For the last eight months, the Covid-19 virus has been the center of attention in the media, the markets, and the medical field. Collectively, countries and government agencies, and academia, and pharmaceutical companies, have poured hundreds of millions into efforts combating the plague that has left so many countries and populations struggling, but despite the attention Covid-19 has garnered, the scourge of cancer remains the most daunting C-word in the medical arena.

We often say “we’re not curing cancer here,” but what if you were giving it a shot, with technology coming from a new angle, that is seen as important enough by those in the know that over $10 million has been granted to help get it done, with $10 million more raised in the last few weeks?

Perimeter Medical Imaging (PINK.V) recently landed on the public markets and, after some early position escaping from someone that ripped it down from a $1.70 to $1.50 in the first few days (PINK.V was $1.50 at open), is starting to find its feet at that level. The story isn’t as easily told as your average weed grow or mushroom spec play. Biotech isn’t traditionally sexy in Canada, as long times to FDA approval and slow news months can be harder to market than “let’s get stoned.”

But those who take the time to learn the details, and the science, and the timelines, can pick some wow-time winners with the added benefit of being invested in things that can leave the world a better place.

The Covid investment wave has changed some of that, with first time investors in the space beginning to get comfortable with it, but Covid could, at some point in the near future, be tackled by a vaccine, or a treatment, or by its naturally fading out over time. Cancer doesn’t go away with a vaccine. and wearing masks does not make you less susceptible to get it (unless you’re a smoker, but let’s stay on course). Covid is hitting hard, but cancer has been hitting hard for centuries.

There’s no hiding from it; we are regularly exposed to cancer-causing agents such as sunlight, radiation, environmental chemicals, and substances in the food we eat. These agents cause mutations in our DNA and, as we age, our immune system becomes less efficient in dealing with cells containing that mutated DNA. Therefore, advancing age is the most important risk factor for cancer overall, which also means if you’re not at risk so much today, tomorrow is going to be different. As life expectancy increases globally, so do cancer numbers.

“Cancer is the second most common cause of death after ischemic heart disease, according to World Health Organization (WHO) estimates. Among women aged 30–59, cancer is the leading cause of death… Projections made by WHO in 2013 predict that by the year 2030 cancer will surpass ischemic heart disease and become the most common cause of death, accounting for 18.5% of all deaths.”

The types of cancer responsible for deaths in men are predominately lung (23%), liver (11%), stomach (9%), colon (8%), and prostate (7%). In women, breast cancer predominates (15%), followed by lung (13%), colon (9%), cervical (7%), and stomach (also 7%). These data are summarized below.

Recently listed on the TSX venture exchange as PINK.V, an homage to the pink ribbons used during Breast Cancer Awareness Month by the Canadian Cancer Society and the American Cancer Society, Perimeter Medical Imaging AI, is a Toronto- and Dallas based company dedicated to providing solutions that drive better patient care and lower healthcare costs by providing critical information, during clinical procedures.

That’s the corporate talk, at least.

Translated: “Perimeter develops, patents, and commercializes advanced in-procedural medical imaging tools.  The OTIS™ platform provides a crucial additional dataset to the clinician to facilitate more informed decision making that could help reduce over-sampling, lower the incidence of repeat procedures, and potentially even lower mortality rates.”

In layman’s terms, Perimeter’s OTIS platform is designed to provide surgeons, radiologists, and pathologists with real-time, ultra-high resolution images which give them the ability to review tissue microstructure during surgery.

Still too complex? I got you.

When it comes to removing a tumor, your surgeon faces a delicate balance. Clearly, there’s nothing more important than removing all traces of the offending tumor. At the same time, surgeons don’t want to scythe out large areas of tissue like something out of a Texas Chainsaw Massacre deleted scene.

Once a tumor is removed, the area around the removed tumor is known as ‘margin.’ All the margin are then tested to check for traces of cancerous tissue.

If the tissue is declared Clear (also called Negative or Clean), congrats, no cancer cells are seen at the outer edge of the tissue that was removed. If the tissue is declared Positive, cancer cells come right out to the edge of the removed tissue and more surgery is usually needed.

According to breastcancer.org:

“In a perfect world, your surgeon would learn the status of the margins before the lumpectomy (removal of cancerous breast tissue) is completed, so as much tissue as needed can be removed until the margins are clean. Unfortunately, analyzing the removed tissue takes about a week. Sometimes after the pathology report is done, the margins are found to contain cancer cells and more surgery is needed”.

Now put yourself in the shoes of a cancer surgery patient. You’ve already been under the knife once and you’re living on the edge of crazy wondering if they got everything. Now you get a visit from the doctor saying, “oops, little bit left, let’s get back in there.”

This is not fun.

 

Enter Perimeter, which has the OTIS system in place to hopefully take us one step closer to the perfect world. With the Perimeter system, your margin management can be performed during the surgery in real time which means, if the system works as advertised, your surgeon can check as she goes and clean everything out that needs cleaning out the first time.

No muss, no fuss.

*Note: Doctors may not actually dance you about the room. Stunt surgeons used on closed course. Do not try at home.

So if we’re going to invest in something that we hope obliterates the need for re-operations, we should figure out how often that happens.

Oh it happens.

About one-quarter of Canadian women who have a “lumpectomy” to remove a cancer tumour will have a second breast operation. The 25 per cent figure mirrors averages in the United States and Europe. The mental anguish of going through another surgery to remove more cancerous tissue is one that no patient should ever experience. The additional surgery means additional chance of complication as well as potential infections.

Furthermore, the second surgery is costly. In US, lumpectomy re-operations cost the medical system $560M USD annually.

Locally, numbers in BC are worse.

The rate of re-operation in B.C. is 37 per cent according to statistics collected by the Canadian Institute for Health Information.

Think about that now… 37 grandmas, moms, sisters out of every 100 that go under the knife come back for a second incision weeks later. but Perimeter Medical Imaging AI’s system could make all of that unnecessary.

BUT DOES IT?

Smarter people than I will need to have the final say on that one, but many already have, including the US Food and Drug Administration, which has cleared the system for use. Perimeter recently received a $7.44M USD grant to develop artificial intelligence plugins for the OTIS platform.

The first of these machine learning plugins pertains to breast tumors and will be achieved by installing their system in different medical facilities to collect data which can then be interpreted and utilized by its algorithm going forward. In short, the machine will learn what a good margin looks like, and use that for future detection.

That’s great – but we don’t yet know the likelihood of the company getting into a US hospital medical facility to bring down such data. We do know they’ve got the money to buy their way in if needed, and we do know they’ve already achieved the FDA’s blessing, so this isn’t one of those biotech deals where we’re going to wait five years for the feds to approve the colour of its label.

From a market perspective, there’s nothing objectionable about how the company came to market. With a very tight cap structure with only 38,680,773 shares issued, you’ve got to imagine there’s potential here for upward stock traction on the back of any news that confirms the system is being used for its advertised use.

What we really like is, breast cancer treatment, as massive a market as that is, isn’t the ceiling on use of this technology. As long as they can haul in the data for their AI system to churn through, there’s potential here for use with any surgery that has similar earmarks.

We like making money. If we can make money with something that literally would make thew world a better place, we’re all in on that. That said, a lot of biotech companies find themselves hung up on testing, partnerships that go slower than hoped, trials that never materialize, and the like. There’s little risk Perimeter will run out of cash in the short term, there’s little risk they won’t be able to monetize – literally, the risk here is can they implement the system in enough places to get real, large scale, ongoing data.

We suggest watchlisting Perimeter and keeping an eye out for news showing they’re getting the traction they need to kick OTIS into gear. When that happens, the more data they drag in, the bigger this deal is.