SINGAPORE, 1 FEBRUARY 2021 – Clinicians and scientists from Singapore shared exciting new data on lung cancer treatment in the Asian population at the World Conference on Lung Cancer Singapore, last week. Lung cancer develops very differently in Western and Asian populations, which makes understanding the disease from an Asian perspective a research priority for Singapore and the region.
In Asian lung cancer patients, the most common genetic alteration is the EGFR mutation which occurs more commonly in non-small cell lung cancer (NSCLC). Over the years there has been an increase in the proportion of non-small cell lung cancer (NSCLC) among all lung cancer cases, making NSCLC the most prevalent form of lung cancer in Singapore (50%). NSCLC is unique as it occurs in patients who are both smokers and non-smokers. An added complication to treating NSCLC is that many lung cancer patients display TKI-drug resistance, or resistance to anti-cancer drugs, making NSCLC very difficult to treat.
These findings are of particular concern in Singapore as lung cancer has been one of the leading cancers in the past fifty years, and was the top cause of cancer death among males and the second leading cause of cancer death among females, with 6,064 deaths in Singapore from 2013 to 20171.
The Lung Cancer Open Fund - Large Collaborative Grant (OF-LCG) Programme, co-headed by co-chair of the Conference, Associate Professor Daniel Tan, Senior Consultant, Division of Medical Oncology, National Cancer Centre Singapore (NCCS), looks at improving the understanding of lung cancer in Asian patients and seeking new treatment pathways to improve survival outcomes. The Lung Cancer OF-LCG Programme, which is supported by the National Research Foundation Singapore and administered by the Singapore Ministry of Health’s National Medical Research Council, is led and championed by leading clinicians and scientists from major healthcare and research institutions including NCCS, National University Cancer Institute Singapore (NCIS), National University Hospital Singapore (NUHS), Cancer Science Institute of Singapore (CSI), Duke-NUS Medical School (Duke-NUS), as well as the Singapore Immunology Network (SIgN) and the Genome Institute of Singapore (GIS) of the Agency for Science, Technology and Research (A*STAR)2.
The Lung Cancer OF-LCG Programme team presented new data at the Conference to show key molecular features of EGFR-mutated TKI-drug resistant patients, share results of trials on a novel combination therapy approach as well as report the natural history of early stage cancer. These abstracts were presented during the scientific oral abstract sessions where top ranking abstracts were featured. The team’s research sharing also provide a valuable resource for genomic lung cancer research (See
Annex A below for more information).
“Our research is conducted by a multidisciplinary team of clinician-scientists, clinicians, researchers, molecular biologists and computational biologists who used a wide range of approaches to examine lung cancer and how it particularly affects the Asian population. The collaboration and integration of methods demonstrates the Lung Cancer OF-LCG Programme’s continued efforts to find new ways to improve treatment outcomes in what can be a challenging disease to treat,” said Assoc Prof Tan, senior author of the research presentations, who is also Deputy Head of the Division of Clinical Trials and Epidemiological Sciences, NCCS.
An example of those efforts is the creation of THOR, a multi-omics genomics platform that hosts thousands of lung cancer samples presented at the Conference by Dr Anders Skanderup. Dr Skanderup, a scientist from GIS, who is the Big Data Theme lead on the Lung Cancer OF-LCG Programme and member of the Conference’s scientific committee, said, “Our work highlights the importance of integrated databases for use by local clinicians and scientists to facilitate collaborations and make new discoveries, as well as helping advance precision medicine.”
Assoc Prof Tan added “This flagship conference also features important plenaries looking at the impact of precision medicine on oncologic care, new targeted and immunotherapies in thoracic malignancies, as well as lung cancer screening in never smokers.”
The World Conference on Lung Cancer, is the largest gathering of international scientists, researchers and patient advocates in the field of lung cancer and thoracic oncology and was held from 28 January to 31 January 2021. The conference is a key event in the International Association of the Study of Lung Cancer calendar and this year adapted from an in-person event to a worldwide virtual event, due to COVID-19 restrictions, with the planning and delivery of the summit conducted in Singapore.
For more information on the Conference, visit:
1Singapore Cancer Registry 50th Anniversary Monograph (1968 – 2017)
2The Lung Cancer OF-LCG Programme is led by Assoc Prof Daniel Tan, NCCS, Prof Gopal Iyer, NCCS, Dr Ng Quan Sing, NCCS, Prof Florent Ginhoux, SIgN, Dr Ross Soo, NCIS / NUHS, Assoc Prof Tan Eng Huat, NCCS, Dr Anders Skanderup, GIS, Asst Prof Tam Wai Leong, GIS, Prof Daniel Tenen, CSI, Asst Prof Lisa Tucker-Kellogg, Duke-NUS, Dr Gillianne Lai, NCCS and Assoc Prof Darren Lim, NCCS.
About the National Cancer Centre Singapore
National Cancer Centre Singapore (NCCS) provides a holistic and multi-disciplinary approach to cancer treatment and patient care. We see close to 65 per cent of the public sector oncology cases, and they are benefiting from the sub-specialisation of our clinical oncologists.
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World Conference on Lung Cancer presentation information
Countering drug resistance
Dr Aaron Tan, a Fellow at National Cancer Centre Singapore (NCCS), presented the multi-omics profiling and analysis of TKI resistant patients with EGFR mutant NSCLC. The group profiled tumour and tissue biopsies from 59 advanced patients treated at NCCS to better understand the molecular features of their disease. TKI-resistant patients have limited treatment options so understanding alternative treatment pathways is the main approach to overcoming this challenge. The group was able to show the interplay between genetic alterations, cell lineage plasticity and the tumour environment which leads to the development of the drug resistance. Their research provides a framework for targeting and planning therapeutic strategies to overcome resistance in EGFR mutant NSCLC. For this research, Dr Tan was awarded an Early Career Award at the Conference.
Performing innovative clinical trials to improve response to treatment
Dr Gillianne Lai, Consultant, Division of Medical Oncology, NCCS shared findings from a randomised phase 2 clinical trial. The group investigated the efficacy of treating EGFR-mutated TKI-resistant NSCLC with a combined immune checkpoint therapy using Nivolumab and Ipilumumab. This combined therapy approach is in line with current research to uncover new lines of treatment against EGFR-mutated TKI-resistant NSCLC. As Ipilumumab could potentially enhance cell function, the group hypothesised that the combined therapy would have better outcomes than the conventionally used monotherapy Nivolumab, which has low clinical efficacy for never smokers. Results for the 31 patients who participated in the study did not demonstrate better outcomes for combined immunotherapy with no new toxicity concerns. This study highlights the need for innovative immunotherapy approaches.
Identifying features associated with relapse in early stage lung cancer
Dr Stephanie Saw, Associate Consultant in Division of Medical Oncology, NCCS, shared the long-term outcomes of a resected cohort of EGFR-mutated early-stage lung cancer. A total of 396 patients were included in this study, which showed that despite curative resection and adjuvant chemotherapy, recurrence rates remain high in early-stage EGFR-mutated lung cancer including Stage IA. The patterns of relapse as well as recurrence-free survival rates were comparable to the control arm of the ADAURA study, which showed an impressive disease-free survival benefit with adjuvant Osimertinib. Exploratory analysis using exome and RNA-sequencing revealed molecular features associated with relapse, which could complement clinical features to improve risk stratification for patients. This study highlights the need to develop individualized adjuvant treatment strategies to improve outcomes for early stage EGFR-mutated NSCLC.
A new multi-omics genomics platform with thousands of lung cancer samples
In poster presentations at the Conference, Dr Jacob Alvarez and Dr Anders Skanderup from the Genome Institute of Singapore, Agency for Science, Technology and Research (A*STAR), who are from the Lung Cancer OF-LCG Programme presented a Multi-Ethnic, Open Access Thoracic Cancer Genomics Resource (THOR) aimed at providing genomics data for lung cancer research. THOR is a flexible and user-friendly multi-omics genomics platform that hosts thousands of processed lung cancer samples from published data, comprising of both Asian and Caucasian samples, and allows for cross-cohort genomics analyses. There is growing evidence that racial and ethnic differences influence incidence, mortality and survival, and this resource will allow meaningful analysis in cohorts across the world to better understand and treat lung cancer.
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