozens of
different drugs acting on these molecules. Clinicians usually choose between 10
different drugs, approximately 8 of which are FDA approved. Usually doctors
prescribe 2-3 different drugs to the certain patient. If all of them do not work it is
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very unlikely that any additional drug will work for this patient as after each
therapy probability of successful treatment by another drug decreases. David
Joseph Kwiatkowski, Senior Physician from Dana-Farber Cancer Institute says,
that drug works only in 55-60% of cases. In approximately half of those cases
tumour gets smaller after treatment. In another half tumour growth stops but it
doesnt get smaller. In this case we continue giving drug to the patient hoping that
tumour would get smaller. But even if drug works, in 99% of the cases the effect of
treatment is temporal: tumour almost always comes back. When clinicians choose
the appropriate drug for the patient, they usually use different approaches, such as:
clinical guidelines, current literature on target drug therapy, clinical trials,
statistical data and their experience. They almost always perform DNA sequence
analysis for the patient in their laboratory to identify, what exact mutation led to
the cancer. They then use literature and statistical data to prescribe a drug for the
patient. Therefore, end user has necessary resources to use our technology (it needs
DNA sequence of patient that is always obtained by a physician). We also found
that clinicians find the process of drug selection very tough and complex. Lots of
them search for different sources of knowledge and find existing solutions
insufficient. Indeed, there are many drugs, and new drugs are emerging every
year. We do not have sufficient information to make 100% right decisions. We can
only predict it from our experience, existing literature and statistical data if it
exists.
In case of kidney cancer problem is rather different. There are not so many
drugs used as 1st line treatment in this type of cancer. Usually clinicians choose
between 2 or 3 drugs. They have standards and, therefore, do not face problems in
this process. However, when they choose a drug for 2nd and 3rd line, they face
uncertainty. Usually they have about 7 FDA approved drugs that they have to
choose from. Aymen Elfiky, physician from Dana-Farber Cancer Institute, tells
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that there is a response to the drug in approximately 80% of cases. However, the
effect is always temporal. The hardest problem is to choose a drug for certain
situation. It includes decision if chemotherapy is needed now or after some time. It
also includes selection of appropriate drugs for 2nd and 3rd line treatment. Today
we have a revolution in target drug therapy in kidney cancer. However, there are
still a lot of dark spots. Its hard to predict, when drug will work for particular
patient and when - not. Therefore, oncologists specialized in kidney cancer seem
to have pain point in choosing right drugs as well. In contrast to lung cancer,
clinicians do not send patients with kidney cancer to DNA sequence analysis. It is
not so much known about mechanisms and targets of this type of cancer.
Therefore, oncologists do not have necessary resource for our technology. On the
other hand, target drug therapy in kidney cancer treatment has very huge potential
in the future. After entering the market of target drug therapy recommendation we
can strengthen our position by developing this process for kidney cancer target
treatment.
Therefore, our beachhead market seems to be a market of target drug therapy
recommendation for lung cancer patients.

4. End-user profile
After choosing beachhead market we analyzed demographics of our end
users. We found out that elder doctors (>50 years old) have less uncertainties than
younger ones. Nowadays they use primarily clinical guidelines, experts opinion
and their own experience to find out what drug should a patient get as a treatment.
Elder doctors dont feel that these drug uncertainties are a big problem. Corey
Langer (56 years old), lung oncologist from Abramson Cancer Center University
of Pennsylvania, told us: We follow institutional or national guidelines for the
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most part, like NCCN, for selection of drug, which are rather accurate. Their
decision is based on empirical statistical data and they have no problem in
choosing a drug. However, younger clinicians would be glad to use some other
possible alternatives to clinical guidelines and literature, and then based on all the
available information, even using information about drugs which are not approved
by FDA, they would provide an answer which drug is better to use for this
particular patient. Eliezer M Van Allen (30-35 years old), young genitourinary
clinician from Dana-Farber Cancer Institute, suggests: We often face a problem in
choosing a right drug, thats why we use all the available information, including
practice guidelines, expert opinion and even information about new drugs and
genetic markers of cancer in just published literature. We also found out that male
clinicians tend to revise more existing approaches and more different sources to
find useful information than females. So they are more appropriate for our end-user
profile.
Therefore, our end-users are 35-50 years old male clinical oncologists,
whose area of expertise is lung cancer, working in cancer center in USA. They got
their MD degree from Medical School. Their salary is about $240,000 per year.
They are smart and responsible. They often revise all the available information
(new literature, where new causes of cancer appearance are described, new
possible treatments and even new prediction/genotyping software) about particular
type of cancer.

5. Key findings
1. The most attractive markets of target drug therapy recommendations seem to
be markets of lung and kidney cancer.

2. A lot of different approaches are combined in process of drug selection.

Generally, it turns out to be very complex and subjective issue. In cases of
lung and kidney cancer target drug selection is a pain point for clinician.
3. Almost every patient with lung cancer in USA passes through DNA
sequence analysis. Cancer centers usually provide this test by themselves
and use this information to make further decisions based on statistics and
literature on common mutations. Therefore, the market of lung cancer has all
necessary for our technology resources. It is the main beachhead market of
our product. In contrast, almost no patients with kidney cancer pass through
DNA sequence analysis. However, nowadays the market of target therapies
in kidney cancer treatment is growing rapidly. Therefore, DNA sequence
analysis and information that can be obtained from it has huge potential. We
can use this potential afterwards to strengthen our position in cancer target
drug therapy recommendation market.
4. Our end-user seems to be a man of 35-50 years who has MD degree and has
clinical practice in Cancer Center in USA. He is a specialist in field of lung
cancer. His income is about $240,000. He is smart and responsible person,
who is interested in novel approaches of cancer treatment. He often reads
new literature related to research in target drug therapies. To make a
decision about appropriate drug prescription for a certain patient he uses
different approaches at once, such as: search of corresponding information in
literature, statistical data, current clinical trials, etc.