“When a patient doesn’t show up for an appointment, I worry about them,” said Professor Gopal Iyer, Head and Senior Consultant, Department of Head and Neck Surgery under the Division of Surgery and Surgical Oncology, Singapore General Hospital and National Cancer Centre Singapore (NCCS), Senior Consultant with the SingHealth Duke-NUS Head and Neck Centre and Head of the Division of Medical Sciences, NCCS.
“I have a running joke with the IRB [Institutional Review Board]. They tell me to make sure to de-identify clinical research subjects but that’s impossible because for me each of my patients has a face and name that I remember.”
This is not something I expected to hear from Prof Iyer, a head of a department and two-time awardee of the National Medical Research Council Clinician Scientist Award – Senior Investigator (CSA-SI), for his research on head and neck squamous cell cancers.
National Cancer Centre Singapore’s Prof Gopal Iyer celebrates a successful PhD thesis defence with his mentor at the University of Cambridge.
The expectation is that a clinician scientist is either more of a clinician or more of a scientist and yet, Prof Iyer seems to be equally both. He completed his medical training at the National University of Singapore before pursuing his PhD in molecular carcinogenesis, or molecular tumour formation, at the University of Cambridge, United Kingdom. Prof Iyer went on to train as a surgeon and research fellow in Australia and in the United States. At the end of his Fellowship at Memorial Sloan-Kettering Cancer Centre in New York, United States, he received an award for being the best fellow in the surgical division for operative skill and research output.
Blast from the past - Prof Gopal Iyer and a team of surgeons pose in the early days of National Cancer Centre Singapore.
Prof Iyer came back to NCCS when he realised it was where he could pursue his two passions - surgery and research. One of the first few clinician scientists, he specialised in general surgery and went on to sub-specialise in head and neck surgery. He picked head and neck surgery as it is complex and posed a challenge. The head and neck are involved in multiple functions including breathing, eating, swallowing and speaking, and no two head and neck cancers are the same.
“During my days as a medical student, the patients we saw with head and neck cancers were those who were smokers, drinkers, and labourers – it was a working class disease,” said Prof Iyer. “It was also predominant in Asia, and as a result was very poorly researched, so there was room for us to improve that.”
Prof Iyer began by looking at prognostic factors (characteristics that define the natural history of the disease) for head and neck cancers and examining who does better and who does worse in both the local and international populations. He also explored the development of new therapeutics for the cancer and new ways to use existing drugs to treat it.
Prof Iyer is known for doing research in personalised medicine. He describes it as first identifying patients who might respond to treatment, then determining what combination of treatment will work for them based on their own tumour mutations and tumour burdens. The treatment prescribed for the individual is thus personalised.
“Once you find out more about something specific it can be applied to different cancers. Every time I operate on a case and if that patient recurs, I think about the science and biology of the case. Knowing the tools means that I can answer the questions of why it might be happening and how we can fix it,” said Prof Iyer.
Zooming in to treat squamous cell cancer
In November 2020, Prof Iyer was awarded the Clinician Scientist Award – Senior Investigator (CSA-SI) by the National Medical Research Council for his work on squamous cell carcinoma. With around 500 cases a year in Singapore, Prof Iyer and his team use a precision medicine approach to better match and time the administration of immunotherapies for enhanced treatment outcomes.
With the first award he received in 2017, Prof Iyer and his team used a focused approach to improve patient outcomes using existing therapies. With the current widespread use of immunotherapy, he is hoping to find out how to identify the 20% of patients who respond to this new class of drugs, and more importantly find out why the remaining 80% don’t − and how to make them respond.
The CSA-SI gives Prof Iyer and his team the resources to continue to pursue this personalised view of medicine to make an impact on patient care. With the award, they want to learn what distinguishes patients who responded to the treatment and improve how these patients are identified. The team also hope to expand the number of patients who respond to immunotherapy by looking at administering
existing therapies and exploiting other molecular pathways, cell therapy and vaccines.
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