Q&A with Foresight Diagnostics on their acquisition by Natera

Foresight Diagnostics is a cancer diagnostics company and CLIA-registered laboratory that was founded in 2020 by Stanford physicians and scientists who sought to develop high-performing circulating tumor DNA (ctDNA) assays. We were proud to lead the Series B round for Foresight Diagnostics in April 2023. The following post is a lightly edited transcript from a conversation between Jim Tananbaum, CEO of Foresite Capital, Jake Chabon, CEO & CSO of Foresight Diagnostics, and Sandra Close, COO, CCO and Head of Product of Foresight Diagnostics.

Jim Tananbaum: Jake, congratulations on your company’s acquisition by Natera! This is a huge milestone for Foresight Diagnostics– and for Foresite Capital, as well. What’s running through your mind right now?

Jake Chabon: Many things. It’s been a long week! Sandy and I both went straight from our company’s town hall, where we announced the acquisition to employees last Thursday, to the ASH annual meeting in Orlando, which is a large hematology conference. We’re excited about what the future holds and what this will mean for patients. We’ve been at a juncture this year where we needed to decide whether we were going to build out the operational infrastructure and scale required to make our tests broadly available to patients ourselves, or if we were going to do that through a partnership or an acquisition. So, we’re just really excited that it worked out. I think Natera, which is one of the largest precision oncology companies globally, is going to be a great partner. And we’re excited at the prospect of our technology and products being incorporated into Natera’s diagnostic portfolio, making them accessible more broadly for patients. Patient access has really been our goal since we founded the company, so I’m really excited about this outcome.

Jim: Can you share one thing you’ve learned about leadership from growing this company and taking it all the way through acquisition?

Jake: I’ve learned a lot about leadership through this journey, much of which I’ve learned from our COO and Head of Product, Sandra Close, and from other people that I’ve hired at the company. I was a first-time founder and CEO out of academia coming from a scientific background. And one of the things I learned – which took me a little bit of time, admittedly – was the importance of bringing in people to complement you, that know things that you don’t know, and then letting them own those areas. I think early on, I had a tendency to want to remain hands-on about everything, and that was one part of leadership that I had to learn over time – the importance of hiring leaders that complement you and entrusting them to make decisions on their own.

Jim: What about you, Sandy?

Sandra Close: I would say one thing that I learned about leadership from this experience is the importance of building a mission-driven culture with a focus on strategy and delivery. Building the team, and then giving them very clear direction and quick answers and decision-making to allow them to execute on that vision. Another critical learning was how far transparency and honesty with that team would go. Even if you don’t know all the answers, but you think, “I have 51% of an answer to this, so let’s go with it, and I’ll have your back.” I think that really helped the team have a sense of safety and also the direction to allow a very small team to deliver quickly. I think the importance of this became more and more apparent to me through this leadership opportunity.

Jim: What advice would you have for scientific founders out of academia? You guys started off with a group of scientific founders and built it into a really sizable enterprise.

Jake: It’s similar to the learnings I had around leadership, honestly. I think it’s bringing in people that complement you, being able to acknowledge the things that you don’t know, and then bringing in people that have done this before and can help you. Essentially, it’s about recognizing quickly and early on that you don’t know everything.

And then letting go – that’s a big thing, too. In academia, individuals are trained to do everything themselves a lot of the time, to be very independent, do all their own analyses, make their own figures, really think things through independently, and sometimes do that in isolation. In more of a corporate setting, it’s important to let other people do things that need to be done and to not micro-manage them. When Sandy joined Foresight as an example, she joined me at a time when I had zero experience with product, regulatory compliance, quality – all of the areas that are required to bring a regulated product like ours to patients. I had to learn to let her own those areas and trust her to make calls independently. I think that’s really important.

And Sandy, you can be honest, having worked with me, what advice would you give to Jake five years ago, coming right out of grad school and starting the company?

Sandra: I think many founders coming straight out of academia underestimate the complexity of business and the importance of the cross-functional work required. Appreciating individuals with different expertise and, more importantly, fostering a culture in which everyone’s perspectives and advice are valued is essential. I think it is helpful, whether it be the board of directors, an advisor, or the management team of the company to bring in some of those people with a depth and breadth of experience who are willing to be honest. You need conversations to look like, “That’s a great idea, but it won’t work if you don’t do this.”

And also, the reason for cross-functional diversity is to help make those 51% risk-based decisions. Very often, less experience comes with a desire to think about things longer, which can lead to over-contemplating, struggling to make a definitive decision, or second-guessing one. Speed and definitive decision-making, I believe, are critical to achieving a mission and staying ahead of the competition. And when you surround yourself with experts who share your mission, that’s how you get that edge.

Jake: Yeah, not making a decision is a decision, and that’s important to recognize.

Sandra: And waffling is worse for the team, because then they get confused  and spin.

Jim: Can you both tell me about a challenge you faced that was significant or unexpected?

Jake: An ongoing challenge is the importance of culture and communication, and as the company scales, making sure people have the appropriate information they need to know what they should be prioritizing. When you’re 10 people, it’s very clear. When you’re 30, it’s still quite clear, but that 30 to 100-people phase was when we really had to rethink our governance structure and our approach to information management. A good example of this is when we set our annual business objectives and key results (OKRs). At the beginning of 2025, we communicated an initial set of OKRs for the year. But about halfway through 2025, things changed and we needed to pivot our OKRs fairly quickly.  Being open with the teams about that change was very important – embracing the change, talking about it, knowing things are going to change. That can help team members and increase their resilience in the face of that change when it inevitably happens.

Jim: Did anything go smoother than expected?

Jake: I feel like we were a victim of our own success in a lot of ways. When we got into the NCCN oncology guidelines for B-cell lymphoma earlier than we had anticipated – that’s an example of change, right? We had already set our OKRs for 2025, and then in January of 2025, we learned of the guideline inclusion, which now created an urgency to make the test available to patients earlier than we had previously contemplated. So, we had to pivot.

Jim: And for members of our community not as close to oncology, what are the NCCN guidelines?

Jake: The National Comprehensive Cancer Network – NCCN for short – clinical practice guidelines are essentially what help guide oncologists on what to do when they’re facing different clinical scenarios. And it’s more than just a driver of utilization, but really something that instills confidence in our test, knowing it’s been evaluated and formally included in the guidelines.

Sandra: I would agree. For a company that had just started scaling in 2023 and then was recommended in oncology guidelines in January of 2025—that speed and that path were faster than anticipated. And while it was a surprise to us how quickly the NCCN guideline committee accepted us, it wasn’t a surprise why. It was because we built a clear strategy focused on developing our tests for specific points in the cancer journey that enable decision-making, rather than trying to do everything or chasing the next shiny object.

That focused strategy, combined with—as mentioned earlier—a team that was aligned and empowered to execute, allowed us to have that clinical impact sooner. But I would say that the guideline inclusion, which then catalyzed customer demand very rapidly, did go smoother than expected.

Jim: So, turning it back around, how has Foresite Capital been helpful to you?

Jake: Foresite Capital has been helpful in a number of ways. To go back to what we were talking about earlier, about the importance of having people with expertise who have done this before as advisors and board members – Uplaksh Kumar was our board member after we closed the Series B, and he came from a heavy operational background in the diagnostic space. He had a breadth of experience and his mentorship and strategic advice for the company was invaluable.

And then when you joined the board, Jim, it was a different flavor, but similar. It really helped me synthesize things and roll it up to the level we should be thinking about, helping to pull us out of the weeds at times. For example, in board meetings the strategic guidance you offered was very helpful this past year. In particular, faced with this important decision of whether we are going to raise a Series C, do a commercial partnership, or pursue an acquisition. And as we thought through the amount of capital required under those different paths and the execution risks associated with these different paths, the Foresite team really helped crystallize this opportunity to combine forces with Natera. It really was the right decision to make.

Jim: Okay, so tell me the truth. Did you guys name Foresight after Foresite?

Jake: Wait, we thought you named your firm after us?!!

Jim: It’s been a very lucky name for both of us.

Jake: Similar visions, similar name … I think we were just meant to work together!

Jim: So, what happens now? How’s your focus shift?

Jake: I think in the near to mid-term, nothing major changes. We’re an independent, wholly owned subsidiary of Natera for the foreseeable future. The reporting structures at Foresight stay the same. We’re still running all the prospective clinical trials that we have active, and starting new trials, so all the activities we have been doing remain. What may likely change is how we will commercially launch our product, and how we will incorporate our proprietary technology into Natera’s portfolio and products so that we can positively impact patients with every type of cancer, not just with lymphoma.

What do you think, Sandy? The focus really shifts.

Sandra: Yes, now it’s about rapid scale. It is about bringing the products and technology with the combined operations and commercial expertise of Natera to the patients more broadly to meet the clinical demand. So, I do think it will really focus more on that clinical adoption and clinical execution from the development side.

Jim: Sandy, you have extensive experience in therapeutics and diagnostics. How’d you decide to join Foresight Diagnostics?

Sandra: Having worked in both the therapeutics and diagnostics arenas, I’ve seen products fail even when the technology was right—simply because the timing was wrong. People often assume failure means you were too late to market, but in many cases, you can be too early. Foresight’s PhasED-Seq technology integrated into MRD was the right technology at the right time. The simplicity of the phased variant approach aligned perfectly with a clinical market that was ready for MRD. MRD has been the holy grail of oncology since the days when we were trying to measure it with qPCR. That combination of mature technology and market readiness is what ultimately made me, initially working with Jake as a consultant, say, “Okay, let’s do this—and let’s do it right.” So, to do that, I felt like I needed to really jump in with both feet and partner with Jake.

Jim: The rest of the history.

Jake: Yeah, I did need your help, and I’m so grateful you jumped in with both feet Sandy! I’ve learned so much from you.

Jim: You were the quiet force behind a lot of Foresight’s success, Sandy! I think that’s the sign of great leadership, where it seems effortless. I know how non-effortless it was, and I can only imagine some of the wide variety of things that you had to respond to, some of which were internally driven, some of which were externally driven, but everything just managed to come in on time, and it’s a pretty remarkable story.

Sandra: I think the other thing that went really smoothly, besides integrating into clinical decision-making, was building the team. Earlier in my career, hiring always felt a little scary—are you bringing in the right people? This time, our ability to hire, train, and keep a really strong, skilled team came from the combination of the technology, the product, the mission, the timing, and clear leadership. Honestly, building this team was easier than I expected, especially compared with other places I’ve been.

Jim: It seemed like every time you were making progress, there was some other thing you had to deal with, but you made it all look effortless.

Sandra: That’s life, isn’t it? That happens, especially in a start-up.

Jim: Well, I wish you all just the very best. I hope you have a wonderful holiday season. It’s been quite a sprint getting here! Thank you so much for taking the time to do this interview.