Pushing the Boundaries of Cancer Care

From 2014 and 2018, nearly 75,000 Singaporeans1 were newly diagnosed with cancer. Such a surge in cases represents the country’s largest uptick in the last five decades—and foreshadows what looms ahead.

But Singapore is prepared. The Ministry of Health provides harmonised guidelines for cancer screening and treatment, which have no doubt helped keep patients alive. Despite the increasing number of cancer cases, patients in 2018 were much less likely to die from their disease than in 19681.

Still, guidelines alone aren’t enough. No two cancer patients are exactly alike, meaning that a more nuanced view of cancer care is needed. While the trifecta of surgery, chemotherapy and radiotherapy remains indispensable, they can also be inefficacious. Often, conventional non-targeted anti-cancer drugs have limited efficacy and come with toxic side effects due to their broad killing strategy, with patients facing complications and additional healthcare costs as a result.

Precision oncology provides the opportunity to optimise cancer care by using information from genes and other molecular markers. Through cancer screening and precision oncology, doctors can not only detect the disease earlier but also select medicines that are most likely to be effective, taking the guesswork out of the equation.

In this feature, we look at two local enterprises putting precision oncology to the test. Way ahead of the curve and utilising cutting-edge technologies, these companies are blazing a trail toward better cancer care in Singapore.

The Apex of Timely Precision Oncology

Before doctors can prescribe a management regimen for cancer, they need to know what they’re up against. Tumour characteristics—such as its size or the mutations they harbour—all influence treatment choice. To obtain this information, doctors typically take a tiny piece of the tumour and subject it to various lab tests.

However, doctors in Singapore and regionally tend to sequentially order multiple single-gene tests, stopping only when they find a treatable mutation. Depending on the number of such tests ordered, the cumulative costs may eventually become more expensive. Furthermore, multiple single-gene testing takes a longer time to identify a druggable mutation and could also quickly exhaust the limited amount of tumour tissue obtained from a single biopsy.

A homegrown company called MiRXES is offering the emerging technology of next-generation sequencing (NGS), with a much broader coverage of genes, as a solution to this problem. One of their products currently in development, called APEX, can detect through a single test a myriad of genetic alterations across 50 genes specially curated based on clinical actionability. By simultaneously searching for treatable mutations in these 50 genes, the chances of finding potential targeted therapies that might be effective against the patient’s tumour is substantially increased.

Notably, the test can flexibly profile tumour tissues and liquid biopsies with the exact same gene coverage within a fast turnaround time of 4 days. These key features are expected to fulfil the different needs of physicians and patients.

“We recognise that early detection is only the first step,” said MiRXES CEO Zhou Lihan. “Therefore, we are expanding from early cancer detection to precision oncology to provide more complete solutions in the care continuum of cancer patients.” To this end, timely and precise treatment guidance from APEX will be vital.

Sensing a Tumour’s Weakness

As APEX demonstrates, a precision approach offers the opportunity to improve cancer treatment and, consequently, patient outcomes. However, precision oncology has been largely focused on genes and might be missing out on equally important information from other biomarkers.

“Currently, when we speak of precision oncology, we think about genetic testing,” said Toh Hong Boon, CEO of local enterprise AVATAMED. In addition to looking at its genetic material, AVATAMED makes use of whole cancer cells—obtained from the patients themselves—to optimise treatment.

Their flagship kit, called the AVATASENSE PanCancer Test, takes and cultures a patient’s tumour biopsy sample. Then, using their automated high-throughput drug screening system called AVATASCAN, the cells are tested against a robust panel of nearly 80 FDA-approved cancer drugs, all of which are known to be effective for different types of cancer.

AVATAMED also utilises a proprietary, highly validated analytical software that takes in huge volumes of drug response data and identify which treatment would simultaneously be most effective against the particular tumour. From start to end, AVATAMED’s entire cancer testing process takes no longer than three weeks, meaning that doctors will receive a precise and actionable report in a timely manner to treat their patients.

Moving forward, Toh hopes to further AVATAMED’s approach and expand their technology beyond cells, eventually also including factors in the immediate environment of the tumour. Combined with genetic and cellular information, such a holistic view of cancer will help clinicians to choose even better treatment plans for their patients.

Though their approaches may differ, both AVATAMED and MiRXES share a common goal: providing more accurate diagnoses for Singapore’s cancer patients. And either through liquid biopsies or cell-based drug screening, both companies are out to prove that precision oncology can revolutionise cancer medicine.

References:

1. Singapore Cancer Registry Health Promotion Board (2021, October 15). Singapore Cancer Registry

Annual Report 2018 [Online]. https://www.nrdo.gov.sg/docs/librariesprovider3/default-document-library/scr-annual-report-2018.pdf?sfvrsn=bcf56c25_0