Curious Dr. George | Plumbing the Core and Nibbling at the Margins of Cancer

SAGE Oncotest: Entering the Next Generation of Tailored Cancer Treatment

Chris Apfel, MD, PhD, MBA
Founder, CEO, and Board Chair of SageMedic Corp.

Curious Dr. George
Cancer Commons Editor in Chief George Lundberg, MD, is the face and curator of this invitation-only column

For people with recurring or drug-resistant cancer, choosing the best-possible next treatment can pose a huge challenge. Our Curious Dr. George asks Chris Apfel, MD, PhD, MBA—Founder, CEO, and Board Chair of SageMedic Corp.—about his company’s solution for many of these patients.

Curious Dr. George: Despite the application of curative surgical, radiation, and systemic treatments, cancer remains the “emperor of all maladies” with 600,000 Americans dying of cancer every year. With many more patients battling recurrent or resistant disease, even with adherence to standard guidelines from the National Comprehensive Cancer Network (NCCN), selecting the next line of treatment—whether cytotoxic chemotherapies, targeted therapies, or immunotherapies—often follows a trial-and-error approach.

To address this unresolved challenge, SageMedic, a CMS and CLIA-accredited and California-based company, has developed the SAGE Oncotest™. In comparison to next-generation genomic sequencing, which provides actionable insights for a smaller number of patients, SageMedic claims that its Oncotest, an extreme drug resistance (EDR) assay, provides actionable insights for virtually all patients within 10 days, thereby avoiding likely failures.

Dr. Apfel, I understand that this is only possible because you are using fresh, live cancer tissue, right? Can you share more about how your test works and how it can help cancer patients?

Chris Apfel, MD, PhD, MBA: The SAGE Oncotest is a next-generation EDR assay in which we use a patient’s biopsy specimen to create microtumors in the lab. We then expose the microtumors to a wide range of drug concentrations, and we measure which drugs at which concentrations are most effective at killing the cancer cells.

Within one day of receiving a fresh biopsy specimen, we can create hundreds of microtumors from virtually all types of solid cancer, including breast, ovarian, prostate, and pancreatic cancers, glioblastoma, and cancers of unknown origin. Thanks to our proprietary technology, these live microtumors maintain the patient’s tumor heterogeneity and microenvironment for virtually every biopsy specimen.

Furthermore, in contrast to organoid approaches that usually take weeks or months for organoid growth, if growth occurs at all, the SAGE Oncotest one-day aggregation step allows for next-day drug exposure, with actionable information generated for virtually every patient within just 7 to 10 days.

Our predicate EDR predicted tumor resistance with about 96% accuracy, and it is highly unlikely that a tumor will respond to a therapy that does not work ex vivo in supra-physiological concentrations, as in the context of the SAGE Oncotest. By ruling out ineffective therapies, we project this assay to identify the most promising drugs with about 80% accuracy, doubling a patient’s chance for a tumor response, significantly improving quality of life, and significantly extending the patient’s life expectancy.

SAGE can test the potential sensitivity and resistance of dozens of drugs and drug combinations, though our current technology does not test for anti-hormonal or immuno-oncology drugs.

If any readers are interested in having their patient’s tissue tested to help inform their treatment plan, we ask them to please let us know at least a week ahead of the patient’s biopsy or surgery, so that we can send the shipment kit to ensure overnight delivery of viable tissue. SAGE Oncotest requires fresh, live cancer tissue rather than formalin fixation, which kills cells within minutes and renders the sample unusable for our assay.

Physicians can choose from two Sage Oncotest panels. The standard panel (“Superior Care within Standard of Care”) tests the microtumors against NCCN guideline-recommended drugs and can inform, especially, initial treatment plans, e.g., stage II or III patients expected to require adjuvant therapy. The expanded panel (“Beyond Standard of Care”) includes the standard panel plus special requests, including targeted therapies and repurposed drugs, which becomes meaningful when standard treatment regimens fail. Of note, if a fresh biopsy is not feasible, we have also been able to retrieve sufficient cancer tissue from pleural effusions, ascites, and even bone metastases.

In summary, the SAGE Oncotest complements other precision oncology approaches by providing actionable information for virtually all patients within 7-10 days to avoid ineffective drugs and significantly increase the chance for best-possible outcomes.

Dr. Apfel can be reached at


Copyright: This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.