Chance for personalised treatment if liver cancer strikes again

Professor Pierce Chow, who is from the surgical oncology division at the National Cancer Centre Singapore (NCCS), showing a model of a liver to a patient during a consultation session in his clinic.
Professor Pierce Chow, who is from the surgical oncology division at the National Cancer Centre Singapore (NCCS), showing a model of a liver to a patient during a consultation session in his clinic. PHOTO: NATIONAL CANCER CENTRE SINGAPORE

Original, recurrent tumours of patients in new study will be sent for in-depth analysis

When liver cancer recurs in people who have already undergone surgery, there is typically not much that doctors can do.

But a team at the National Cancer Centre Singapore (NCCS) is offering new patients the chance to get personalised treatment if cancer strikes again. Ninety-five per cent of recurrences will happen within three years.

If patients agree to be part of the study, their tumours will be cut up after surgery and sent to various institutions for in-depth analysis.

This includes studying the genetic make-up and immune profile of the cancer, so as to better understand what makes it tick.

Doctors hope that by the time the cancer recurs, they will have learnt enough about the specific tumour to tailor treatment to the patient's needs.

The problem with liver cancer, said Professor Pierce Chow, who is from the surgical oncology division at NCCS, is that it is complex and not well understood.

What is known, said Prof Chow, is that a number of genetic mutations are behind every liver cancer. However, they do not know which ones are significant.

But by comparing samples taken when the person was first diagnosed with cancer and when his cancer recurs, doctors can figure this out.

"If I were to sample the recurrent tumour... and compare that with the original tumour, and we find common mutations - these will be the mutations that are important for this person," he said.

Existing drugs could then be used to target these mutations. "Currently, we don't have enough information to know who benefits from what," Prof Chow said.

Liver cancer is the fourth most common cancer among men in Singapore, with 2,264 cases between 2010 and 2014.

It is also among the top five killer cancers for both men and women, even though it does not fall among the common women's cancers.

The study will involve 100 patients, 40 of whom will be recruited by three centres in Singapore. The rest will come from Thailand, the Philippines and Malaysia.

In Singapore, the NCCS, Singapore General Hospital and National University Hospital will be collaborating on the study.

It will also involve four other research institutions, including the Genome Institute of Singapore.

Patients who are scheduled for liver cancer surgery will be offered the opportunity to take part.

There are no added risks, and follow-up will be done every three months.

The study will also pay for CT scans, blood tests and liver function tests.

A version of this article appeared in the print edition of The Straits Times on October 27, 2016, with the headline 'Chance for personalised treatment if liver cancer strikes again'. Print Edition | Subscribe