Diagnostics · Precision oncology
Cofactor Genomics
An RNA test that tells oncologists which cancer patients are likely to benefit from immunotherapy. Medicare covers it in head and neck cancer, and in December 2025 Labcorp and Ascension Ventures put money behind the next phase.
A decision with three doors
An oncologist sits with a patient whose head and neck cancer has come back. There are three reasonable paths. Give a checkpoint inhibitor on its own and spare the patient chemotherapy. Give it with chemotherapy and accept the toxicity. Or skip immunotherapy and treat with chemotherapy alone.
The test meant to guide that choice is PD-L1 combined positive score, a stain counted under a microscope. In the PREDAPT validation paper, the authors note that patients scoring 1 to 19 showed no clear survival benefit from monotherapy, which pushes many oncologists toward the harsher combination by default.
More than 65 percent of patients with squamous cell cancer of the head and neck eventually develop recurrent or metastatic disease, and median overall survival for those patients runs about 10.7 to 13.0 months. Only about 10 to 15 percent respond to checkpoint inhibitor monotherapy.
Cofactor Genomics built a test for that fork in the road. It reads RNA out of a biopsy that has already been taken, runs it through machine learning models, and returns one word: low, medium or high.
Why RNA, and not DNA
The founding argument is that DNA answers the wrong question. A mutation panel tells you what a tumor could do. RNA tells you what it is doing now, including how much immune activity sits inside it.
Jarret Glasscock put it bluntly to TechCrunch in 2017: “DNA is pre-symptomatic. But with RNA, we think we’ll be able to see a molecular signature sooner.”
Cofactor calls its models Health Expression Models, held in a database it calls PRISM. The claim is that a multidimensional read of immune activity beats any single stain or mutation count. It is a testable claim, and the company has spent six years testing it.
Three scientists and a used sequencer
Cofactor was founded in August 2008 in St. Louis by Jarret Glasscock, Matt Hickenbotham and Ryan Richt, who left the Washington University Genome Center and bought their first next generation sequencer with money from a California angel.
Y Combinator records give the founding year as 2015, which is when the current Delaware corporation was formed and when the company went through the Summer batch. The longer history sits in the independent record: a 10,000 square foot St. Louis headquarters in 2013, an NIH small business grant from 2014, and a genome sequencing project for Ozzy Osbourne that drew the first press.
Two moves turned a sequencing shop into a diagnostics company. In February 2016 Cofactor bought Narus Biotechnologies of San Francisco, gaining a second office and a diagnostics team. That year it became one of the first laboratories accredited by the College of American Pathologists for RNA sequencing, and in February 2017 it launched Pinnacle, a laboratory developed assay. That September Menlo Ventures led an $18 million Series A with DCVC, Ascension Ventures, iSelect, Y Combinator, Wilson Sonsini Goodrich & Rosati and Stanford.
The long trial, and the handoff
PREDAPT began enrolling in February 2020: collect pre-treatment biopsies from patients about to receive checkpoint inhibitors, follow what happens, and see whether the RNA score called it. Eleven solid tumors are in scope.
The head and neck readout came first, announced in November 2023 and published in the Journal for ImmunoTherapy of Cancer a year later. Palmetto GBA granted national Medicare coverage in October 2024, and a lung cancer version launched a month after that. In January 2025 Glasscock handed the chief executive job to Chris Parker, a diagnostics operator from Affymetrix, Exact Sciences and Adela, and took the president and chief technology officer roles himself.
In December 2025 two things landed in the same week. Labcorp and Ascension Ventures made strategic investments of undisclosed size, and Cofactor released the lung cancer validation: 1,487 samples across four cohorts, predicting response, progression free survival and overall survival in the two immunotherapy treated groups, and predicting nothing in the two groups that never received immunotherapy. That last part matters. A biomarker that predicts outcomes in everyone is a measure of how sick the patient is. One that predicts only in treated patients is a guide to treatment.
What is proven, and what is still claimed
| Evidence | What the record shows | Source type |
|---|---|---|
| Clinical validation, head and neck | Journal for ImmunoTherapy of Cancer, Nov 3, 2024. Across 17 US healthcare systems the score correlated with disease control in the monotherapy cohort (n=62, p=0.004) and the chemo-immunotherapy cohort (n=50, p=0.01). More than threefold higher specificity than PD-L1 combined positive score, nearly fourfold higher sensitivity than tumor mutational burden. | Public record |
| Reimbursement | Palmetto GBA granted national Medicare coverage for OncoPrism in recurrent and metastatic head and neck squamous cell carcinoma, Oct 18, 2024. Confirmed by 360Dx the same day. | Public record |
| FDA status | No 510(k) and no premarket approval found. OncoPrism is sold as a laboratory developed test. The phrase “Medicare-approved” in company materials describes a payer coverage decision, not an FDA authorization. | Not found |
| PREDAPT, as registered | NCT04510129 is an observational biospecimen collection study. Collaborator Curebase Inc., estimated enrollment 1,650, start Feb 5, 2020, primary completion estimated Feb 2027. One location listed: Curebase, San Francisco. | Public record |
| PREDAPT, as described | Company boilerplate says 38 healthcare systems, representing 20% of US healthcare. The peer-reviewed paper says 17. The Nov 2023 release said twenty-five institutions. The website says more than 24. | Counts differ |
| Lung cancer validation | Announced Dec 17, 2025: 1,487 samples, including 195 anti-PD-L1 treated patients from the OAK trial and 89 from PREDAPT. Released as a MedRxiv preprint, so not peer reviewed at announcement. | Public record |
| Revenue and test volume | Not disclosed. No named hospital customers, no count of tests run, no revenue figure in any filing or release. | Not found |
Read plainly: the head and neck evidence is real, peer reviewed and paid for by Medicare. The lung cancer evidence is larger but still a preprint. The size of the clinical network is described inconsistently across company materials, and the trial registry lists a single collection site rather than the national network the releases evoke. Nothing public says how many tests Cofactor runs, which is the number that decides whether a covered test becomes a business.
What to watch
- Peer review of the NSCLC validation, still a MedRxiv preprint.
- Medicare coverage for the lung indication, where the patient volume sits.
- What Labcorp does next. A national reference lab taking equity usually precedes a distribution deal, and none has been announced.
In their words
“DNA is pre-symptomatic. But with RNA, we think we’ll be able to see a molecular signature sooner.”
Jarret Glasscock, founder, to TechCrunch, 2017 · Independent
“If you get a DNA test, the doctor will be able to tell you that instead of a 7 percent chance of cancer, you have a 14 percent chance.”
Jarret Glasscock, quoted in Wired via MedCity News, 2016 · Independent
“RNA is the unwritten chapter in the book of personalized oncology care.”
Mark Siegel, partner, Menlo Ventures, to TechCrunch, 2017 · Investor
“Most importantly, this is a win for cancer patients. More accurate prediction of response results in more informed treatment prioritization and better patient outcomes.”
Jarret Glasscock, then CEO, on Medicare coverage, quoted by 360Dx, 2024 · Independent
“Therapy selection is the unmet need between early detection and disease recurrence monitoring.”
Chris Parker, CEO, March 2025 release · Company release
“For more than a decade, clinicians have lacked a reliable test that predicts which lung cancer patients will benefit from immunotherapy.”
Jarret Glasscock, CTO, December 2025 release · Company release
“Cofactor’s technology has the potential to change how immunotherapy decisions are made for a significant portion of U.S. cancer patients.”
John Kuelper, Ascension Ventures, December 2025 release · Investor, company release
Related companies
Sources
- Public recordPREDAPT head and neck validation
- Public recordAnalytical performance of OncoPrism-HNSCC
- Public recordClinicalTrials.gov NCT04510129, PREDAPT
- Public recordNIH RePORTER, project R44DA038993
- Public recordForm D filings, CIK 0001710475
- Public recordFDA 510(k) and PMA databases, no record found
- IndependentCofactor Genomics Immunotherapy Response Test Nabs Medicare Coverage
- IndependentOncoPrism-NSCLC Test Predicts Key Clinical Outcomes in Lung Cancer
- IndependentCofactor Genomics Lands Investments from Labcorp, Ascension Ventures
- IndependentCofactor Genomics pulls in $18 million
- IndependentCofactor Genomics Acquires Narus Biotechnologies
- IndependentCofactor Genomics, founders and company history
- CompanyLabcorp and Ascension Ventures investment
- CompanyCEO transition, Chris Parker appointed
- CompanyOncoPrism, our story and home pages
Profile researched and written by Healthcare Discovery. Last updated September 29, 2026.
