SINGAPORE - It can take three to four months to determine which drugs are most effective against a liver cancer patient's condition.
However, several Singapore research institutions, along with South Korea's Samsung Medical Centre, have come up with a programme that could cut this waiting time to just three or four weeks - which may prove to be a lifesaver for some patients.
The Purpose Programme's Joint Laboratory, located at Biopolis in Buona Vista, was launched on Monday (April 30) to improve the treatment of liver cancer.
It is billed as the world’s first patient-specific platform for liver cancer that can better predict which drugs may work for individual patients.
The programme is a collaboration between the Agency for Science, Technology and Research's Institute of Molecular and Cell Biology and Genome Institute of Singapore, the National Cancer Centre Singapore (NCCS), the National University of Singapore (NUS) and Samsung Medical Centre.
The disease is the second most fatal type of cancer globally, and 80 per cent of patients who die from it are Asian.
Liver cancer can be treated through surgery but only 20 per cent of patients are diagnosed early enough for surgery to be an option, researchers say. This is because the majority of patients with liver cancer have no symptoms and the disease is often detected by chance through ultrasound or CT scans for unrelated problems.
Typically, liver cancer is discovered in the intermediate to advanced stages, and if untreated, most patients do not survive beyond six months.
For advanced or inoperable liver cancers, patients undergo chemotherapy but it is difficult to identify which drugs to use, doctors say.
Targeted-therapy drugs such as sorafenib, regorafenib and immunotherapy drug nivolumab have been shown to prolong patients’ survival.
"There is (currently) no good therapy for liver cancer," said Professor Pierce Chow, senior consultant of the oncology division at the NCCS. "Outcomes for these patients are significantly poorer than for other patients with breast or colon cancer for the same stage of disease."
Treating liver cancer is especially challenging as the tumours tend to vary among individuals and there is no one-size-fits-all approach, say doctors.
"The therapy has to be personalised for the patient. For liver cancer, there is an absolute absence of precision medicine, clinicians are not able to identify the best drug for a particular patient," said Prof Chow.
"Now, clinicians give the best possible drug based on statistics, say a drug clinically proven to work for 60 per cent of patients, but what if the patient is in the (other) 40 per cent? There is no way for the clinician to tell."
Through the programme, tumour samples are taken from a patient, and the cells are tested against different drugs to see which works best for a patient. To narrow down the range of drugs tested, analysis of a patient’s genetic make-up is also conducted.
The programme will be using Samsung Medical Centre's robotic Avatar Platform, which allows hundreds of sets of cells to be screened at the same time, unlike current research processes available here which are more laborious and time-consuming – only one set of cells can be screened at a time.
The most suitable drugs can be identified in three to four weeks.
Samsung Medical Centre’s robotic Avatar Platform will be used for the first time in Singapore’s medicine scene.
The programme hopes to complete its first clinical trial proving the efficacy of patient-specific drugs within the next two years, so that it can move towards its goal of providing this service to liver cancer patients in all hospitals.
Patients participating in the trial are from the NCCS and National University Hospital.
The service is expected to benefit patients at all stages of liver cancer. Post-surgery patients could also turn to this for subsequent therapy to avoid relapses.
Other benefits to patients could include cheaper drugs, said Prof Chow. For example, the research could allow pharmaceutical companies to know which drugs to produce for subgroups of patients with certain genes.
They could then determine which groups of patients require new drugs to be made or whether other existing drugs for other cancers can be repurposed for liver cancer treatment.
A more targeted approach to clinical trials would cut costs in drug development such that these cost savings could be passed on to consumers, said Prof Chow.
"This will also cut down on costs of drugs for patients," he added. "The first drug used is likely to be more effective opposed to a trial-and-error kind of approach."