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Eye on the big picture

Associate Professor Melvin L.K. Chua is busy. He’s the newly appointed Head of the Department of Head & Neck and Thoracic in the Division of Radiation Oncology at the National Cancer Centre Singapore (NCCS). He is also Principal Investigator of the Precision Radiation Oncology Programme at the Tan Chin Tuan Laboratory of Optical Imaging, Photodynamic and Proton Therapy as well as the Director of the Data and Computational Science Core at NCCS. To add to that, Assoc Prof Chua was just awarded a renewal of the National Medical Research Council’s (NMRC) Clinician Scientist Award – Investigator at the end of 2021.

When asked how he finds time to do it all, Assoc Prof Chua was clear.

“I think the answer is prioritising, cutting out the noise and focusing on what’s important,” he shared.

Finding focus

Assoc Prof Chua understood early in his career that to make a positive impact and improve patients' lives, he wanted to serve as an oncologist and conduct innovative research. 

Zeroing in on head and neck cancer as a focus was inspired by his mentors who encouraged his interest. Moreover, nasopharyngeal carcinoma (NPC), or nose cancer, is a cancer that is prevalent in Singapore, and it is the second-most common cancer for Chinese men here aged 40 to 49 years.

“My patients come to me in the prime of their lives,” said Assoc Prof Chua. “When they are diagnosed, it’s so unexpected that they are lost and struggle to handle the situation.”

Over 50% of NPC patients present with stage four disease. While the prognosis is usually good, these patients live with the constant fear of a cancer relapse and deal with toxicities associated with cancer treatment. Additionally, a cancer diagnosis in men of this age can have a significant socioeconomic impact on their families, as they are often the breadwinner of the family.

Assoc Prof Chua has pushed forward to understand NPC better and bring clinical trials to Singapore. His first NMRC Clinician Scientist Award – Investigator in 2016 allowed him and his team to collaborate on two global clinical trials. One of those trials led to the publication of a paper in the prestigious New England Journal of Medicine in 2019, which found that administering chemotherapy before the standard chemo-radiotherapy, improved tolerance to treatment and prolonged survival in patients with stage three and four NPC.

"That was probably the proudest moment of my research career, because we not only got our work published we more importantly were able to change the standard of care for patients the very next day," said Assoc Prof Chua.

Finding solutions for all cancers


From left to right, National Cancer Centre Singapore’s Assoc Prof Melvin Chua and Dr Ong Choon Kiat collaborate to find better treatments for many cancer types.

While NPC is his research focus, Assoc Prof Chua is also leveraging patient data to improve cancer care. As the Director of the Data and Computational Science Core at NCCS, he is looking to build a research platform that will facilitate the collation of data for multiple cancers. This will enable analytics within individual cancer types and across multiple cancer types. Ultimately, this will help to assess and predict disease progression, identify factors that lead to disease and model effective treatments for all types of cancers.

“Data is the richest resource,” shared Assoc Prof Chua, "Investing in this effort to develop this sandbox will help us accelerate the research we conduct. It will also position NCCS well to engage in local and international collaborations and move the needle for the field”.

Getting a handle on a devastating disease

Nasopharyngeal carcinoma (NPC) is a head and neck cancer prevalent in Asian populations. In Singapore, around 200 Chinese men are diagnosed with NPC annually, and 70% are diagnosed with more advanced disease (stage three to four). The disease affects those aged 30 to 60 years and up to 30% of NPC patients suffer a relapse, even after intensive chemotherapy and radiotherapy.

Assoc Prof Chua and his team have been able to identify an inheritable genetic mutation in the RPA1 gene in approximately 80% of NPC patients. This mutation appears to confer resistance to radiotherapy, which is problematic as radiotherapy is the primary treatment for NPC.

Having received a renewal of NMRC’s Clinician Scientist Award – Investigator in 2021, Assoc Prof Chua plans to investigate other genes implicated in NPC and conceptualise new drug-radiotherapy combinations to treat affected patients. Findings will allow for more informed cancer screening and early diagnosis, and improve NPC survival rates in Singapore. The team also plans to use their models in the laboratory to screen for drugs that can enhance the anti-cancer effects of radiotherapy in patients with these genetic mutations. The ultimate goal is to improve outcomes for patients affected by the devastating disease.