As one of my cousins has been diagnosed with pancreatic cancer I researched this subject--and found a trial being run by an Israeli firm recently written up in Globes Israel, the stock market website. I also have cousins once removed at Technion in Haifa. This article was translated from the Hebrew by Globes and I have shortened it a bit. I am buying NovaCure tomorrow as my first footing stock for the New Year. It uses a unique system to be paid by patients, another nice touch. It is not cheap but we didn't know about it last year.

NovoCure (NVCR), developer of a medical treatment for cancer,  was worth $12 bn in Nov, having surpassed Teva's (TEVA) market cap.By now it has gained another 30%, to $17 bn, more than doubling its value in 2020.

NovoCure's market cap makes it the 3rd most valuable Israeli company traded on Wall Street.: Teva, once the undisputed leader among Israeli companies, is currently only 10th. After failures of Israeli healthcare companies on their way to the stock market, NovoCure shows what heights can be reached.

Asaf Danziger, NovoCure's CEO almost since its inception two decades ago, seems a little embarrassed when asked to comment directly on these figures. "Market cap is very nice, but it's not the main thing as far as we're concerned," he says in a rare interview with Globes. "Certainly when you look at a company like Teva, which has sales of more than $1 billion a quarter and touches so many people," he adds.

NovoCure does not yet have Teva's numbers. In the first 9 months of 2020, it had revenue of $350 mn, 38% more than in the 9 most of 2019.  This revenue is based on 3,300 active patients at the end of the period, who made a monthly payment for the treatment. This looks like a very small number of patients, in comparison with the company's market potential in the type of cancer it treats, and even smaller in comparison with the range of types of cancer it could treat in the future.

NovaCure sells a treatment for glioblastoma, a brain cancer. "About 29% of the patients that manage to persist with the treatment survive for 5 years after treatment starts, which compares with 4-5% who survived for 5 years from the date of diagnosis before our product reached the market. This product has demonstrably changed the outcome of this aggressive disease," says Danziger. NovaCure sells electrodes to treat tumors.

They are approved for marketing for treating glioblastoma in the US, Japan, China, several European countries, and in Israel. It is covered by private and state health insurance in all these countries. It became part of the Israeli "health basket" in 2020 and was approved to treat a rare lung cancer, mesothelioma, caused by asbestos. The success in clinical trials and in obtaining approval for this indication demonstrated that the NovaCare's technological concept works for conditions besides brain cancer, and theoretically it could treat many cancers. It is now doing Phase III trials for difficult-to-treat cancer, such as cancer of the pancreas, ovaries, lungs, and brain metastases from lung cancer. It uses electrodes.

Asked about the company's future, Danziger responds cautiously, "If you look at the types of cancer for which our product is undergoing trials, metastases of lung cancer in the brain, for example, is a market ten times bigger than glioblastoma." If these trials succeed like the trials for glioblastoma, the market potential could grow substantially.

"When we came to making an offering on Nasdaq in 2015," Danziger says, "we came with the first FDA approval in hand, and within a month we had another approval. In other words, we told the market 'we only have execution risk.' "We floated the company at a valuation of nearly $2 bn. As far as I know, only 3 biotech companies ever reached the stock exchange with a valuation like that."

The IPO in 2015 actually closed at a price lower than was sought, because of market conditions, and the stock fell at first. Thanks to the low pricing at the outset, those who invested in the IPO eventually made a dream return. "We promised at the time of the IPO that the product would be in daily use and that the insurance companies would pay for it, and we kept our promise. To make a promise and fulfill it is apparently something not very common."

Why have you not been sold by now? Cancer treatment companies have been sold at much earlier stages.

"AS CEO of a public company I have almost no control over the question whether we will be sold."

NovoCure's technology is a completely new approach to treating cancer, developed by Prof. Yoram Palti, now aged 82, professor emeritus of physiology and biophysics at the Technion-Israel Institute of Technology. It consists of electric fields directed at the growth from several directions that disrupt the growth of the cancerous cells, without damaging other areas. The treatment is akin to radiation, but without the damage done by radiation to tissues that it encounters on the way to the growth.

"No-one believed in this idea at first," says Danziger. "They told him (Palti) that his ideas were fundamentally untenable. Today, he continues to develop and create and invent like ten doctoral students."

Palti has related in the past how he received the initial money for financing the company, some $300,000, from a friend called Lennart Perlhagen, formerly a senior manager at European pharmaceuticals companies Meda AB and Pharmitalia. Perlhagen served as a director of NovoCure until 2018, and the value of his personal holding in the company is in the hundreds of millions of dollars, as is that of Palti.

Danziger was in effect the company's first CEO, and he even let his brain be used in its initial trials, as did all the managers - so Palti has said in the past.

When the company reached proof of concept, it immediately began to attract international interest. William Doyle, who had management experience in global medical devices companies, invested in the company at the outset, and he serves as its chairman to this day.

The disadvantage of NovaCure's product now is a degree of discomfort in using it. It does not cause the severe side effects of radiation or chemotherapy. However, in order to use the company's device for brain cancer, for example, the hair must be shaved off and electrodes must be attached to the head, and the machine that produces the electric fields has to be carried around everywhere.

You said that the product is effective in 29% of the people who manage to persist in the treatment. Are there people who do not manage to persist?

"The treatment extends the lives even of patients who are not completely strict about using the device. In the company's early days, fears were expressed that patients would not use the product, and that women would not agree to shave their hair. Sick people want to live. We have had a very good response to the treatment, and the device is much more convenient than in the past. Use of the treatment is steadily growing in time around the world. After all, we receive payment every month, and our revenue is rising as patients use the treatment and live longer."

In treating lung cancer there is no need to shave the head and the device is not visible. It still has to be used for most hours of the day. This product does not yet have insurance cover, but the company has already started to sell it to patients. "From an ethical point of view, our approach is that as soon as we have an approved product, we start marketing it to patients, and the insurance cover will come later. This is not a strategy for expediting cover - what interests the insurance companies is the trial results, and not if you are pleasant or ask nicely. It simply seems to us the right thing to do for the patients."

How has the coronavirus pandemic affected you?

"In February, we went into 'coronavirus mode'. We appointed a VP for coronavirus who is also a doctor, and by the end of February our team was protected as very few hospitals in the world are protected. No patient of ours anywhere in the world missed a minute of treatment because of the coronavirus. We launched a digital product that passed FDA approval, in order to enable patients to download data from the device and send them to their doctors or to us. We continued to recruit patients for our trials and we continued to grow.

"For a long time now, we have allowed working from home. Beyond that, it has been business as usual. We help our employees as much as possible, whether it's a psychologist or a babysitter - in the US there's even a 'Zoom-sitter', someone whose job it is to sit with the children on Zoom and make sure that they are succeeding in studying remotely. Our employees are very important to us. Our staff turnover is orders of magnitude lower than the norm in the industry."

Are you bringing about a revolution in cancer that could be as big as immunotherapy?

"Why compare? Revolution is a word that the media love to use, and we deal in science and medicine. I can say that we are introducing a new kind of therapy, like radiation, like chemotherapy, and I believe that one day there won't be a single cancer patient who isn’t treated with electric fields."