Kicking off a grand tradition

The oncology community was treated to a head-to-head battle of wits between two oncology greats on 29 November 2023. The occasion? The first ever National Cancer Centre Singapore (NCCS) Medical Grand Rounds. Traditionally, medical grand rounds are meetings, common to academic medical centres, where clinical cases, new treatments and, or, innovations are presented and discussed, with the goal of inspiring doctors and the wider healthcare community.

The NCCS Medical Grand Rounds are a platform to share advances in oncology and spark solutions for a better future

(From left) Prof Tony Mok, Chairman of the CUHK’s Department of Clinical Oncology, and Prof Fabrice André, incoming President-Elect of ESMO, battle it out in the first ever, NCCS Medical Grand Rounds

The first medical grand rounds at NCCS took the format of a debate between two oncology giants who were in Singapore for the ESMO Asia Conference 2023. Professor Fabrice André, incoming President-Elect of the European Society of Medical Oncology (ESMO), and Professor Tony Mok, Chairman of the Chinese University of Hong Kong’s (CUHK) Department of Clinical Oncology and ESMO faculty member, went head-to-head to debate the motion: This house believes that advances in breast cancer are so good - it leaves lung oncology behind catching its breath!

The grand debate

Prof Fabrice André, incoming President-Elect of ESMO declared that all conceptual advances in cancer have come from breast cancer

Prof Tony Mok, Chairman of the CUHK’s Department of Clinical Oncology, rebutting Prof André’s argument!

Prof André, a world-renowned breast cancer oncologist and global leader in precision medicine, kicked off the debate by declaring that all conceptual advances in cancer treatment have come from breast cancer. According to Prof André, breast cancer was the first cancer to use systemic adjuvant treatment for early-stage disease, prescribe neoadjuvant therapy before surgery, and trial the first targeted treatment for cancer – trastuzumab for HER2 positive breast cancer. He asserted that these advancements in breast cancer treatment, which were introduced as early as the 1980s, were subsequently adopted or copied in other cancers, such as lung cancer.

Prof Tony Mok, Chairman of the CUHK’s Department of Clinical Oncology, countered that it was now the time for lung cancer to make bold advances in treatment

Prof Mok, an illustrious lung oncologist, countered that while breast cancer may have charted advancements many years ago, lung cancer had made significant improvements in understanding and effectively treating the disease in the past 20 years. These include identifying multiple gene mutations, such as EGFR, ALK and RET, which can now be effectively targeted with specific therapies. He argued that overall survival of lung cancer patients has increased at a rapid rate, with a striking increase in long term survivors, even at advanced stage lung cancer. His main argument, that the time for advances in any field were different and while breast cancer had its heyday in the past, the time for rapid advances in lung cancer, has now arrived.

Both discussed conceptual versus incremental advances in breast and lung cancer, and how they have transformed cancer treatment. They also looked ahead, with Prof André challenging the audience to consider that disease specification is no longer relevant and that the way forward was an organ-agnostic approach using precision targets to direct treatment for all cancers.

Final verdict

Debate co-chairs, Prof Toh Han Chong, DCEO (Strategic Partnerships), NCCS, and Prof Rebecca Dent, immediate past Chairperson of the Division of Medical Oncology, NCCS, asking the hard questions

Enjoying a light moment at the inaugural NCCS Medical Grand Rounds before the debate! (From left: Assoc Prof Ravindran Kanesvaran, Prof Toh Han Chong, Prof Fabrice André, Prof Tony Mok and Prof Rebecca Dent)

The result was carefully weighed by a team of illustrious judges from institutions across Singapore. Duke-NUS Medical School’s Dean, Professor Thomas Coffman, and Professor Roger Vaughan, National Cancer Institute Singapore’s Executive Director, Associate Professor Chee Cheng Ean, and National Cancer Centre Singapore’s Professor Pierce Chow and Associate Professor Joanne Ngeow were picked for their expertise in their respective fields – and impartiality as none of them treat lung nor breast cancer. With the winning place in the close debate going to lung cancer!

Co-chairs of the debate, Professor Toh Han Chong, Deputy Chief Executive Officer (Strategic Partnerships), NCCS, and Professor Rebecca Dent, immediate past Chairperson of the Division of Medical Oncology, NCCS, shared that the goal of the exchange was to allow young oncologists to not only learn from the best medical minds but to realise that they too have the ability to advance and transform oncology care.