Innovations to tackle cancer

We all know that cancer is a challenging and complex disease to treat and there is an urgent need to improve outcomes for patients.

At the National Cancer Centre Singapore (NCCS), clinical and research teams are working overtime on cutting-edge innovations to improve how we diagnose, manage and treat cancer. While chemotherapy, radiotherapy and surgery have been mainstays of treatment, a new generation of treatments including immunotherapy, adjuvant therapy and enhancements to diagnostics and therapeutics are providing new hope to individuals affected by cancer.  

Tapping on Asian cancer research expertise to improve diagnostics

National Cancer Centre Singapore’s Prof Teh Bin Tean laid the groundwork for the development of a novel diagnostics platform specifically for cancer biomarkers in Asian patients by researching Asian-specific cancers.

Prof Teh Bin Tean, Deputy Chief Executive Officer of Research at NCCS has been leading efforts to improve our understanding of Asian-specific cancers. This is important because the majority of cancer research and treatments are targeted at Western populations, yet there are certain cancers such as liver cancer, bile duct cancer and nose cancer that are more common in Asian populations. Identifying why these cancers develop in Asian populations would help prevention and treatment of these diseases.

With this in mind, when Prof Teh joined NCCS in 2010 he and his team tapped on a tissue bank established by NCCS with collaborators to conduct genomic studies of cancers common among Asian populations. This led to breakthroughs that uncovered cancer-causing mutations for some of them, such as fibroepithelial tumours of the breast, hepatobiliary and genitourinary cancers.

This work laid the groundwork for the development of a novel comprehensive tissue diagnostics platform announced in September 2021 by biomedical firm, Lucence. UNITED (Tissue500™) is a next-generation Sequencing test specifically for cancer biomarkers prevalent in Asian patients. It covers 572 genes and 71 RNA fusions curated for 15 cancer types common in Asia. The innovative test has a two-week turnaround time and facilitates matching patients to targeted therapies and available clinical trials.

The successful translation of this research was a result of a two-year collaboration between the Agency for Science, Technology and Research (A*STAR)'s Diagnostics Development (DxD) Hub, Singapore General Hospital, Lucence and NCCS.

"This collaboration is significant because it brings together multiple organisations to translate research to commercial outcomes that can directly benefit patients," said Prof Teh. "It is a model of a successful collaboration between public health institutions and commercial entities."

UNITED (Tissue500™) is currently available in Singapore and Southeast Asia.

Boosting clinical decision making for cancer care

Using AI-powered solutions is how National Cancer Centre Singapore's Assoc Prof Iain Tan aims to improve data analytics clinical workflows.

In public healthcare institutions like NCCS, electronic medical records systems serve as a way to consolidate patient data from different sources. However, in most cases these systems do not automatically organise, extract and display data in an intuitive fashion to assist clinical decision making. Instead, doctors manually perform this data sorting.

Associate Professor Iain Tan, Senior Consultant and Director of Research of the Division of Medical Oncology at NCCS, hopes to change all that by leveraging patient data to improve diagnosis, investigation, treatments and outcomes. Through a collaboration with GE Healthcare, NCCS will leverage AI-powered solutions to improve data analytics and clinical workflows via a new smart system called Oncoflow, which extracts key clinical information from patient data such as tumour stage, previous treatments, laboratory results and clinical response. It also presents the information in an intuitive manner that shows the longitudinal progress of a patient.

With the smart system, doctors will have a more comprehensive view of patients’ records and be able to compare treatments against similar records, helping with faster and more accurate treatment decision-making.

“We’re continually exploring the latest digital innovations to improve the delivery of cancer care at NCCS. We aim to leverage next-generation digital tools to enhance integration of information, augment clinical decision making and ultimately improve outcomes for our patients,” said Assoc Prof Tan, Principal Investigator for this collaboration.

Is it possible to prevent cancer? National Cancer Centre Singapore's Assoc Prof Toh Han Chong is working on it.

The idea of a preventive cancer vaccine has been gaining popularity because if we can prevent cancer, isn't that better than treating it? A possible way to do this is by directing a patient's own immune system to identify new mutations, on cancer cells, as targets to be destroyed. These new cancer mutations, known as neoantigens, are not present on normal cells, are seen as foreign to the body's immune system, and are specific to each individual patient. The benefit of customised neoantigen-specific vaccines are that they can activate and boost neoantigen-specific T cells in the immune system to directly destroy cancer cells with minimal to no side effects.

The big challenge in developing these types of vaccines is accurately identifying the correct neoantigens to target. Only a small fraction of tumour mutations are potential neoantigens, that can be recognised by the patient's immune receptor which then triggers a specific immune response in the patient. And the process to identify them is complex and time-consuming.

To address these challenges, Associate Professor Toh Han Chong, NCCS' Deputy Chief Executive Officer of Strategic Partnerships, and his team, are collaborating with a private biotech, the National Supercomputing Centre (NSCC) and NVIDIA, to harness high powered computing and AI to identify the right neoantigens to construct into these neoantigen-based cancer vaccines. The team's AI algorithm is trained on vast biological data sets and uses the patterns and information from the data to accurately predict neoantigens from genetic information.

The team is currently conducting a clinical trial involving 60 patients – half of whom have primary liver cancer and half with liver metastasis from advanced colorectal cancer – who have had their cancers surgically removed, and so are cancer-free. The likelihood of relapse two years after surgery is at least 50% for both cancers. The AI-driven platform seeks to identify up to 10 neoantigens per patient, with the aim of activating and expanding neoantigen-specific T cells in the patients with a customised vaccine using the body's most efficient immune cells – dendritic cells - to present these neoantigens. The vaccine will be delivered as an injection and combined with a well-established antibody (immune checkpoint inhibitor) that can activate cancer-specific T cells, providing a further immune boost against any cancer cells still in the body.

"The exciting part of our endeavour is that this vaccine is applicable to most, if not all cancer types as the field of identifying neonatigens continues to become more sophisticated," explained Assoc Prof Toh. "Developing a way to effectively engineer these tailor-made, personalised and highly-effective vaccines, could potentially reduce the chance of cancer returning after surgery for more cancer patients."

New frontiers in cancer innovations

From left to right: National Cancer Centre Singapore's Assoc Prof Iain Tan, Prof Teh Bin Tean and Assoc Prof Toh Han Chong are driving cutting-edge innovations to improve how we diagnose, manage and treat cancer.

All these projects have something in common - they were borne in the clinic, studied in the lab and ultimately taken to clinical application in collaboration with commercial partners. All with the aim of ultimately benefiting patient care by proposing new solutions in the battle against cancer.

Where in-depth research and data analytics can spur the development of more precise diagnostics, and use of patient data can boost clinical decision making and workflows. The cutting edge technology used to develop cancer vaccines can potentially be extended for target identification and vaccine development against diseases such as influenza and coronaviruses. Innovations like these will pave the way for improved cancer care.