Over the last few decades, the growth and evolution of the medical device industry can be best attributed to the transition from open surgical to less or minimally invasive surgeries (MIS), such as laparoscopy, interventional cardiology, and a host of other clinical areas. Surgeons have generally adopted these new approaches, only when they have gained sufficient confidence in new techniques and technologies, including utilizing surgical robots. Hospitals are investing huge sums in these surgical robotics systems, such as those marketed by Medtronic, Intuitive Surgical, Stryker, Johnson & Johnson (J&J), and others, creating fierce competition among these players.
As surgical oncology follows suit towards increasing adoption of minimally invasive techniques and procedures, the ability to locate and see tumors is vital. Once a surgeon loses the ability to visualize directly and use tactile sensation to identify and locate tumors, what can provide that needed layer of confidence? Advances in imaging, such as near-infrared (NIR), and chemistry have added new technologies that help surgeons see cancer tissue in real time, during the procedure. These new imaging modalities can identify small tumors that may not appear on preoperative imaging, as well as identify tumor margin so that surgeons can determine whether the entire tumor was resected.
This is why Windham is excited to invest in Vergent Bioscience, a Minneapolis-based company, developing a novel molecule of tumor visualization. Vergent designed VGT-309 (aptly named for the 1981 hit song "867-5309/Jenny") to target tumors by covalently binding to cysteine cathepsins (including cathepsins B, L, S and X/Z). These cathepsins are proteases overexpressed in most cancers and are prevalent in tumor cells, activated tumor associated macrophages (TAMs), and the tumor microenvironment. This binding action to cathepsins allows the ICG dye component of the molecule to fluoresce, which “lights up” tumor tissue under NIR imaging. ICG and NIR have become standard components of surgeons’ workflows, especially with the increased utilization of surgical robotics.
With a death toll exceeding 9 million a year globally, cancer is the second leading cause of death, with 1 in 6 deaths due to cancer. Thanks to advances in clinical research over the past several years, numerous novel cancer treatment approaches are available to patients, including effective immunotherapy and targeted drug treatments. Although these new therapies could serve as a primary cancer intervention, surgery remains the most common approach for many types of solid tumors.
Patient outcomes for surgical oncology, though, are impacted by the extent to which all cancer cells can be effectively removed from the affected organ, while sparing as much of the surrounding healthy tissue as possible. Excess resection of tissue often leads to complications, while incomplete removal leads to increased recurrence rates (about 30-65%), lower survival rates, and the need for repeated surgeries (20–50% in breast cancers), causing stress and burden for patients, surgeons, hospital systems, and payers.
Vergent’s lead indication is lung cancer. Lung cancer is obviously a large market – it is the third most common cancer in the US and the number one cancer in terms of mortality. Early detection/diagnosis is expected to increase as the lung cancer screening guidelines were revised in 2021 and as new detection technologies are developed (such as Windham portfolio company, Delfi Diagnostics), potentially leading to rising numbers of patients undergoing surgery to remove tumors. Although their beachhead market is lung cancer, Vergent plans to expand to other solid tumor types, including breast cancer and colorectal cancer. This applicability to other indications creates significant opportunity to generate great impact in surgical oncology and reach a large number of cancer patients.
Vergent has successfully completed Phase 1 and Phase 2 studies in Australia and is currently in the midst of a Phase 2 study at the University of Pennsylvania. Results so far have been impressive! VGT-309 has shown that it is able to bind effectively to cathepsins and “light up” tumor tissue, enabling surgeons to locate tumors and resect the whole tissue for lung cancer resections. There have been numerous real-life patient stories where the clinical course was altered based on what VGT-309 found.
Beyond the promise of Vergent's market, there is much to like about the business that helped build our conviction. We enjoy working with John Santini, Vergent CEO and an industry veteran, and his team. The team has made significant progress in a highly capital efficient manner, and we know this capital will enable them to achieve several important milestones, including an upcoming pivotal trial. The team has made many wise decisions, including designing VGT-309 so that it is compatible with all imaging systems on the market today, consistent with current surgeon workflow, and broadly effective at binding to multiple tumor types. We are pleased to partner with Orlando Health Ventures, REX Health Ventures, Intuitive Surgical, Spring Mountain Capital (SMC), Colle Capital, and others to support this game-changing technology.
We believe VGT-309 will alter the standard of care for cancer surgery and improve outcomes and survival for cancer patients worldwide!