Simranjit Singh

Photo: Veronica Tay

Simranjit Singh loves the work he does as CEO of Guardant Health AMEA. Here, a blood sample and an array of advanced tests can reveal the type of cancer a patient suffers from. “This work has an actual meaningful impact on patients’ lives,” he tells me during our interview one Wednesday morning. 

To the layperson, the work that Simranjit is referencing might be hard to understand. After all, when presented on a website, these things come across as clinical, with copy that hints more at the outcome than the process. Inevitably, with life-changing technologies like what Guardant offers, it’s essential to be well-funded — and there’s nothing investors love more than outcomes, I’m sure. 

“Our Guardant 360 Liquid Biopsy involves identifying fragments of tumour DNA circulating in the bloodstream,” he offers helpfully when I ask him how exactly Guardant detects cancer cells with pinpoint accuracy. The tumour releases its DNA into the bloodstream when its cells die. “It’s similar to how a pregnant mother’s bloodstream carries DNA from the foetus, which can be tested for genetic conditions like Down Syndrome or Turner Syndrome.”

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“Once we’ve detected these fragments, we use advanced technologies like AI and bioinformatics to make multiple copies of them and piece them together like a puzzle.” This, he explains, helps them determine which mutation is causing the patient’s cancer. “When we find it, we report it to the doctor, who can then use the information to guide the patient’s therapy — like a GPS.”

Using blood tests to detect cancer

Photo: Veronica Tay

Before the advent of Guardant’s 360 Liquid Biopsy, doctors had to do tissue biopsies, where they would physically extract tissue samples from the tumour site. However, this method had limitations, especially in advanced cancer patients with multiple tumour sites. 

“And even then, a tissue biopsy only provided a partial picture of the tumour DNA,” Simranjit shares, “as mutations could differ across different sites. The process also took longer — almost a month.”

“With our blood test, we can obtain a comprehensive picture of all the tumour DNA in the bloodstream, including from various sites, within seven days. It is a significant advantage for advanced cancer patients, where time to treatment is critical.”

The non-invasive nature of the blood test is also incredibly beneficial for frail and older patients who shouldn’t undergo stressful procedures like biopsies. “Guardant’s technology is based on the premise of providing a less burdensome and more comprehensive diagnostic approach.” 

Empathy & impact

Simranjit recalls his early days as CEO when he visited hospitals and doctors to educate them about Guardant’s liquid biopsy. “One of the doctors took me to the ICU and introduced me to a stage 4 lung cancer patient who needed a tissue biopsy but was too frail for the procedure,” he shares. It turned out to be the big break he needed. 

And despite the lack of logistics and support in those early days, Simranjit managed to get the patient’s sample tested in the United States. “The results revealed a rare and treatable mutation. The doctor initiated the appropriate treatment, and a few weeks later, the patient was well enough to be transferred to step-down care.”

Witnessing this impact first-hand solidified his belief in what the company was doing. It was a powerful moment that would inform the work he continues to do. 

“Many people who join our team at Guardant have personal experiences or know someone who has battled cancer. They bring empathy and a deep understanding of why we do what we do — to help patients as much as we can within our limitations and make a meaningful impact.”

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In favour of affordability

Blood tests
Photo: Unsplash/National Cancer Institute

Still, Simranjit readily admits some limitations of Guardant’s liquid biopsy technology. Sitting up a little straighter, he tells me that, for now, they’ve only received approval for diagnosing solid tumours. “Like those in organs and tissues,” he shares. “It doesn’t apply to blood cancers like lymphoma or leukaemia. There are also certain challenges when it comes to glioblastoma — a type of brain cancer — due to the presence of the blood-brain barrier.”

“Nonetheless, for all other solid tumours, we achieve a specificity of about 97 per cent and a sensitivity of about 95 per cent,” he adds. Statistically, those are impressive numbers. Still, for Simranjit, those statistics paint a broader, more social picture. 

“From a healthcare system perspective, particularly in the context of Singapore, where 2 per cent of patients account for 35 per cent of costs, this technology proves beneficial,” he explains, laying out the inevitable relation between health and cost. Cancer therapies, Simranjit reminds me, can be expensive. 

By accurately identifying the most suitable therapy for a patient, the healthcare system can save resources and prevent patients from investing significant amounts of money into treatments that may not be effective. “It ensures we make informed decisions rather than merely relying on guesswork.”

The economics of health

I asked Simranjit if he believes health technology like what Guardant possesses could be the solution to narrowing the healthcare divide between economically disparate communities. Technology is not the ultimate solution, but it is one of the answers to address specific problems. It cannot stand alone.”

He posits that regulation plays a crucial role, along with the availability of specific health insurance, whether provided by the national or private sectors. “It is imperative, as relying solely on out-of-pocket payments, particularly in cancer care, is not sustainable.”

Simranjit adds that while having advanced technology is beneficial, it becomes redundant without the necessary supportive regulatory and financial frameworks. “In such a scenario, only those at the top of the pyramid will have access to the technology, while others will be left behind.”

Many people who join our team at Guardant have personal experiences or know someone who has battled cancer. They bring empathy and a deep understanding of why we do what we do.

Simranjit Singh, CEO of Guardant Health AMEA

Future plans

Simranjit Singh
Photo: Veronica Tay

Today, Guardant’s future looks bright. In the first quarter of 2023, the company earned $128.7 million in revenue — an increase of 34 per cent over the first quarter of 2022. Additionally, Guardant Health expects revenue this year to be in the range of $535 million to $545 million, representing 19 to 21 per cent growth compared to 2022.

Still, financial robustness is no reason to stagnate. According to Simranjit, future plans include recurrence monitoring for stage one and stage two cancers. This is especially pertinent for patients who have had a seemingly successful tumour removal but still face a considerable risk that cancer cells might remain in the body, specifically in lymph nodes or other undetected areas. 

“To address this concern,” Simranjit shares, “a test has been developed to detect circulating tumour DNA or epigenomic markers in the blood two to three weeks after surgery. If these markers are present, there is a high probability of cancer recurrence.”

Currently, doctors are more defensive about recurrence in patients who have undergone surgery to remove cancerous tumours, prescribing up to 12-month chemotherapy treatments as a precaution. “Just in case, you know,” Simranjit tells me. Still, while understandable, this safeguard comes with its own set of challenges. “Some patients,” he intones, “don’t die of cancer recurrence; they die of the toxicity of the chemotherapy regime.”

With the new Guardant test post-surgery, doctors can make better and more informed decisions about the specific type of therapy patients need to treat recurrence. It allows for a more tailored treatment plan based on individual risk.

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Collective strength

It all looks pretty hopeful — accurate cancer detection, more personalised and relevant therapies, and the possibility of being able to detect cancer before it even has a chance to take root. But for Simranjit, it is the way the health community rallied together during the COVID-19 pandemic that gives him a tremendous amount of hope. 

“In a crisis, we didn’t think we only needed to protect ourselves. There’s a demonstration of collective strength and a shift away from a mindset focused solely on self-protection. Instead, there was an understanding that the situation required a broader perspective and a recognition of the universal nature of health.”

He adds that by openly sharing genomic sequencing and data, countries were able to contribute to a global effort and create structures that fostered true global collaboration. “The pandemic proved this is possible — we didn’t need to adopt a protectionist mindset. Healthcare should and must be everybody’s responsibility. The sense of accountability cannot be the agency of a select privileged few.”