Prof Josep Tabernero, President, European Society for Medical Oncology (ESMO)
Prof Solange Peters, President-Elect, ESMO
Prof Fortunato Ciardiello, Past-President, ESMO
Dr Keith McGregor, Chief Executive Officer, ESMO
Prof Choo Su Pin, President, Singapore Society of Oncology (SSO); and Local Officer, ESMO Asia 2018
Dr Ravindran Kanesvaran, Immediate Past President, SSO
Distinguished Guests
Ladies and Gentlemen
1. Good morning and welcome to the ESMO Asia 2018 Congress. This is the fourth year that the congress has been held in Singapore.
Growing cancer burden
2. The World Health Organization (WHO) lists cancer as the second leading cause of death globally. Cancer was responsible for an estimated 9.6 million deaths in 2018. This means that nearly one in six deaths was due to cancer[1]. Similarly, cancer is Singapore’s leading cause of death, constituting about 30% of the deaths in 2017, with over 64,000 cancer cases diagnosed from 2011 to 2015. The estimated lifetime risk for developing cancer in the Singapore population is one in every four to five persons. Hence, we need to redouble efforts to tackle this challenging issue.
Importance of prevention and early detection
3. According to the WHO, between 30 to 50 percent of all cancer cases are preventable[2]. Modifiable risk factors include tobacco and alcohol use, an unhealthy diet, physical inactivity, obesity, and certain infections. To address this, the Health Promotion Board runs many programmes to promote a healthy lifestyle among Singaporeans. One example is the National Steps Challenge™, which uses incentives and gamification to motivate participants to keep active and clock additional steps each day.
4. Primary prevention through the management of risk factors remains the most important and cost-effective way to fight cancer. Take lung cancer for instance, which in Singapore is the most frequent cause of cancer death in males and the second most frequent in females. To tackle this, the Government has adopted a multipronged approach to reduce the prevalence of smoking, a major risk factor for lung cancer. This includes public education on the harms of tobacco use, support for smokers who wish to live tobacco-free, legislation to restrict tobacco advertising and sales of cigarettes to minors, as well as taxation.
5. Secondary prevention, or screening to pick up cancers in their early stages, should also be actively promoted. To reinforce this, the Ministry of Health enhanced the Screen for Life programme last year. At a cost of $5 or less, eligible Singaporeans can undergo subsidised health screening for colorectal and cervical cancer. Community Health Assist Scheme cardholders pay $2, while the package is free for our Pioneer Generation.
Advances in cancer research in Singapore
6. At the same time, continued innovation and research remain crucial in the fight against cancer. To this end, the Singapore Government has invested substantially in cancer research.
7. One such project funded by the National Medical Research Council (NMRC) is the “Cell Therapy of Cancer”, led by Professor Dario Campana from the National University Health System (NUHS). Prof Campana’s team has developed new methods to avert cytokine release syndrome, one of the most serious side effects of cancer cell therapy. His team has also developed new ways to treat leukaemia and lymphoma by increasing the anti-tumour activities of T cells and natural killer, or NK, cells. Prof Campana has since founded a Singapore-based start-up, Medisix Therapeutics, which takes a novel approach to develop chimeric antigen receptor (CAR) T cells against T-cell leukaemia and lymphoma.
8. Another ongoing project, also funded by NMRC and led by Professor Antonio Bertoletti from Duke-NUS Medical School, has demonstrated potential efficacy of T-cell Receptor (TCR) therapy in the control of Hepatitis B Virus (HBV) related liver cancer relapses. Prof Bertoletti’s work in TCR immune cell therapy has led to the founding of the biotechnology start-up, LION TCR, in February 2015. The company recently obtained approval from the Health Sciences Authority for its Phase I/II multicentre clinical study of its product candidate (LioCyx™) for the treatment of relapsed liver cancer post-liver transplantation. This is the first such trial in the region that uses precision TCR immune cell therapy to target HBV-related liver cancer.
9. Aside from these projects, other institutions have also fostered their own collaborative efforts, which are aimed at improving patients’ treatment and access to care. The expanded Integrated Molecular Analysis of Cancer Programme is one such example. Started in May 2017 as a collaboration with Roche subsidiary Foundation Medicine, and led by Dr David Tan of the National University Cancer Institute, Singapore, the programme screens patients’ tumours for abnormalities in 315 genes in order to match them to suitable early-phase clinical drug trials. This facilitates the search for promising new cancer treatment options.
10. The PuRPOSE programme, a collaboration between the Agency for Science, Technology and Research, the National University of Singapore, the National Cancer Centre Singapore, and Samsung Medical Center from South Korea, was launched in April this year. It aims to determine the most appropriate drug of choice for liver cancer patients by capitalising on an Artificial Intelligence platform to allow hundreds of sets of cells to be screened at the same time. This is expected to reduce the time needed to determine the most effective drug for advanced liver cancer patients from between three to four months to between three to four weeks.
Beyond quality to value
11. Singapore has taken the lead in strengthening our policies to combat the scourge of cancer. We are also at the forefront of cancer research and development in the region. Nevertheless, as clinicians, we need to constantly strive to do more and do better for our patients. Affordability of cancer therapies will become an increasing challenge for patients, healthcare systems and governments going forward. As such, even as research brings about new, innovative therapies, we have to ensure that these treatments remain cost-effective.
Closing
12. To conclude, the battle with cancer is a continuous fight and requires a strategic and collaborative approach that combines prevention, screening, treatment and research to achieve affordable, quality and patient-centred care. Today’s congress provides a valuable platform for collaborative opportunities and the building and strengthening of such partnerships.
13. I wish you all a fruitful learning and networking experience at the congress.
Thank you.
[2] Source: www.who.int/cancer/prevention/en/