About 1.7 million Americans are diagnosed with cancer each year, and only 3% of adult patients enroll in clinical trials whose data were captured in a way that could later be retrieved CL2. Everything learned in routine treatment stays in electronic health records spread across practice servers that do not communicate well, with much of the detail written in clinical notes CL1 CL2. An oncologist cannot easily see how her patients fared against peers or guidelines, and a researcher cannot study the other 97% of patients without pulling records from many systems and making them comparable CL1 CL2.
CancerLinQ
CancerLinQ used ASCO's standing to gather oncology records from practices on many different EHRs and licensed the work of turning them into research data to outside firms, while Flatiron owned the clinic software, did its own abstraction, sold to drugmakers directly and was bought by Roche.
Why CancerLinQ lost to Flatiron Health
Versus Flatiron Health: Flatiron Health owned the oncology EHR its records came from, curated them with trained abstractors and software, and sold the data to 14 of the top 15 oncology drug companies before Roche agreed to pay $1.9 billion for the shares it did not hold CLX-2 CLX-10 CLX-1. CancerLinQ collected records through ASCO's members across systems it did not control, licensed curation and sales to Tempus and Precision HealthAI, and was sold in 2023 to that partner's successor on undisclosed terms CL3 CLX-6 CLX-5.
Arena: Market Conditions Before CancerLinQ
How each step happened
Step 1 of 5 · 2013–19
A network over records it did not own
CancerLinQ began as a professional society's answer to a research gap. About 1.7 million Americans are diagnosed with cancer each year, and only 3% of adult patients enroll in trials whose data can later be retrieved; in 2011 ASCO's board asked whether records produced in daily care could feed one learning system CL2. ASCO announced a completed prototype in March 2013, built on de-identified data from 100,000 breast cancer patients treated at leading institutions CL1 CL2. What it offered practices was quality feedback: ASCO guidelines, more than 200 quality measures from its QOPI program, and reports on trends in their own patients. Robert Miller, its medical director, put research second: "Secondarily, the big data aggregation that is enabled by CancerLinQ will produce insight for exploration and hypothesis generation" CL2.
A society serving every oncologist could not ask members to change software, so CancerLinQ was built to accept data from whatever system a practice used CL2. In early 2015 ASCO picked SAP to build and deploy the platform, keeping control of the data and the products built on it CL2. ASCO's name opened doors: by October 2016, 70 practices had signed and CancerLinQ held more than one million records from most major EHR systems CLX-3. Each practice was its own integration, and signing ran ahead of data flow; in May 2019, 51 of the 100 practices signed nationwide were sending data CLX-4.
Rivals Flatiron Health, founded in 2012, raised $130 million led by Google Ventures in May 2014 and agreed to buy Altos Solutions, maker of OncoEMR, an oncology EHR used daily by more than 1,300 clinicians whose physicians saw more than 550,000 cancer patients a year CLX-2. Its records came from software it ran, with an integration layer for clinics on other systems CLX-2.
Step 2 of 5 · 2017–19
Chart abstraction left to partners
Collecting records was a separate job from making them comparable. Much of what matters in oncology sits in physicians' notes, and records from more than 100 practices arrived in conflicting language and formats that left their insights buried CLX-6. Making them usable for research required standardizing incoming data, clinician abstraction and natural-language processing, with identifiable care data kept apart from research access CL4.
Money set the limit. ASCO had budgeted an estimated $80 million for CancerLinQ's first five years, roughly $15 million to $20 million a year, and five years into the project it concluded that cleansing, structuring and expanding the data would take hundreds of millions of dollars CLX-5. Societies can gather patient information but often lack the money and technical skill to analyze it, and building the database and adding practices already cost tens of millions of dollars a year CLX-6. So in December 2017 CancerLinQ handed the curation work to others, engaging Tempus and Precision HealthAI to curate its data and commercialize research insights under licensing arrangements CL3. By 2019 Tempus and Concerto HealthAI were extracting structured and unstructured information into curated data sets and supplying analytic skills CancerLinQ lacked CLX-4.
Rivals Flatiron Health kept abstraction in-house: its founders held that physician notes, pathology and radiology reports carried the value if cleaned consistently at scale, and its database is curated by technology-enabled abstraction of physicians' notes and other documents CLX-8 CLX-10.
Step 3 of 5 · 2017–19
FDA work done through partners
CancerLinQ reached regulators through the firms it had licensed. CancerLinQ Discovery, launched in 2017, gave researchers aggregated, de-identified data sets, and Tempus and Concerto HealthAI analyzed a data set of more than 10,000 patients treated with immune checkpoint inhibitors that was provided to the FDA CLX-4. The analysis that reached the FDA was the licensees' work, run on CancerLinQ's data CLX-4.
The 2019 plan for CancerLinQ 2.0 pointed back toward practices: a quality management framework for QOPI reporting and Medicare MIPS submission, with pilots of QOPI certification, molecular and tumor registry data, and self-service onboarding CLX-4. Its own spending went to oncologists' reporting duties, the work ASCO's quality mission and budget could carry CLX-4 CLX-5.
Rivals Flatiron Health began a research collaboration with the FDA's INFORMED program in 2016 on how evidence from de-identified EHR data could support regulatory decisions, starting with advanced lung cancer patients on immunotherapy; it was renewed and expanded for two years in February 2019 CLX-9.
Step 4 of 5 · 2017–19
Data licensed to two firms for fixed fees
CancerLinQ's licensing deal sold access to two firms. Tempus and Precision HealthAI paid fixed annual sums for the right to analyze de-identified records on more than 1 million patients and deliver insights to doctors, and ASCO chief executive Clifford Hudis said the deal would keep the effort financially sustainable CLX-6. CancerLinQ was expected to keep losing money even with the licensing revenue, and in 2017 Hudis set break-even as the goal CLX-6 CLX-5.
Drugmakers stood behind CancerLinQ as supporters of ASCO's foundation; Amgen, AstraZeneca, Genentech, Janssen Oncology and Pfizer Oncology were named among them in 2016 CLX-3. By 2019 CancerLinQ was still weighing subscription fees for practice tools and had not reached break-even CLX-4. Fixed fees from two licensees capped what each new drugmaker customer could add to its revenue CL3 CLX-6.
Rivals Flatiron Health sold its curated data directly. Roche led its $175 million round in January 2016 with a multi-year, non-exclusive agreement to buy its life science products, and by February 2018 Flatiron worked with 14 of the top 15 oncology drug companies CLX-7 CLX-1.
Step 5 of 5 · 2019–23
Sold to its former partner's successor
That funding gap never closed inside ASCO, a society with $107.6 million in revenue in 2021 CLX-5. In December 2023 ConcertAI, the successor to Precision HealthAI, acquired CancerLinQ, and ASCO kept a multi-year cooperation agreement that preserves its access for quality work and research CL5 CLX-5. The terms were not disclosed CLX-5.
The network ASCO sold was large: more than 100 cancer centers and practices, 10 EMR integrations and nearly 7 million patient records CL5. Its buyer had 1,100 to 1,200 employees and served over 1,900 clinical sites, and its chief executive Jeff Elton said it was "committing more than $250M" to quality, data and clinical trial products over the coming few years CLX-5 CL5. The patient records ASCO gathered through its members now sit inside a company that does its own curation, the job CancerLinQ licensed out in 2017 CLX-5 CL3.
Rivals Flatiron Health was bought by Roche, which held 12.6% and agreed in February 2018 to pay $1.9 billion for the remaining shares; Flatiron then partnered with more than 265 community cancer clinics and six academic research centers CLX-1. By 2019 it partnered with more than 280 community cancer practices and seven academic research centers, and the FDA had renewed its research collaboration CLX-9.
Key dates
- 2012Flatiron Health founded CLX-2
- 2013-03ASCO completes a prototype on 100,000 breast cancer patients CL1 CL2
- 2014-05Flatiron raises $130M and agrees to buy OncoEMR maker Altos CLX-2
- 2015ASCO picks SAP to build the platform CL2
- 2016FDA research collaboration with Flatiron begins CLX-9
- 2016-01Roche leads Flatiron's $175M round and agrees to buy its data products CLX-7
- 2016-03250,000 patient records More than two dozen practices, 600+ oncologists CL2
- 2016-101 million patient records 70 practices signed CLX-3
- 2017-12Curation and sales licensed to Tempus and Precision HealthAI CL3 CLX-6
- 2018-02Roche agrees to pay $1.9B for the Flatiron shares it does not own CLX-1
- 2019-02FDA renews Flatiron collaboration; 280+ community practices CLX-9
- 2019-051.5 million records Over 900,000 from cancer patients; 51 of 100 signed practices sending data CLX-4
- 2023-12Nearly 7 million patient records ConcertAI acquires CancerLinQ; terms undisclosed CL5 CLX-5
Sources
Oldest first.
- CL1 ASCO's approach to a learning health care system. Participant research
- CLX-2 Flatiron Health raises $130 million Series B led by Google Ventures and agrees to acquire Altos Solutions. Company press release with founder quote
- CLX-7 Flatiron Health raises $175 million Series C round. Company press release with founder quotes
- CL2 Update on CancerLinQ. Executive account
- CLX-3 CancerLinQ platform hits milestone of having more than one million patient records in system. Trade press with executive quote
- CL3 CancerLinQ engages Tempus and Precision HealthAI. Primary disclosure
- CLX-6 STAT report on ASCO licensing CancerLinQ to Tempus and Precision HealthAI. Trade press with executive quotes
- CLX-1 Roche to acquire Flatiron Health. Acquirer press release with Flatiron CEO quote
- CLX-9 The FDA and Flatiron Health expand real-world data cancer research collaboration. Company press release with founder and FDA quotes
- CLX-4 Introducing CancerLinQ 2.0 and a New Era in Precision Oncology. Executive interview
- CL4 Development of CancerLinQ across multiple EHRs. Participant research
- CLX-8 Interview with Zach Weinberg. Founder interview
- CLX-10 Applying the Estimand and Target Trial frameworks to external control analyses using observational data. Research paper by Roche and Flatiron researchers
- CL5 ConcertAI acquires CancerLinQ. Primary disclosure
- CLX-5 After more than a decade, ASCO sells CancerLinQ to ConcertAI. Trade press with executive interviews