By Melane Sampson
Closely held First Ascent Biomedical is working to redefine how oncologists select therapies by pairing genomics with a proprietary live-cell testing platform that evaluates how an individual patient’s cancer responds to hundreds of FDA-approved drugs and combinations. The company believes its approach—known as functional precision medicine (FPM)—can help physicians bypass the trial-and-error cycle that contributes to poor outcomes, high toxicity, and soaring treatment costs.
“We have the first and only platform capable of testing hundreds of FDA-approved therapies and combinations, in parallel, on both liquid and solid cancers,” Jim Foote, co-founder and CEO, says in an interview with BioTuesdays.
“Part one is guiding personalized treatment for patients. Part two is enabling pharmaceutical companies to discover new indications, expand labels, and understand where their drugs are functionally effective,” he adds.
The First Ascent platform integrates patient-derived live tumor cell testing, genomic and transcriptomic sequencing, and an AI engine that ranks potential therapies. Within an average of ten days, oncologists receive a treatment report showing which drugs a patient’s cancer is most—and least—likely to respond to.
“Not all patients are alike, and neither are their cancers,” Mr. Foote says. “Our platform brings the biology of each individual patient to the center of the treatment decision.”
More than two million Americans will be diagnosed with cancer this year and over 600,000 will die of the disease. Despite advances in immunotherapy and targeted agents, Mr. Foote points out that the standard of care remains largely consensus-driven. “Even with all the technology and drug innovation available today, one in three cancer patients in America will lose their fight with cancer. We are trying to change that.”
Mr. Foote’s motivation is personal. Formerly a senior technology executive, he entered oncology after losing his 16-year-old son, Trey, to osteosarcoma. “I did my research at the time and was shocked to find that Trey’s treatment protocol hadn’t changed in 25 years,” he recalls. “When his cancer came back, there were no known options left. As a parent, that’s unimaginable. But as a technologist, I saw a solvable problem.”
Mr. Foote partnered with First Ascent’s CTO Dr. Noah Berlow and cancer researcher Dr. Diana Azzam to build the company in pursuit of that solution. Their FPM approach, later validated in studies published in Nature Medicine, demonstrated improved patient outcomes in 83% of cases compared with standard of care or physician’s choice treatments.
The company’s Miami-based CLIA-certified laboratory opened in 2025 and can process 5,000 samples annually, serving both adult and pediatric cancer patients. A second lab in Erie, Pennsylvania, is expected in 2026. The Florida facility was supported by the Florida Cancer Innovation Grant aimed at extending access to advanced oncology technologies across rural regions.
Mr. Foote believes the platform provides something that genomics alone cannot—biological proof of what works. “If three people are diagnosed with the same cancer, they’re usually treated the same way, even though we know they are genetically different.”
“We take a living biopsy, test hundreds of FDA-approved drugs against it, combine it with DNA and RNA sequencing, analyze everything with AI, and deliver actionable results in ten days. This isn’t guesswork. This is individual tumor response,” he says.
The company’s clinical data is compelling. In a prospective study of refractory cancer patients—individuals who had already failed standard treatments—therapies guided by First Ascent’s platform improved progression-free survival by more than eightfold. “These were patients who had exhausted their options,” Mr. Foote notes. “To see that level of response is extraordinary.”
First Ascent has generated ten peer-reviewed publications and is conducting seven funded clinical studies, including an NIH-supported pediatric cancer trial and a colorectal cancer study funded by the Fight Colorectal Cancer Foundation. The company is also collaborating with payors—a major insurer is sponsoring an economic analysis in pancreatic cancer after early data showed improved outcomes and reduced costs.
The value proposition for biopharma is equally significant, Mr. Foote believes. By mapping functional responses across thousands of patients and cancer types, the platform can identify where approved drugs show unexpected activity, enabling indication expansion or combination strategies. “A company might have a drug approved for one cancer, but our data can show where else it works,” he contends. “We can help accelerate clinical development and make trials more efficient by highlighting the patients and tumor types most likely to respond.”
Mr. Foote describes the company’s long-term vision as building an ecosystem where treatment decisions are made with real-time biological evidence. “Imagine a world where doctors know what drug will work before treatment begins; where hospitals cut bottlenecks and move from biopsy to treatment-ready in days; where payors approve therapies based on functional data; and where drug companies see early, patient-level proof of efficacy. That’s what we’re building.”
The platform also addresses a key gap in oncology, identifying drugs that won’t work. “The lifelong benefit isn’t only in choosing the right therapies—it’s in eliminating the wrong ones,” Mr. Foote emphasizes. “We’ve seen cases where children were receiving expensive, highly toxic drugs that were 100% ineffective, and others that were actually stimulating their cancer. Avoiding that toxicity can change a patient’s entire future.”
Real-world cases illustrate these stakes. In one published report, a refractory osteosarcoma patient being treated at $12,000 per month transitioned to a therapy costing only hundreds per month and achieved 84 weeks of progression-free survival with no evidence of recurrence. In another, a child with acute myeloid leukemia entered remission in record time after the platform revealed a standard regimen drug that was not only ineffective but harmful to long-term heart health.
First Ascent’s business model is currently patient pay, priced slightly higher than stand-alone genomic sequencing but inclusive of sequencing, drug testing, AI analysis, and a comprehensive treatment report. As partnerships with pharmaceutical companies grow, Mr. Foote expects revenue from drug-development collaborations to reduce or eliminate patient cost.
At its core, he says, First Ascent is a data company. “Everyone talks about AI unlocking cancer, but most AI is built on consensus-based data—the same data that informs consensus-based standard of care. We’re building from the bottom up—thousands of patients, thousands of drugs, across dozens of cancer types. Our AI learns from individual biology, not population averages. That gives us higher fidelity when predicting what will work for patients who can’t get a biopsy or who have very rare cancers.”
Looking ahead, the company plans to pursue FDA Breakthrough Device Designation within three years, which would accelerate global adoption. Mr. Foote hopes pediatric oncology will be the first area transformed. “Right now, most children are treated like small adults,” he asserts. “We believe we can guide treatment from the moment of diagnosis, not only after failure. Our goal is to prove that personalized, biology-driven plans can improve outcomes and dramatically reduce costs.”
To date, First Ascent has secured roughly $12 million in non-dilutive funding to build and validate the platform, and an additional $6 million to commercialize it. The Miami lab is now fully CLIA-validated and generating revenue.
For Mr. Foote, the mission remains rooted in personal loss but driven by a clear business opportunity. “Cancer is a global problem—ten million people die every year,” he says. “If we can improve outcomes by 83% and help drug companies at the same time, the commercial opportunity takes care of itself. Our focus is helping patients first. If we do that, the rest will follow.”
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