In oncology, time is one of the most precious resources a patient has. Yet for many cancer patients, treatment decisions are still made with limited information about whether a therapy is likely to work for them. Immunotherapies have transformed what is possible in cancer care, creating durable and even potentially curative responses for some patients. But many patients do not respond, and today’s tools often cannot tell clinicians that early enough.

Elephas is working to change that. The company’s elive™ platform is designed to bring a new kind of functional insight to oncology: the ability to assess how a patient’s live tumor tissue responds before treatment begins. Rather than relying only on static biomarkers or retrospective signals, Elephas is focused on preserving and profiling living tissue in its native biological context—helping clinicians, researchers, and drug developers better understand response in real time.

For Maneesh Arora, Founder & CEO of Elephas, this work is part of a much larger shift in how cancer care could be practiced. He has spent more than two decades helping build and scale companies at major inflection points in diagnostics and human health, including leadership roles at Third Wave Technologies and Exact Sciences. Those experiences gave him a front-row seat to what it takes to introduce a new category in healthcare: the data required, the trust that must be built, and the persistence it takes to move an idea from development into clinical and commercial use.

Now, as Elephas enters an important commercial launch period, Maneesh is focused on bringing the elive™ platform into the hands of oncologists, pharma R&D teams, leading cancer centers, and global partners.

In this Founder Spotlight, Maneesh shares the problem Elephas was built to solve, why live tissue response could represent a meaningful paradigm shift in oncology, what he has learned from building category-defining diagnostics companies, and why he believes the platform’s potential extends far beyond the U.S.

Elephas is entering an important commercial launch period. For oncologists who may be encountering elive™ for the first time, what is the core problem you believe Elephas can help solve in cancer treatment decision-making?

MA: Absolutely. First, the name elive™ is a play on Elephas, but over time the pronunciation has really become “alive”, and that is the differentiation of our platform. We are looking at tissue that is alive.

The problem we have in oncology, especially when it comes to assigning which drugs to give to which patients, is that we still don’t have a great way to know what will actually work before treatment begins.

Keytruda has become one of the biggest drugs in the world, outside of the GLP-1s, because immunotherapies have the potential to create durable responses, potentially even curative responses, and that is fantastic. The challenge is that four out of five people who take an immunotherapy like Keytruda do not respond.

That is a massive issue, not just in terms of expense to the healthcare system, but because that patient does not have unlimited shots on goal. From an oncologist’s standpoint, what we saw is that there really is no strong biomarker to guide that decision.

In infectious disease, it’s very logical. If you have an infection, you take a test, and based on that test, you know what to prescribe. That is how medicine works. But not in oncology. In oncology, a patient has cancer, we use biomarkers that are really poor, and then we start treating. You cross your fingers and hope. There are major tests now, like MRD tests, in a market that is really growing, but you often do not get that information until the patient has already been on therapy for multiple cycles. Then you may find out, “Oh gosh, this isn’t working.”

So the problem we set out to solve was: can you treat oncology more like infectious disease? Can you see, before a patient gets a therapy, whether it is likely to work or not?

That is a big, gaping problem. There has not been a way to do it, and that is what the elive™ platform was built to address for oncologists.

And I think people don’t always realize the scale of the issue. If you are an oncology patient, you want hope, and that is what immunotherapy has created. So many of us know people with cancer who have taken an immunotherapy and it has changed the course of their disease. They have gone into remission. They have had durable responses. That is incredibly exciting.

What people do not always hear are the statistics, which are much more challenging.

The elive™ Test is designed to show how a patient’s live tumor tissue responds before treatment begins. Why is functional response prediction so important, especially in a field where so much decision-making has historically relied on static biomarkers or retrospective data?

MA: The best biomarkers out there have largely been based on looking at proteins from fixed tissue, and that does not really capture the heterogeneity of the tumor.

The leading static biomarker is PD-L1 immunohistochemistry. You are looking at proteins, and what we have found is that it has incredibly poor sensitivity and specificity. When you get a positive PD-L1 test, you may have a positive predictive value of only 20 to 30%.

Our data on elive™, which we recently shared at ASCO, is showing a positive predictive value of over 90%. That is the level of efficacy we are seeing, and we are still running trials prospectively to prove it out.

That is what we think has the potential to change the world for cancer patients.

As Elephas begins working with select oncologists, what do you hope clinicians experience when they use the elive™ Test in practice? What would make this feel valuable, practical, and actionable for them?

MA: This is still a projection, because we have not yet made the elive™ Test broadly available to oncologists. We will be piloting it in the back half of this year.

But based on what we have done in our clinical studies, the experience for the oncologist and the patient is designed to be very similar to the current workflow. When you are a cancer patient, you are already going to get a biopsy. Today, that biopsy is typically fixed in formalin, sent to the lab, sliced into very thin sections, stained, and evaluated for markers like PD-L1.

With the elive™ platform, the patient still gets a biopsy. The oncologist’s workflow is largely the same. The difference is that instead of fixing the tissue and killing it, the sample is sent in our buffer so we can process it while it is still alive. 

Then, within about a week, the oncologist receives a functional readout that provides information on whether the patient is likely to respond to immunotherapy.

So from a process or workflow standpoint, there is no major change for the oncologist or the patient. The bigger change is for the pathology lab. Instead of fixing the tissue, killing it, and looking at one slice, the lab uses our platform to process the live tissue and generate a functional result.

Initially, we plan to launch this in a pilot stage out of our lab here in Madison. Eventually, as we generate more evidence, the goal is for this to be available more broadly within the standard workflow of a hospital system.

Elephas is also working with pharma R&D teams to help predict immunotherapy response, de-risk pipeline decisions, and optimize trial design. How do you see functional live-tissue insights changing the way drug developers make decisions?

MA: Today, there really is not a great model for preclinical drug development. Because the models are relatively poor, you see many programs start in pharma, but only very low single-digit percentages ultimately make it through the clinic.

Historically, the big model has been animal models. But there is now a major push, including from the FDA and in the EU, to move away from animal models—not only for humane reasons, but because they often are not very predictive. We have gotten really good at curing cancer in mice, and that has not translated well to humans.

That is where we believe Elephas can be very valuable for pharma. Our platform gives drug developers the ability to look at immune functional responses in live human tissue, ex vivo. It is not a mouse model. It is not an organoid. It is human tissue, and it allows them to do something they have not really been able to do before.

Earlier this year, after we published on the platform, we saw enormous interest from a number of pharma companies. The platform can be used in the preclinical setting, and eventually in the clinical setting, to help drug developers evaluate how their compounds or combinations are interacting with the immune compartment in human tissue.

For example, we did a joint webinar earlier this year with AstraZeneca, and we are excited about the partnership we have with them. They are using the elive™ platform to run their own experiments with their own compounds, including immunotherapy combinations.

You can imagine a future where pharma companies are able to evaluate new combinations of immunotherapies in live human tissue before they make major clinical decisions. That could help them prioritize programs, design better trials, and make more informed decisions earlier.

We have had a lot of exciting conversations because of this new capability: the ability to functionally test live human tissue, particularly the immune compartment, outside the body.

Before Elephas, you held leadership roles at both Third Wave Technologies and Exact Sciences—two companies that helped shape the diagnostics landscape. What lessons from those experiences are most relevant to this moment at Elephas?

MA: Over the last 20-plus years, I have had the chance to be part of companies that were introducing new categories and new ways of doing things.

At Exact Sciences, we were bringing a new approach to market, and there was enormous pushback in the beginning because it represented change. Any time you are introducing real innovation, it takes time and it takes data. But once you can show the evidence, people start to come on board.

The same was true at Third Wave. That was really the dawn of molecular diagnostics, and there was a lot of education that had to happen. Those companies were successful, but the launch and introduction periods took time.

That is probably the biggest learning I bring to what we are doing now at Elephas. People look at our platform and say, “Wait a minute, this is different. This is new. The data looks spectacular.” But we still have to do the work of getting it into the hands of the right partners and generating more data.

For us, that means getting the platform into the hands of pharma companies, as well as leading institutions like Mayo Clinic, MD Anderson, Moffitt, and international partners. That is what we are immensely focused on.

The data becomes the bedrock. It is all of those steps—all of those little things you need to do—that eventually make something the standard.

I believe that is going to be a long journey. We are at the very beginning of it, but it is exciting.

Why did Elephas decide to partner with Clarevia, and what has been most valuable about having a healthcare-focused investor with deep roots in diagnostics, medtech, and life sciences?

MA: The partnership with Clarevia was very natural for me personally. I have been involved with Clarevia for more than 20 years. Third Wave was a Clarevia company, so there is a long history there.

It really comes down to knowing the people and having trust. I am in Wisconsin, and I think there is a natural synergy in having local roots combined with deep healthcare knowledge and deep experience.

That has been additive for me. Having people here who I can lean on, and who I trust, has been important.

When you were growing up and discovering what you were most curious about or excited about in the world, were there any early signs that you would end up in the kind of roles you’ve been in—leading companies focused on human health?

MA: I can tell you confidently that, as a young man, I could not have told you this is where I would be.

But I knew I liked innovation. I knew I liked to build. And then your own personal circumstances shape you. Watching my dad deal with health issues and navigate the healthcare system shaped me. Seeing my wife become a molecular biologist and biochemist shaped me. That was 30 years ago, and those experiences helped me think about where I wanted to make a difference in the world.

For me, as a non-scientist, the question became: how can I bring business, financial, and general management skills to make a contribution?

This is the path that arose from that. I have been really fortunate to work with great people and to help make some small changes in the world.

My hope is that, at Elephas, we are going to make much bigger changes.

As Elephas grows, what else should people understand about the broader vision for the platform?

MA: I want to highlight the international and global nature of the company. The premise behind Elephas was never just to do something for Western medicine. It was to help patients around the world assess whether a therapy is likely to work for them.

That is something I am very excited about. We have executed a partnership with a leading company in Malaysia and Singapore, and we are about to execute an arrangement with the second-largest lab in India to make the elive™ platform clinically available to patients around the world in a really unique way.

In the next 12 months, people in India—where 1.3 billion people now have growing access to immunotherapy options—will be able to use the elive™ platform. So will people in Singapore, Southeast Asia, and the United States.

I think that is an important and underappreciated aspect of Elephas. It is not just U.S.-focused. It is global. It is clinical. It is translational research. It is pharma.

It is a platform that allows for something truly new: functionally profiling live tissue to assess response, with a whole host of applications.

Learn more about Elephas at elephas.com.