2. Agenda
• MIST background and project objectives
• Research methodology
• Primary research findings
• Market size forecast
• Financial attractiveness for customers
• Recommended market penetration strategy
2
3. MIST is commercializing microwave technology
for breast cancer screening, diagnosis, and therapy
• Founded by Dartmouth
professors Keith Paulsen
and Paul Meaney
• Technology developed with
>$6M from the NIH
• Provides high contrast, safe,
and comfortable breast cancer
imaging
• Proof of concept demonstrated
in >150 patients at DHMC
3
4. Our project objective is to assess the therapy
monitoring market for MIST
Patient Workflow
• What are the standards of care for treating breast cancer patients with
NACT?
• Who are the key decision makers in the treatment planning process?
Market Sizing
• What is the current size of the breast cancer therapy monitoring market?
• How fast is this market expected to grow over the next five years?
Market Penetration Strategies
• Is the therapy monitoring market an attractive opportunity for MIST?
• What course of action should MIST pursue in order to bring its device to
market?
4
5. Our methodology relied on extensive primary
research
Identified key
drivers of market
size through
secondary
research
Conducted
physician
interviews to
understand
workflow and
quantify drivers
Built customized
model to estimate
current and future
market size
Determined
economic
attractiveness for
customers
5
6. We interviewed sixteen physicians at a variety of medical
centers
6
Breast Surgeons
Medical
Oncologists
Radiologists
• Dartmouth-Hitchcock
Medical Center
• Massachusetts
General Hospital
• MD Anderson (TX)
• Cancer Care Northwest
(WA)
• Danbury Hospital (CT)
•
• Dartmouth-Hitchcock
Medical Center (3)
• Vermont Cancer Center
(2)
• Avera Sacred Heart
Cancer Care (SD)
•
• Concord Hospital (NH)
• Dartmouth-Hitchcock
Medical Center (2)
•
• Lahey Clinic (MA)
• University of Florida
7. NACT is used to shrink tumors prior to surgery
7
Mammogram
/ Biopsy
Surgical
consultation
Primary Care
Physician
Surgical
Oncologist
Lumpectomy
/ Mastectomy
Surgical
Oncologist
Treatment
Planning
Medical
Oncologist
NACT &
Monitoring
Medical
Oncologist
& Radiologist
8. Therapy monitoring is typically used before NACT begins and
after NACT is complete
8
Pre-NACT Mid-Cycle
Post-NACT /
Pre-Surgery
Probability of
using imaging
• High • Very low • High
Rationale for
imaging
• Generate baseline
data on tumor size
and location
• Gauge tumor
response to NACT
• Change treatment
(if necessary)
• Gauge tumor
response to NACT
• Inform surgeon of
tumor specifics
prior to surgery
• Determine if the
patient is a
candidate for
lumpectomy
Most common
modality
• MRI • MRI, Clinical
exams
• MRI
9. However, the use of NACT varies depending on
institution
% of Patients Treated with NACT
0%
25%
50%
75%
100%
All Hospitals DHMC MD Anderson Cancer Care NW
1
0.9
0.2
100%
Inflammatory Breast Cancer Stage III Breast Cancer
9
10. We estimate the current size of the therapy
monitoring market at $6MM
Patients
(000s)
'- 0
15
30
45
60
2008 2009 2010 2011 2012 2013 2014
$15
$13
$11
$9
$8
$6$6
IBC Patients Stage III Patients Revenues
10
11. Even with optimistic NACT usage and pricing assumptions, the
market size is still small
11
Price Per Scan ($)
% of 14,813$ 100$ 200$ 250$ 500$ 1,000$
Stage III 10% 2,729 5,458 6,822 13,644 27,288
Patients 25% 4,483 8,966 11,207 22,415 44,829
w/ NACT 50% 7,407 14,813 18,517 37,033 74,066
75% 10,330 20,661 25,826 51,651 103,303
100% 13,254 26,508 33,135 66,270 132,539
2014 Therapy Monitoring Market Size
Sensitivity Analysis
12. Very few providers could afford a stand-alone
device for therapy monitoring
Hospital
Annual
Volume
DHMC
Cancer Care
Northwest
MD Anderson
Cancer Center
Breast cancer
patients
400 300 3,000
Patients receiving
NACT
60 150 900
Device utilization 2% 5% 29%
Therapy
monitoring
revenues
$24,000 $60,000 $360,000
Depreciation
(as % of sales)
47% 19% 3%
12
13. MIST should stay focused on screening and pursue
creative approaches to fund clinical trials
Segment the Screening Market
• Focused patient populations (e.g., high risk patients) could have smaller
clinical trials
Explore
Technology Licensing
• Large medical imaging firms offer a variety of modalities — could be open to
MIST technology
Pursue
Alternative Funding Sources
• NCI has funding for early stage clinical trials
• Patient groups have influenced research funding; some also offer grants to
support clinical research
13
14. Summary of Findings
Patient Workflow
• NACT is prescribed to a small sub-segment of cancer patients: IBS and
Stage III patients
• The usage of NACT varies widely between different providers
Market Sizing
• Therapy monitoring represents a $6MM market opportunity, growing to
$15MM in 2004
• Most hospitals do not have the volume to afford a stand-alone device for
therapy monitoring
Market Penetration Strategies
• The therapy monitoring market is too small to pursue in isolation
• MIST should focus on screening, and seek creative sources of funding for
clinical trials
14
16. Market Forecast Model Drivers
16
Forecast Drivers Assumption Data Source
US Female Population 1% CAGR US Census Population Projection
Breast Cancer Incidence
(per 100,000)
123.31 (2009)
132.41 (2014)
American Cancer Society (2009);
Journal of Clinical Oncology (forecast)
% IBC Patients 4% Physician interviews
IBC NACT Treatment Rate 100% Physician interviews
% Stage III Patients 30% American Cancer Society
Stage III NACT Treatment Rate
17% (2009)
50% (2014)
Estimate from physician interviews
Monitoring Therapy Penetration 90% Estimate from physician interviews
Scans / Patient / Year 2 Estimate from physician interviews
Price per scan $200 June 2006 MIST Presentation
