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By Rick Bradt
A convergence of technologies is set to revolutionize how physicians examine the body for signs of cancer.
The official term for such searches is “endoluminal”—within a tubular organ or structure. Advances include the integration of CT scanning for preprocedural mapping of the search, 3D imaging, electronic rapid sensing to track the catheter, flexible ultrathin catheters and, in particular, the ability to use a computer to robotically control the placement of the device itself. The robotic placement and control of the catheter maximize precision and stability, at a level far beyond what surgeons could do on their own.
This utilization of robotically assisted surgical tools follows 20 years of momentum in using the same for soft tissue and orthopedic surgical procedures. Increasingly in the U.S., academic training in the use of robotic tools has become standard for many aspiring surgeons. What differentiates the opportunity with the flexible catheter is the minute nature of the cancer nodule, as well as the associated frequent challenge in reaching it. With breakthrough efforts in medical technology, the initial target is typically the one with the easiest path to market—thus the current application, lung bronchoscopy. According to many experts, its advantages are compelling: superior access to the peripheral lung, where approximately 70% of nodules reside, and the ability to biopsy upon discovery.
But given the nature of the integrated offering, we believe that lung biopsies comprise only the first frontier. And while roughly one million lung biopsies are performed annually in the U.S., with about 200,000 annual findings of lung cancer, that pales in comparison to the holy grail of this opportunity: the colonoscopy, with an estimated 15 million per year. Further, there is every reason to expect that future evolution of robotic endoluminal procedures could include the ability during the procedure to treat the cancer, either via ablation or with drugs.
The market currently has two competitors: Johnson & Johnson (JNJ) and Intuitive Surgical (ISRG). In health care, mainstream usage is predicated not just on technology, but on the combination of tech, FDA approval, payer coverage, and positive trial data at scale. The latter has been the missing link but could be addressed with a pending trial that showed preliminarily an 83% diagnostic yield, i.e., 83% of biopsies appropriate for diagnosis. Both J&J’s “Monarch” and IS’s “Ion” platforms have momentum: Monarch is conducting 2,000 procedures per quarter (or +100% year-over-year), while Ion is doing 5,000 (or +250% year-over-year). And Monarch has just received approval for its second indication, urological removal of kidney stones.
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