Solving the Missing Middle in Cancer Care

We’ve mastered the bookends of cancer diagnostics.

At baseline, we can sequence tumors and match patients to targeted therapies.

At the endpoint, we can scan or run MRD tests to see if the disease is detectable.

But the 8–12 weeks in between? That’s a diagnostic black hole.

Why the blind spot matters

Most treatment is started with expectation that it will immediately show results. If the patient’s doing well, great — but if they’re not, you won’t know until damage is done.

• Ineffective regimens get months of runway before anyone realizes they’re not working — wasting precious time and often adding $50K–$100K in avoidable downstream costs per patient from salvage therapies, hospitalizations, and palliative care. In head and neck cancer alone, ~24,000 U.S. patients each year fall into this category, representing $1.2B–$2.4B in unnecessary healthcare spending.

• Toxic side effects accumulate without proof the treatment’s worth it — side effects that may themselves require costly interventions or even emergency admissions.

• Promising therapies get abandoned too early because the first hard readout looked flat — potentially sending patients onto less effective, more expensive options prematurely.

It’s trial-and-error medicine in its purest form — and in oncology, trial-and-error can kill.

Why faster isn’t enough

We’ve tried to fill the gap with “faster” versions of current diagnostics in imaging and molecular assays.

But at its core, they still only provides a snapshot in time of how the cancer is responding.

Imaging (CT, MRI, PET) measures changes in tumor size or metabolic activity, usually every 8–12 weeks. But physical changes lag behind molecular changes — meaning a scan can look stable while the disease is already adapting or progressing.

Even recent Minimal Residual Disease (MRD) assays give you a binary yes/no on whether cancer cells are still detectable in the blood — often after treatment or between therapy cycles. They can show if ctDNA is dropping, but that’s still an indirect proxy for whether the therapy is biologically working. If the cancer doesn’t shed much DNA (“poor shedders”) or hides in areas blood tests can’t reach (“sanctuary sites”), MRD can look falsely reassuring.

Ultimately, they tell you whether the cancer is detectable — but nothing about how the rest of the body is reacting to treatment. A tumor can shrink while the immune system crashes, or stay stable while the patient’s biology is already shifting toward resistance. Without that context, you’re flying blind on the true trajectory of the patient’s health.

What’s really missing

We don’t need more snapshots.

We need a treatment velocity signal — a real-time view of whether the patient’s biology is moving in the right direction and at what speed.

Why does this matter? Because the signals we get from MRD and imaging don’t always tell the same story as the patient’s biology:

• Early true response, late MRD clearance — Some therapies take time to clear tumor DNA from the blood, but trigger rapid biological improvements in immune activity or metabolism. Velocity data shows progress weeks before MRD turns “negative,” helping avoid premature treatment changes.

• Apparent MRD negativity with hidden progression — “Poor shedder” tumors release little ctDNA, so MRD can look reassuring even when viable disease remains, especially in sanctuary sites like the brain. Velocity data can flag these mismatches before they become catastrophic.

• Stable scans, biology in decline — Imaging every 8–12 weeks might show no measurable growth, but molecular patterns could already be trending toward resistance, prompting an earlier pivot.

• Toxicity without tumor progression — MRD may confirm tumor control, but velocity data can reveal systemic immune suppression or metabolic stress that requires dose adjustment or supportive care before symptoms spiral.

Without this velocity signal, we’re stuck interpreting cancer’s response in isolation, missing the bigger, faster-moving picture of how the patient is responding.

Some of the most promising approaches go beyond a single signal, layering proteomic, metabolomic, and other biological readouts to capture a richer trajectory of treatment. Multi-omic views aren’t the only path forward — but they’re proving to be among the most powerful for closing the missing middle.

What does this mean for investors?

Until we close the missing middle, cancer care will remain stuck between two disconnected islands of information — the “what to try” at baseline and the “did it work” at the endpoint.

To paraphrase the line often attributed to Henry Ford: today’s newer diagnostics based on MRD are the “faster horse.” Tests for diagnosing “treatment velocity” is the automobile — not just a speed upgrade, but a complete reimagining of how we measure and guide treatment.

It will come from building new kinds of diagnostics that read the body in motion, connect cancer response to whole-body biology, and give clinicians the confidence to act in weeks instead of months.

For investors, this isn’t a hypothetical future. Companies like Guardant Health, whose blood-based monitoring products helped build a multi-billion-dollar valuation by giving oncologists earlier signals to guide therapy, showing treatment guidance is a growing market. Investing in this next generation of diagnostics will help drive diagnostics to the next level, delivering faster, smarter answers to the patients who need them most.

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