February 7, 2025
SINGAPORE – Grab driver Yong Hock Lim thought that the niggling tummy pain that he was experiencing in January 2024 was because of his irregular meal times.
But as the pain persisted and his appetite worsened, further tests in May 2024 revealed that he had stage 3 liver cancer.
“I was shocked about my diagnosis because I don’t usually drink,” said Mr Yong.
The 73-year-old, who also does not have a history of hepatitis B or C, is not the typical profile of a patient who is offered regular screening for liver cancer.
But Mr Yong had an increased risk of developing liver cancer as he had fatty liver disease. For now, there are no cancer-screening programmes for patients like him.
That is about to change, with $6 million awarded to National Cancer Centre Singapore (NCCS) senior consultant surgeon Pierce Chow, who over the next five years will research liver cancer screening strategy for patients with non-traditional risk factors.
The funding comes with the prestigious Singapore Translational Research (Star) Investigator Award, which was given to Professor Chow, 63, by the Ministry of Health’s National Medical Research Council.
Another surgeon-scientist, Professor Gopal Iyer, 52, the head of the department of head and neck surgery at NCCS, received the same award and funding to conduct clinical studies on treating head and neck cancers. Prof Iyer will work to develop a more cost-effective method of manufacturing an innovative cell therapy to treat such cancers.
A media briefing was held at NCCS to announce the awards and new research efforts on Feb 6.
Liver, and head and neck cancers are more prevalent in Asia, highlighting the need for improved understanding and treatment options here.
Elaborating on his study, Prof Chow said that research has shown that 92 per cent of those with liver cancer eventually die of the disease. The poor outcome is largely due to late diagnosis.
Currently, screening for liver cancer is available only to patients who have chronic hepatitis B and C.
But while patients with chronic viral hepatitis made up about 90 per cent of people diagnosed with liver cancer in Singapore 20 years ago, the profile of patients is changing, he said.
Today, about 60 per cent of liver cancer patients at NCCS have chronic viral hepatitis, and about 40 per cent of them have fatty liver disease.
However, almost 40 per cent of the Singapore population have various degrees of fatty liver disease, Prof Chow noted.
It would be impractical to enrol such a large number of people in lifelong surveillance programmes for liver cancer, which require twice-a-year ultrasound scans and blood tests.
With the funding from the Star Investigator Award, Prof Chow and his team will be able to differentiate patients with fatty liver, so that those at higher risk of developing liver cancer can be enrolled in surveillance programmes.
To do so, the research team will analyse the gut microbiomes of those with fatty liver disease. The gut microbiome is the ecosystem of bacteria, fungi and other microbes found in the digestive system.
Findings from two other studies that Prof Chow is leading indicate that the gut microbiomes of patients who develop liver cancer versus those who do not, are “strikingly different”, containing different types of bacteria and enzymes.
“Because of the different types of enzymes and bacteria that react differently with bile acids, we found different ratios of bile acids in the bloodstream,” said Prof Chow.
Using information on bile acid ratios in patients, researchers aim to develop a population-level algorithm to predict liver cancer risk. A blood test will also be developed to identify those with gut microbiomes that present the highest risk of getting cancer.
Additionally, Prof Chow and his team will look into how diet and lifestyle changes can reverse gut microbiome imbalances and reduce the risk of developing cancer.
“This will be the first programme that addresses the specific risks of developing liver cancer for patients with fatty liver disease. This gives those at high risk of developing liver cancer the chance to be diagnosed early through enrolment in surveillance programmes with potentially life-saving outcomes,” said Prof Chow.
Separately, Prof Iyer is hoping to improve access to novel treatments for head and neck cancers.
Such cancers are more common in Asia than other parts of the world. In Singapore, around 950 new cases of these cancers are diagnosed each year.
While early-stage head and neck cancers are often treatable, survival rates for advanced cases remain low, with only a 20 per cent survival rate for late-stage diagnoses.
Prof Iyer will be working on a clinical-grade production process to produce tumour-infiltrating lymphocyte (TIL) therapy to treat head and neck cancers. TIL therapy is a type of cell therapy which involves extracting immune cells from a patient’s tumour, enhancing their cancer-fighting abilities, and then re-infusing them to kill cancer cells.
The first TIL cancer treatment was approved in 2024 in the US for advanced melanoma, a type of skin cancer.
While the novel approach has shown promise in treating melanoma, it has not been used for head and neck cancers.
An impediment to the widespread use of TIL therapy is having the know-how on the centralised manufacturing process.
Prof Iyer and his team have developed a lab-based system to produce the therapy, and will be collaborating with the Netherlands Cancer Institute and Swiss biotech company Tigen Pharma to further refine the production process. Their goal is to slash the time required into a three-week protocol from the current one-month.
TILs will be produced at the Advanced Cell Therapy and Research Institute, which is housed in the NCCS building in Outram.
With the ability to produce it locally, Prof Iyer is hoping to slash the cost of TIL therapy to one-tenth of its current cost. Such treatment currently costs US$500,000 (S$677,000) a dose.
“We are standing at the cusp of a new era in cancer treatment. With our expertise, technologies and capabilities at the National Cancer Centre Singapore, we are uniquely positioned to develop and deliver a more cost-effective TIL therapy.” said Prof Iyer.