#318: Hereditary Genetic Testing Could Benefit All Cancer Patients, & More

Recent scientific studies demonstrate the importance of hereditary genetic testing for patients with active cancer diagnoses, increasing the likelihood that medical guideline organizations and insurers will recommend hereditary genetic testing across a broad range of cancer types. Despite mounting evidence from Myriad Genetics (MYGN), Invitae (NVTA), and other genetic testing leaders suggesting that patients with many cancer types could benefit, hereditary testing today is focused primarily on breast and ovarian cancers.

As examples, 17%, or 1 in 6 patients, with prostate, colorectal, pancreatic, or dermatological cancers have hereditary cancer mutations that are clinically actionable. Invitae has shown that pancreatic cancer (PDAC) patients with certain hereditary variants respond better than others to chemotherapy, suggesting that testing would have prognostic utility. A Myriad study showed that, for certain mutations, an increase in a measurement of risk, the odds ratio (OR), could help oncologists tailor cancer surveillance strategies.

Patients with hereditary mutations in certain genes could be eligible for a precision therapy called PARP inhibition––already widely available and reimbursed––suggesting that hereditary testing could be important both prognostically and therapeutically. Moreover, because family members can pass down hereditary variants, cascade testing should prevent or detect certain cancers earlier than otherwise would be the case.

While universal hereditary genetic testing could provide prognostic, diagnostic, and therapeutic information to cancer patients, the barriers to adoption today still are significant: a shortage of genetic counselors, a lack of education for physicians and patients, and restrictive medical guidelines. With lower costs and increasing evidence of clinical utility, we believe that current policies will change, ultimately increasing the demand for hereditary testing.

Last week, Walmart announced plans to offer drone delivery to 4 million households across six states by the end of the year, creating the largest drone delivery operation in the United States. Currently involving FAA-certified pilots, Walmart’s drone strategy appears to be much more aggressive than that of its peers, Amazon and Alphabet, both of which have been researching and developing drone delivery operations for nearly a decade.

ARK estimates that fully autonomous drones could deliver consumer packages by air profitably in as little as 30 minutes for less than a dollar. If our research is correct, drones could transform logistics and address nearly half of all global e-commerce, generating ~$100 billion in revenue per year globally within the next decade.

Last week, actor Seth Green suffered a phishing attack on four of his NFTs, one a Bored Ape. Unlike the rights associated with most NFTs, Bored Ape owners receive a license to make commercial use of their NFTs, including the right to reproduce the image. Green purchased the Bored Ape in July 2021 with the intent to leverage the license and develop a TV show series involving the Ape’s image. After the theft, he might have lost the commercial rights to use the Ape’s image on his show, surfacing an interesting conundrum around NFT ownership rights.

Some experts claim that theft of an NFT does not transfer the owner’s rights automatically: blockchain rights do not translate directly into legal rights.

Other experts believe the ownership rights are ambiguous, “depend[ing] on property law, copyright law, and most importantly the interpretation of the Bored Ape Yacht Club (BAYC) license.”

Further complicating this case, the thief sold Green’s NFT to an unsuspecting user for $200,000. Jessica Rizzo points out that “the law protects buyers who inadvertently shell out for fraudulently procured property,” suggesting that the new owner has exclusive licensing rights to the Ape.

Seth Green has identified the new owner and has asked for an arrangement to reclaim the NFT. As of this writing, we do not know whether or not he will be able to release the next episode of his Bored Ape show.

While NFTs could confer the immutable ownership of digital assets, tying on-chain asset rights to off-chain value will not be risk-free. Little if any law today governs the transfer of intellectual property rights via smart contracts. Green’s legal battle could create an informative precedent.