Driving The Next Frontier In Cancer Treatments

Cancer remains to be the leading cause of death in Singapore, accounting for over 28% of all deaths annually. But the good news is, compared to when the Singapore Cancer Registry first began tracking population-based cancer in 1968, the survival rate is decidedly higher today.

Professor Chng Wee Joo, Executive Director, Singapore Translational Cancer Consortium (STCC), shares, “Over the past one to two decades, completion of the human genome project and the whole genome sequencing technology have greatly helped the advancement of our knowledge and research in cancer biology—contributing to better understanding of cancer as a disease, and research in biomarkers and medicines that are more targeted and effective. As a result, the prognosis of cancers like lung cancer or multiple myeloma has improved significantly—from incurable to long-term maintenance of remission or complete eradication of disease.”

Particularly, growing emphasis on precision medicine and precision oncology is encouraging the development of more targeted drugs and more precise disease treatments, improving cancer survival rates. “Thanks to the precise and high throughput sequencing technology we have now, we can identify abnormalities in different cancer types in a very precise and sensitive manner. That enables us to develop drugs that target a specific mutated gene or a specific signalling pathway,” Professor Chng says.

Setting up a robust translational cancer research platform

To further gains in these areas by empowering more synergistic cancer research and translational capabilities, STCC was set up in 2020. Professor Chng says, “Since our founding, STCC has achieved notable milestones in a few aspects. One of which is the setup of a comprehensive PI (Principal Investigator)-initiated translational cancer research contractual framework for collaborations and data sharing. PIs can now easily tap into STCC’s platform and collaborate with companies or institutions located in multiple sites to lead network consortium trials in Singapore and other countries in the region.

“What’s more—we are already leveraging the positive impact of this work. One such exciting project is the collation of cancer tissues which were previously banked in different institutions and hospitals into a national catalogue. Thereafter, we will link everything to the clinical data from the next generation electronic medical records across various public healthcare institutions to form a Singapore Cancer Data Commons. Both initiatives offer a lot of potential—from the perspective of research value, opportunities for collaboration, and advancing healthcare for cancer patients,” Professor Chng elaborates.

Looking to precision medicine for cancer prediction

“Project CADENCE (CAncer Detected Early caN be CurEd) is another STCC milestone that has the potential to transform how care is delivered to cancer patients in Singapore. Through applying the microRNA (miRNA) and DNA methylation biomarkers detection technology of our partner—MiRXES—to tissues collected from patients who develop cancer, we are looking to validate whether it is possible to detect nine high incidence and high mortality cancers early with their system. We will then subsequently apply our findings to a cohort to check if it is possible to truly predict these cancers ahead of time,” says Professor Chng.

According to Professor Chng, the recent launch of the SG100K study will also help STCC’s cause, albeit in a less immediate and direct manner. Professor Chng explains, “Although the SG100K study in this initial stage focuses very much on healthy individuals, it will undoubtedly provide new insights to disease predisposition relevant to Singapore and the region. For example, we may in this process identify some individuals who are healthy now but develop mutation in their cancer predisposition gene later on. Hence, such a study is pivotal in bolstering our research and translational research efforts in Asian-centric cancers such as gastric cancers, nasopharyngeal cancer, T-cell lymphomas, etc.”

Professor Chng adds, “Additionally, with SG100K, an ecosystem complete with infrastructure, framework, methodology and collaborators is set up. This presents an opportunity for STCC to leverage the ecosystem—whether it is to import relevant capabilities or attracting like-minded international researchers and industry partners. These conditions create a favourable environment for STCC to springboard our efforts.”

Tapping into precision oncology for more targeted treatments

Besides disease prediction, the ability to offer appropriate and effective therapy with minimal side effects is also a key tenet of precision oncology. That is why there is growing focus to not only develop drugs targeting specific pathways and genes, but also employ technology such as artificial intelligence (AI) to find the best drug combination for treatment in recent years. Adding on to these exciting developments, STCC has entered into a collaboration with Roche in September 2022 to sequence genomes of cancer types where there is either unmet medical needs or inadequate body of knowledge.

Professor Chng says, “As part of the project, we will identify patients suitable for targeted treatment and clinical trials using comprehensive genomic profiling and recommendations from Molecular Tumour Boards at each participating hospital. We will eventually make these data available on a singular trial network platform—so that researchers keen to conduct similar trials can save time and effort from negotiating partnerships with respective hospitals or qualifying participating patients. At a macro level, we are also looking to generate conclusive results that allow us to evaluate the effectiveness of precision oncology, and its impact on costs and benefits to our healthcare system.”

Professor Chng continues, “While it may be a bit too early for STCC to report any major outcomes for our research now, but we are definitely headed in the right direction—so it is a matter of time for results to materialise in some tangible form with real impact

[1] National Registry of Diseases Office (23 December 2022). Singapore Cancer Registry Annual Report 2020. https://nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-2020-annual-report_web-release.pdf?sfvrsn=e0a73b99_0

The Straits Times (17 December 2022). AI platform that suggests drug cocktail for patients with relapsed lymphoma to undergo clinical trial soon. https://www.straitstimes.com/singapore/ai-platform-that-suggests-drug-cocktail-for-patients-with-relapsed-lymphoma-to-undergo-clinical-trial-soon