Research

WHY LUNG CANCER RESEARCH?

Lung cancer is the leading cause of cancer deaths worldwide. In Singapore, it was consistently ranked as one of the leading cancers in the past 50 years (1968-2017) and the overall survival rate for lung cancer patients was poor, especially for males. This is partly due to the fact that majority were diagnosed at advanced stage (source: thespore-cancerregistry_commerativebook_-1.pdf (nrdo.gov.sg)).

Our study has shown that the epidemiology of non-small cell lung cancer (NSCLC) here differs significantly from that seen in the West. In particular, never-smokers with this condition are rather prevalent in Singapore. 

Over the past decade, improved understanding of the genomic alterations in lung cancer has led to an improved classification of this disease, which impacted the way treatment is selected. To date, several mutations are screened for routinely and the presence of which indicated the use of targeted therapies for the different mutations found. These seminal discoveries mark the beginning of a new era where genomic researches are being translated rather rapidly to significant changes in treatment paradigms. 

In more recent years, the development of certain immunotherapeutic compounds has showed promising results, especially to those patients who have no druggable mutations.

Despite the above achievements, there are still some unsolved problems that require further research, which include but not limited to:

  1. More druggable mutations
  2. The mechanism of resistance following targeted therapy
  3. The recurrence mechanisms following curative treatment
  4. The predictive biomarker for the selection of immunotherapy
  5. The intrinsic factors predisposing a person to lung cancer

OUR RESEARCH: NLCR

National Lung Cancer Research (NLCR) is a research study designed to tackle problems in our local setting, with the aim to improve lung cancer diagnosis, management and patient care. It started in 2000s and it is ongoing. 

The study recruits all lung cancer patients, regardless of stage and histology subtypes, in order to build up our local database. We invite all our lung cancer patients to take part in our research:

  1. To allow us to review medical records to build up the real-world database
  2. To donate blood and tissue samples for biomarker and genomics study
  3. To answer a life-style questionnaire for us to identify risk factors and study the gene-environmental interactions.

RESEARCH PROGRAMMES

i. Lung LCG (2019-2024)

The team received a $10 million funding in 2018 from National Medical Research Council (NMRC) under the Open-fund Large Collaborative Grant (OF-LCG) for “Next-Generation Clinical Trials and Integrative Research for Fighting Lung Cancer”. This is a 5-theme research program designed to tackle the entire continuum of non-small cell lung cancer, in collaboration with clinicians and scientists across the country. The objectives for the 5 themes are:

  • Designing and implementing innovative adaptive clinical trials to improve therapeutic response. 
  • Enhancing cancer immunotherapy and discovering novel targets to predict response and toxicity. 
  • Using big data to identify novel molecular biomarkers of clinical trial treatment response and guide treatment of NSCLC. 
  • Understanding disease biology to identify novel targets for the development of viable therapeutics. 
  • Developing a screening algorithm in a population with low smoking prevalence to detect early-stage lung cancer.

ii. Lung TCR (2013-2019)

Prior to the award of LCG, the team has received a $9 million TCR (Translational Clinical Research) award from NMRC in early 2013 with the following aims:

  • Conducting a comprehensive analysis of the cancer genome of never-smokers with lung cancer to gain a complete or near-complete view of genomic mutations. 
  • Discovering novel genomic mutations that new targeted agents can potentially treat can be used in combination with existing treatment guidelines to enhance the efficacy of standard therapies. 
  • Determining the spectrum of acquired genomic alterations that can contribute to the onset of resistance to targeted agents and designing rational clinical studies that combine newer targeted agents with standard therapies to address mechanisms of resistance. 
  • Unravelling the behaviour of cancer stem cells (CSCs) and developing strategies to circumvent their growth/survival to lead to a more durable remission of lung cancer

Photo: A/Prof Daniel Tan (NCC), A/Prof Darren Lim (NCC) and Dr Tam Wai Leong (GIS) at the award ceremony. Source: https://www.nmrc.gov.sg/media/news/nmrcnewsdetailpage/Index/new-projects-under-of-lcg-and-clinician-innovator-award

CLINICAL TRAILS

  1. A clinical trial is a research study conducted to investigate new treatments, such as a new drug compound or an existing therapy, in human volunteers or research participants. It is the primary way for researchers to find out if a new treatment is safe and effective.

    Singapore has been active in conducting clinical trials over the years. The Health Sciences Authority (HSA) data shows that over 50% of new trials conducted in Singapore in 2021 are oncology or cancer trials.

  2. To find out more about clinical trials, visit (Links)
  3. If you are interested in trial participation, do speak to your treating physician.

Publications