Mallikarjun Sundaram spent much of his childhood traipsing across Tamil Nadu, pulled along by his father’s job in the excise department. Money was tight, so Sundaram – the sixth of seven brothers – had an ordinary schooling at Tamil-medium government institutions in Sivakasi and Madurai. In Class 8, he attended his first English-medium school in Mumbai, where he had moved in 1983 to live with an elder brother soon after their father’s death. Another tragedy awaited the family.

In 1986, the youngest of Sundaram's brothers was diagnosed with cancer, and passed away soon after. “That’s when my awareness of cancer first started,” said Sundaram.

Three decades later, Sundaram is at the cutting-edge of the fight against cancer. Mitra Biotech, a company he helped found in 2010, is pioneering technology that can rapidly test the impact of drugs on a cancer patient by examining a tiny tumour sample in a lab. It means that cancer treatment can be personalised to a degree never achieved before, helping physicians and patients pick the most effective drugs while avoiding cost and side-effects of other medication. The company’s offering also has utility in the pharmaceutical industry, potentially speeding up the discovery and development of cancer drugs.

The promise of Mitra Biotech’s technology, which it has trademarked as CANScript, has already attracted some serious money. In late August, the company raised $27.4 million from Sequoia India, Sands Capital Ventures, and RA Capital Management. It was the second time the company raised funds, after receiving initial financing in 2010 and 2013.

Banaras to Chennai, via MIT

After finishing school in Mumbai, Sundaram entered what was then the Institute of Technology at the Banaras Hindu University, now IIT-BHU in Varanasi. He spent four years in the holy city by the Ganges reading for a degree in pharmaceutical engineering, before heading to the University of Utah for a PhD in medicinal chemistry. In 1999, he arrived at the Massachusetts Institute of Technology as a post-doctoral researcher in bioengineering.

Within two years, Sundaram turned entrepreneur. He was a founding scientist at Momenta Pharmaceuticals, along with a bunch of other academics from MIT. The company specialises in the sequencing and engineering of complex sugars for drug development. In 2004, Momenta went public, raising $34.8 million in an initial public offering. The same year, as Momenta grew from four founders to 250 employees, Sundaram enrolled at Wharton School of the University of Pennsylvania for an MBA.

Around this time, Sundaram began a series of conversations with Pradip K Majumder and Shiladitya Sengupta. Majumder is a cancer biologist who previously taught at Harvard Medical School. Sengupta is an assistant professor of medicine, also at Harvard Medical School. Both are also alumni of New Delhi’s All India Institute of Medical Sciences.

“The idea was kinda vague,” Sundaram said, explaining the results of many rounds of brainstorming. But it broadly revolved around using analytics to improve cancer treatment, and it was enough to excite Sundaram to jump in. So, he finished at Wharton in 2006, quit Momenta in 2007 and put together a business plan for their new venture by early 2008. With half a million dollars scraped together from friends and family, the trio began Mitra Life Sciences.

Soon after, Sundaram arrived in Chennai to get down to work, although the nature of the exact product was still evolving. The decision to develop the product in India was driven by a single factor. “We wanted to use all the money to develop the product,” he said. The costs in India were significantly lower, including cheaper access to clinical data, which was critical to the entire project.

It also helped that Sundaram’s father-in-law offered him an 800-square-foot apartment in Chennai rent-free. “The kitchen became the histopathology lab, the bedroom became a cancer biology lab,” Sundaram recalled. “The other bedroom became the boardroom.”

The company was later reincorporated as Mitra Biotech in January 2010, around the time it moved its India headquarters to Bengaluru.

Cancer conundrum

Cancer occurs when the DNA of one of the trillions of cells in the human body undergoes an unusual change. The single cancerous cell then aggressively multiplies, eventually forming a tumour that spreads through the body. No two cancers are the same because their origins and proliferation are varied. That is also why every cancer patient reacts differently to medication.

Apart from surgery to remove tumours, chemotherapy and radiation are the most common treatments for cancer. But both, although intended only for cancerous cells, often also end up damaging healthy cells, resulting in unwanted side-effects. To counter this situation, a growing stable of precision medication tailored to target only a patient's cancerous cells has emerged. To ascertain the combination and dosage of these drugs, however, physicians need a better understanding of the specific characteristics of each individual patient’s cancer. This is where Mitra Biotech’s CANScript promises to revolutionise the treatment process.

CANScript basically looks to replicate the microenvironment of a cancer tumour on a plate inside a laboratory. For this, the platform requires a tiny sliver of tumour tissue, which can be removed during the biopsy, and 10 millilitres of blood. It then tests out multiple drugs on this laboratory sample, trying to replicate how a patient would react to these medications. They then measure many parameters, including tumour cell-death, cell morphology, and rate of tumour growth, to understand the full impact of a particular drug, or a combination of drugs. These are combined into a single numeric score (M-score) that is assigned to a particular drug. “Higher the M-score, the greater the chance of tumour burden reduction,” Sundaram explained.

There are several other technologies that can peer into a single patient’s cancer cells. By investigating the genetic material of cancer cells, scientists can identify the DNA alterations that fuel the growth of a tumour. Such information can be useful for physicians to find a more targeted treatment for an individual patient. In one out of five breast cancer patients, for example, a protein known as HER2 can result in the proliferation of cancer cells. With drugs that specifically target HER2, the growth of breast cancer cells can be arrested, without damaging healthy cells. But such a genomic-based approach, Sundaram contended, only works in a small percentage of cancer cases.

Then there are also methods like the “human tumour xenograft,” wherein cancerous tumour cells from a human patient are transplanted into mice. It’s a process that Mitra Biotech experimented with in their early days while working out of their small Chennai apartment, and then discarded. “All tumours don’t grow in mice,” Sundaram said. “Maybe one out of 10 will grow.” Even when these tumours grow, it can take up to three months before any conclusive data can be obtained. It is also a problem to find the right mice in India for these tests, so Mitra Biotech had to import theirs, which added to the cost.

In comparison, Sundaram argued, CANScript delivers results within seven days, can test multiple drugs and is relatively affordable at about $600 or Rs 40,000 per examination in India.

In a February 2015 paper in Nature Communications, a peer-reviewed scientific journal, Mitra Biotech published the results of testing CANScript’s model for head and neck squamous cell carcinoma and colorectal cancer. The study first recreated the microenvironment of 109 patients suffering from one of the cancers, tested the response of a set of drugs on the tumours and then used the data from this set to shape a predictive model. This model was then tested on a group of 55 patients with one of the cancers and treated with the same drugs as the earlier study. In this test, CANScript essentially correctly predicted each cancer patient’s response to the treatment.

“We are also dedicated to demonstrate clinical utility of the system in different cancers, different class of drugs through additional clinical studies that will continue along with the commercial launch of the product,” Sundaram said, adding that these studies would be conducted in multiple geographies, including the United States, Europe and India.

These are still early days, but Mitra Biotech has already begun working with a handful of hospitals in Bengaluru and New Delhi, Sundaram added.

Great ambitions

Yet it isn’t only cancer diagnostics that Mitra Biotech is targeting. CANScript also has application in the pharmaceutical industry, with major drug companies, governments and philanthropists pouring massive sums of money into finding new medication that can beat cancer.

The platform’s ability to quickly test multiple drug combinations quickly and relatively cheaply is among the reasons why Mitra Biotech – which operates out of Boston and Bengaluru – thinks it has a shot at owning a corner of the $100-billion global oncology market. “All the major pharma companies (globally) have started working with us,” Sundaram asserted, without divulging any names.

The company’s aim, though, is much bigger and, as Sundaram explained, relatively straightforward: To become the global leader in cancer therapy selection. It may seem a tad too ambitious for a start-up that traces its foundation to a nondescript Chennai apartment with five employees. But Mitra Biotech, with a solid pedigree, a product at the cutting-edge of medical science, a global footprint and $27 million in funding as of late August, is hardly your usual company.