Vincent Keereman Presents XEOS at LSI Europe '23

XEOS is focused on improving outcomes in surgical oncology by leveraging the power of molecular imaging in the operating room.
Vincent Keereman
Vincent Keereman
Founder & CMO, XEOS



Vincent Keereman  0:05  
Okay, thanks, Stephanie for the for the introduction. So it's my pleasure. Good afternoon, everyone. It's my pleasure to present XEOS to you. So the problem that we're trying to tackle with XEOS as well known to everyone, here in the in the audience, there's a lot of cancer diagnosis, about four out of 10 people will be confronted with a cancer diagnosis in their lifetime. And still 45% of patients need to undergo resective surgery as part of their treatments. Now, what's the problem with that resective surgeries is that many of these surgeries do not actually reach their goal. Many surgeries are incomplete. When you look at the final results. When you look in breast cancer, it's one in five patients that have an incomplete resection and prostate cancer one in four, and then had a neck cancer. These are just a few examples, these numbers go up to almost half of patients. The problem with incomplete surgeries is of course, that it yields a lot of psychological stress, not only for the patient, first and foremost for the patients, but also for the surgeon who needs to tell the patient that he or she failed at doing his job perfectly. Sometimes there's a need for a reoperation after an incomplete surgery, that can be the need for additional therapies, there's a higher recurrence risk. And of course, all of this adds together to a huge cost to society. Now, what is the reason for having these incomplete surgeries, it's because the surgeon has insufficient information during surgery. In fact, the standard of care for determining whether or not a resection was completed assisted pathological evaluation. And this takes inherently a couple of days before you get the results. By that time, of course, the patient has long gone home. What we have done is developed a new approach to provide the surgeon with as much information as possible during surgery to avoid having an incomplete resection. And we do this by employing a mobile high resolution that CT scanner a PET CT specimen imager, and this device provides the surgeon with a three dimensional image within minutes right at the point of surgery and gives the possibility to the surgeon to make decisions right there. What needs to be done. How does this work? So it's a specimen that CT imager, so we employ that CT imaging, this means that the patient needs to get injected with a radial tracer. It's a low dose injection and a radial tracer for those who don't notice is a substance that is specifically targeted at highlighting specific bodily physiology, for example, specifically highlighting cancer cells after the patient has received this injection surgery starts as per usual, the tumor piece is resected. And once the tumor pieces out, it is placed inside of a plastic container. And this plastic container is placed inside inside our device our specimen PET CT imager, and this device generates a three dimensional high resolution image within 10 minutes. The surgeon in the meantime can continue surgery can for example, perform lymph node resections while waiting for this result, and once the images are there, within these couple of minutes, the surgeon can decide based on these images, whether or not he or she feels confident enough that surgery reached its goal, and if not can expand the resection. Now, what do these images look like? What you see here is the type of type of data that we provide inside the operating theater. It's actually a screen capture from from our device. What you see here on the top line and on the left bottom image are three sections in three directions through the three dimensional PET CT image, and you see in grayscale a CT image which provides density information and color scale superimposed the pet image and this highlights radiotracer uptake. This highlights actually in this case, it's a breast tumor FDG. As radiotracer was administered, it highlights highly metabolically active regions. And this in this case here to assist the tumor cells. Based on this image to surgeon decides intraoperatively should I perform an extra resection or not? The bottom right image is a 3d render which provides a nice indication of where the tumor is located inside the specimen. So why did we choose this? This technology? Well, first of all, because we are strong believers in the power of molecular imaging, but as well known in oncology, it's a very powerful technique, very sensitive technique to highlight cancer cells and also to highlight other other things in medicine. We have truly tomographic imaging this means that we provide a full three dimensional image there is no superposition. There is no sampling bias, you see the entire resected specimen. There's minimal disruption of the surgical workflow. In fact, while imaging is going on, the surgeon can continue other steps of the surgery. And while I'm talking here about surgical oncology, there are many other applications that we also see intersective surgery. So a little word about our status as a company where we are so we have in our product portfolio actually two products it's the specimen imager to scaner they just described and also a disposable specimen container which is used to keep track of orientation of the specimen during surgery. Both products are CE labeled, we just received our FDA approval, and we just announced it two weeks ago. So that was very nice summer news. The system is installed in six sites in Europe, where it's being used mainly in breast cancer and prostate cancer. Now, when you look at the application sides, it's that's the imaging. So there's many different types of applications within the cancer space that can be that can be tackled, we have most data in breast and prostate cancer. But here is just a few indications where we have images of specimens of patients that have undergone surgery. Now, rather than going into detail on the complete evidence base that we have built up, I will show two examples where our imaging was clearly very, very relevant. And this first example is an example of a breast cancer patient. So you see here again, three images, again, same story in grayscale, the CT image in color scale, the superimposed, but uptake. And you see in these three directions that the surgeon can see very, very nicely in three dimensions where the tumor is located in the specimen. And this case specifically is from an interventional study that is ongoing. Here, the surgeon saw on the coronal section of the image that's in the infra lateral sides, that uptake reached the border of the specimen had the suspicion that this could be a positive resection margin. So the surgeon decided intraoperatively to take an extra resection there. And indeed, it was confirmed afterwards, by pathology, that this was the correct decision. And in fact, this patient's avoided to reoperation. Another illustration of what we can do with this technology you can see on the bottom right, this is a lymph node that was removed during surgery, we can literally image anything that comes out of the of the patients and here we could confirm that this was a metastatic Lee invaded lymph node. This is for example, relevant if a surgeon is hunting for specific lymph nodes and a biopsy, this kind of technology could also be used. An example of a prostate cancer specimen here, same story again, in cullercoats, the uptake different radiotracer. Here, PSM a was used, which is very specifically targeting prostate cancer cells. And you see here where you have the circular pointer, that the radiotracer uptake again reached the border of the specimen, there was a suspicion of a positive resection margin and it was confirmed with histopathology if the surgeon has this information intraoperatively he or she can make a decision and and decide right there on the spot to take an extra resection and avoids the need for a reoperation or in the case of prostate cancer closer follow up. Where are we from a market point of view, while we see nicely first market adoption, we have first sales in Europe, we have a wealth of wellfield sales funnel, people are applying for Research and Innovation Grants within their hospital to acquire the system. And there's a couple of nice publications that are coming already from our users. What's the business model behind all this, there's it's of course the scanner is a capital equipment. So there's capital equipment sales on one side, which is about half of what we assess as being the serviceable addressable markets yearly. And then there's part recurring revenue in part service contracts for the system and in parts, sales of the consumable specimen container. And then finally, to close of course, a word about our team and about the company. So I founded the company together with Ruth on Holden, who is our CEO. We've known each other for many years. And we have actually a history of successfully building another company and exiting its which is called molecules. It was a company in preclinical imaging and it was acquired by bootcut, two years ago. We're very happy with our management team that we have built. We're about 23 people now. And we're very much focused on our for company values, transparency, dedication, agility, and excellence. And we really select on these values, our team, we were based in Ghent, in Belgium. And as for the financing part, we're up until now, completely business angel funded. We raised 13 million, we just recently closed the last 4 million round to get to that 13 million. So for now, we're okay with funding into 2024. And in the course of 2024, we expect to raise another capital rounds. So with that, I would like to thank you for your attention. And if there's any questions, please feel free to reach out to me.

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