Medical Professionals Version - National Cancer Centre Singapore
Medical Professionals Version - National Cancer Centre Singapore Medical Professionals Version - National Cancer Centre Singapore
Issue No. 01 • MICA (P) 207/10/2008 an nccs bi-monthly publication October / November 2008 ...helping readers to achieve good health Taking Cancer Care to the next level An interview with Prof Soo Khee Chee
- Page 2 and 3: Page A2 In Other Words SALUBRIS Oct
- Page 4 and 5: Page A4 In Focus SALUBRIS October /
- Page 6 and 7: Page C2 Under The Microscope SALUBR
- Page 8 and 9: Page C4 Spotlight SALUBRIS October
- Page 10 and 11: Page A6 People SALUBRIS October / N
- Page 12: Page A8 NCC Foundation SALUBRIS Oct
Issue No. 01 • MICA (P) 207/10/2008<br />
an nccs bi-monthly publication<br />
October / November 2008<br />
...helping readers to achieve good health<br />
Taking <strong>Cancer</strong> Care<br />
to the next level<br />
An interview with Prof Soo Khee Chee
Page A2<br />
In Other Words<br />
SALUBRIS<br />
October / November 2008<br />
Taking <strong>Cancer</strong> Care<br />
to the next level...<br />
The <strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong><br />
<strong>Singapore</strong> (NCCS) is known<br />
not just for its expertise in<br />
cancer treatment but as<br />
one of the key centres in<br />
cutting-edge research. Behind<br />
this success is its founding<br />
director Prof Soo Khee Chee,<br />
whose passion for research has<br />
put NCCS on the world stage.<br />
Be it 0730 hours or 1930 hours,<br />
whichever time of the day you<br />
pick, it is not uncommon to see<br />
the lights at his office on the fourth<br />
level of Goh Song Chiang Building.<br />
Not an unearthly hour, yet many of us<br />
would still be in our pyjamas. But not<br />
for Prof Soo Khee Chee. Tranquility for<br />
him is an opportunity to get his paper<br />
work done.<br />
In more than one way, Prof Soo, or just<br />
Prof, as he is affectionately known to<br />
his colleagues, wears many hats but is a<br />
man of few words.<br />
As NCCS Director, he is tasked with<br />
looking into policy matters and research<br />
projects. On his plate is the constant<br />
need to raise funds to support these<br />
research projects. He attends to patients<br />
at his clinic, performs surgery, and also<br />
shares his experience and expertise<br />
with his specialists, as well as teach the<br />
younger doctors. Not only that, he is the<br />
Vice Dean, Clinical and Faculty Affairs,<br />
of the Duke-NUS Graduate <strong>Medical</strong><br />
School, and his latest additional role<br />
is his appointment as Assistant CEO of<br />
SingHealth Group overseeing research<br />
and education.<br />
Prof Soo is one of the<br />
pioneers who saw the birth<br />
of NCCS, and today runs it<br />
with clockwork efficiency,<br />
attending to the majority<br />
of public patients. He is the<br />
face of NCCS in the global<br />
fraternity and is one of the<br />
founders of the Asian <strong>National</strong><br />
<strong>Cancer</strong> <strong>Centre</strong>s Network.<br />
A firm believer in research, he is<br />
constantly strategising and encouraging<br />
his team of investigators and clinician<br />
scientists. His prime worry is finding the<br />
funds to keep their projects going. For<br />
the Penang-born professor, his efforts<br />
have not been in vain.<br />
Today, NCCS is an example of what a<br />
premier cancer centre should be. Teams<br />
of specialists from various medical<br />
disciplines work together, supported by<br />
a talented pool of clinician scientists,<br />
focusing on how the patients can benefit<br />
from their discoveries. On hand are<br />
also the latest medical equipment, for<br />
example in radiation technology, so that<br />
they can also leverage on advances in<br />
IT to complement their efforts. NCCS, as<br />
part of its comprehensive service, also<br />
offers patients psycho-social counselling<br />
and carries out a whole menu of support<br />
programmes to help patients journey<br />
through their illness.<br />
Doctors at NCCS also carry out clinical<br />
trials as they have a wide patient base<br />
which is required for any trial to be<br />
effective. This also means that the<br />
doctors get to see the different types of<br />
cancer and hence are better exposed<br />
and experienced in responding to the<br />
patients’ needs.<br />
When asked about how things have<br />
turned out so far, a modest Prof Soo said:<br />
“I am pleasantly surprised that it has<br />
worked out better than we thought.”<br />
There were several issues that were<br />
important for NCCS at the time of its<br />
inception. One was to be able to create<br />
various multi-disciplinary segments so that<br />
sub-specialist care can be given to the<br />
patients in an efficient and timely manner.<br />
“This has turned out well because we are<br />
now able to offer a comprehensive range<br />
of specialist care in each of the major<br />
cancer groups,” he added.
Today, NCCS is an example of what a premier cancer centre should<br />
be. Teams of specialists from various medical disciplines work together,<br />
supported by a talented pool of clinician scientists, focusing on how the<br />
patients can benefit from their discoveries.<br />
Page A3<br />
In Other Words<br />
SALUBRIS<br />
October / November 2008<br />
Prof Soo, who was recently<br />
conferred the first national award<br />
by the Ministry of Health in<br />
recognition of his contribution to<br />
mentoring young doctors, is not<br />
one to rest on his laurels. One area<br />
where he feels things could have<br />
turned out better would be to<br />
house all cancer specialists under<br />
one umbrella, attending to cancer<br />
patients throughout <strong>Singapore</strong>.<br />
Getting<br />
the<br />
talents<br />
The other consideration involved<br />
recruiting highly talented scientists<br />
to generate a regular flow of in-depth<br />
research papers and create intellectual<br />
property in a productive way given the<br />
limitation in grants and other financial<br />
support for research projects.<br />
“NCCS is getting recognition for its<br />
work not only within <strong>Singapore</strong> and the<br />
region, but also globally,” said Prof Soo.<br />
In fact each year, he also schedules a<br />
few overseas trips to keep abreast of the<br />
latest in cancer treatment. He is also<br />
a sought-after speaker at distinguished<br />
overseas gatherings.<br />
“…But, what’s more important – winning<br />
the prize or curing polio? Of course<br />
it’s curing polio. It’s the science that’s<br />
important, not the recognition.”<br />
Prof Peter Courtland Agre 2003 Nobel Prize<br />
in Chemistry, in reference to Jonas Salk who<br />
though he made the polio vaccine, he never<br />
won the Nobel Prize.<br />
Some high profile research discoveries included the works by Dr Kon Oi Lian on<br />
developing cell-based treatments for metabolic disorders such as diabetes mellitus and<br />
haemophilia A; colorectal cancer vaccine and T cell therapy for nasopharyngeal cancer<br />
patients by Dr Toh Han Chong, and the role of the tumour-supressor genes, p53 and p73<br />
by Prof Kanaga Sabapathy.<br />
Now, NCCS has moved to the next level where it is sharing its expertise with others. Already<br />
it has proven to be a fertile training ground for grooming cancer specialists in <strong>Singapore</strong>,<br />
but now it has moved beyond its boundaries and are training specialists within the region.<br />
Doctors from Indonesia, Malaysia, Thailand, Vietnam are benefiting from this programme.<br />
Prof Soo, who was recently conferred the first national award by the Ministry of Health<br />
in recognition of his contribution to mentoring young doctors, is not one to rest on his<br />
laurels. One area where he feels things could have turned out better would be to house all<br />
cancer specialists under one umbrella, attending to cancer patients throughout <strong>Singapore</strong>.<br />
So far NCCS has helped the other hospitals to set up clinics to provide cancer services<br />
to their patients, such as at Changi General Hospital, KK Women’s and Children’s<br />
Hospital, <strong>National</strong> University Hospital and Tan Tock Seng Hospital.<br />
NCCS continues to be the only centre providing training for healthcare providers in<br />
palliative medicine, and with the setting up of the new Lien <strong>Centre</strong> for Palliative Care,<br />
the training programme is expected to benefit even more people.<br />
Asked how he retains talent within NCCS, he said the human resource structure is<br />
undergoing some robust changes, and the main clinicians and scientific investigators<br />
are now becoming faculty members of Duke-NUS Graduate <strong>Medical</strong> School. This<br />
Duke-NUS collaboration will help create a more intellectual milieu for the campus<br />
and advance the course of academic medicine. At the same time, it will train more<br />
specialists to meet the demand of a greying and expanding population.<br />
By Sunny Wee
Page A4<br />
In Focus<br />
SALUBRIS<br />
October / November 2008<br />
A Cure at what Price?<br />
– Searching for Personalised Yet Affordable Medicine<br />
For five years, Prof Huynh The Hung<br />
from the Laboratory of Molecular<br />
Endocrinology in <strong>National</strong> <strong>Cancer</strong><br />
<strong>Centre</strong> <strong>Singapore</strong> (NCCS) and his team<br />
have been working towards a noble dream.<br />
They embarked on a journey to<br />
come up with a personalised and yet<br />
affordable medicine to treat cancer.<br />
While personalised medicine is not<br />
new, most researchers are focused on<br />
looking for a treatment or drug that<br />
works in treating cancer.<br />
What sets this project apart is that the<br />
cost of therapy for the patient, should the<br />
treatment require more than two or three<br />
drugs, is another key consideration.<br />
Hence, Prof Huynh has to strike a<br />
tough balance, which could possibly<br />
explain why researchers often ignore the<br />
question of cost.<br />
This project entails taking tissues from<br />
a tumour of, for example, a liver cancer<br />
patient for implantation into the liver of<br />
six to eight mice. These SCID mice, as<br />
they are known, are immuno-deficient<br />
and they are commonly used as hosts for<br />
normal and malignant tissue transplants.<br />
This process is known as surgical<br />
orthotopic implantation and is believed<br />
to be available only in NCCS for research<br />
on hepatocellular carcinoma (HCC).<br />
The tumours are then allowed to grow<br />
in the mice while the team maps out<br />
several treatments for them using a<br />
combination of not more than three<br />
different drugs. These drugs are then<br />
administered to the mice as they would<br />
be to the patients. The mice are then<br />
monitored to gauge the response of the<br />
different drugs or combinations of drugs<br />
using the CT and PET scans.<br />
In doing so, it gives the team an idea<br />
of the combination of drugs that would<br />
work best for the respective patients<br />
whose tissues were grown in the mice.<br />
However, due to the underlying liver<br />
disease, not all patients are able to<br />
donate their tumour tissue for making<br />
xenografts and not all the HCC tissues<br />
from the patients will successfully grow<br />
in mice for drug testing. Furthermore,<br />
many patients may not have enough<br />
time to wait for the test results or be<br />
able to finance the surgical orthotopic<br />
implantation procedure or the drugs<br />
recommended. In these cases, Prof<br />
Huynh may still be able to find<br />
effective solutions by comparing the<br />
protein profile and/or gene signature<br />
of the affected patient with other<br />
patient-derived HCC xenografts in his<br />
therapeutic programme database to<br />
look for similarities and therapeutic<br />
regimens. Following this, he may also<br />
be able to recommend less expensive<br />
drugs that are likely as effective.<br />
Recently, NCCS joined hands with<br />
AstraZeneca, an Anglo-Swedish<br />
pharmaceutical firm, to test drugs to<br />
combat HCC. The combination of drugs<br />
being tested by the team is almost infinite.<br />
Apart from testing new compounds<br />
periodically provided by pharmaceutical<br />
companies, they may also combine the<br />
new compounds with existing drugs to<br />
see if better results can be attained. And<br />
even though Prof Huynh and his team<br />
now primarily deal with liver cancer,<br />
results of their work could potentially be<br />
used on other solid tumours.<br />
It was not smooth sailing for<br />
Prof Huynh when he first embarked<br />
on his research. In fact, it drew<br />
a lot of flak from the research<br />
community as tissues from patients<br />
were implanted and grown under<br />
the skin of the mice.<br />
But his persistence has finally paid<br />
off. With the new technique of<br />
surgical orthotopic implantation,<br />
many pharmaceutical companies<br />
have been approaching him to do<br />
pre-clinical testing for their new<br />
drugs. Hopefully, in the near<br />
future, this will result in patients<br />
having access to drugs that are<br />
personalised yet affordable.<br />
By Carol Ang
KIDNEY CANCER<br />
– Fighting the War with New Weapons<br />
Page C1<br />
Under The Microscope<br />
SALUBRIS<br />
October / November 2008<br />
Introduction<br />
Kidney cancer accounts for about 3% of all adult cancers<br />
with more males than females affected. Each year, there<br />
are more than 200,000 new cases diagnosed world-wide<br />
while more than 100,000 will die from the disease. The<br />
local incidence of this cancer has been increasing over the<br />
past 35 years and an estimated 90 men and 56 women are<br />
diagnosed with this cancer yearly.<br />
By Dr Tay Miah Hiang<br />
Visiting Consultant,<br />
Dept of <strong>Medical</strong> Oncology,<br />
NCCS<br />
This cancer typically affects people<br />
in the fifth to seventh decade of their<br />
lives. Most kidney cancers arise de<br />
novo, except for families with hereditary<br />
kidney cancer related to the von Hippel-<br />
Lindau syndrome. Risk factors for kidney<br />
cancer include smoking, obesity, long<br />
term uncontrolled hypertension and<br />
long-term dialysis for kidney failure. In<br />
the past, the prognosis of patients with<br />
advanced renal cell cancer was poor,<br />
with life expectancy not exceeding<br />
a year. Conventional treatment using<br />
interferon α is the standard systemic<br />
treatment as chemotherapy is not<br />
effective and high dose interleukin<br />
is too toxic. Our treatment of kidney<br />
cancer in recent years has changed<br />
with the understanding that attacking<br />
blood vessels feeding the tumour is an<br />
important treatment strategy.<br />
Signs and Symptoms<br />
Most kidney cancers develop silently.<br />
In its early stage, there are either no<br />
symptoms at all or transient symptoms<br />
which are often discounted by patients.<br />
By the time patients display symptoms,<br />
the cancer is already in the advanced<br />
stages. Common symptoms include<br />
painless microscopic or macroscopic<br />
haematuria, pain or palpable mass in<br />
the flanks of the body. Paraneoplastic<br />
syndromes are also common, such<br />
as fever, symptoms secondary to<br />
hypercalcemia and weight-loss. Stauffer’s<br />
syndrome, which is an abnormal<br />
liver function in the absence of liver<br />
metastasis, is also frequently seen. In<br />
advanced stages, where the disease has<br />
metastasised to other organs, symptoms<br />
such as cough from involvement of the<br />
lungs, bone pain or jaundice from liver<br />
involvement may arise.<br />
Diagnosis<br />
Kidney cancer can be classified<br />
into several types, and, because<br />
the treatment methods differ, it is<br />
important to subtype them accurately.<br />
Although most diagnoses can be<br />
made radiologically, usually via a CT<br />
scan or ultrasound, histopathological<br />
confirmation is important. This<br />
is usually via cytoreductive<br />
nephrectomy if the affected kidney<br />
is resectable, a core biopsy of the<br />
kidney or a metastatic lesion biopsy.<br />
Cytoreductive nephrectomy (to reduce<br />
tumour bulk) has also been shown<br />
to improve outcomes to subsequent<br />
systemic therapy (immunotherapy or<br />
targeted therapy with tyrosine kinase<br />
inhibitors) for the clear cell subtype.<br />
There are no tumour markers to measure.<br />
Histological Subtypes of<br />
Kidney <strong>Cancer</strong><br />
Clear cell type 75%<br />
Papillary type 15% to 20%<br />
Chromophobe type 5% to 10%<br />
Others
Page C2<br />
Under The Microscope<br />
SALUBRIS<br />
October / November 2008<br />
KIDNEY CANCER<br />
– Fighting the War with New Weapons<br />
Continued from page C1.<br />
Palliative treatment of metastatic kidney cancer<br />
The Future<br />
Chemotherapy and radiotherapy are<br />
common effective treatments for most<br />
cancers but is usually ineffective for<br />
kidney cancer. The most recognised<br />
and accepted treatment until recently<br />
is immunotherapy. High dose<br />
immunotherapy may potentially<br />
induce a cure in less than 5% of<br />
patients. However, this treatment is<br />
toxic and potentially life-threatening<br />
as well. The most common alternative<br />
to high dose interleukin is low dose<br />
immunotherapy which can control<br />
the disease (for an average of 3 to 6<br />
months) in 15% of all patients treated<br />
with interferon α. Despite its low<br />
dose treatment, side-effects such as<br />
fever, chills and loss of appetite can<br />
be a prominent feature, resulting in<br />
interruption or treatment cessation.<br />
Recent research has led to a better<br />
understanding of kidney cancer of<br />
the clear cell subtype. The loss of<br />
the tumour suppressor, von Hippel-<br />
Lindau gene at chromosome 3p,<br />
results in exuberant abnormal<br />
neovascularisation that not only feeds<br />
the tumour but forms the basis of<br />
metastasis. With this understanding,<br />
new drugs belonging to the class<br />
of tyrosine kinase inhibitors (TKIs)<br />
or mammalian target of rapamycin<br />
(mTOR) inhibitors have been<br />
developed to target this defect.<br />
These drugs include sorafenib<br />
(Nexavar), sunitinib (Sutent) and<br />
temsirolimus (Torisel) and they have<br />
been approved by FDA (USA) for the<br />
treatment of kidney cancer.<br />
These drugs are neither chemotherapy<br />
nor immunotherapy but what we call<br />
biological targeted therapy. Each of<br />
these agents stop cancer growth by<br />
blocking the cellular signaling pathway<br />
which stimulates growth such as<br />
the abnormal tumour blood vessels<br />
and the tumour cells themselves.<br />
These treatments have proven to be<br />
superior in terms of better response<br />
and duration of disease control as<br />
compared to interferon.<br />
Locally, sorafenib is the first of these<br />
drugs to be approved by HSA for<br />
treatment of metastatic renal cell<br />
cancer of clear cell subtype. The<br />
pivotal trial that led to FDA and HSA<br />
approval was a phase III randomised<br />
clinical trial which compared patients<br />
on placebo in the control arm with<br />
patients on sorafenib. These patients<br />
have metastatic renal cell cancer and<br />
have previously been treated with<br />
some form of immunotherapy.<br />
The study showed that the<br />
progression-free survival duration for<br />
patients receiving sorafenib doubled<br />
compared to patients on placebo<br />
(5.5 months vs 2.8 months) with a<br />
hazard ratio of 0.44 (95% CI, 0.35-<br />
5.5) which was statistically significant<br />
(p
DCE MRI for<br />
Anti-Angiogenic<br />
therapy<br />
Page C3<br />
Spotlight<br />
SALUBRIS<br />
October / November 2008<br />
A team from the <strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> <strong>Singapore</strong><br />
recently presented a paper on the use of Dynamic<br />
Contrast-Enhanced Magnetic Resonance Imaging<br />
(DCE MRI) for Phase I anti-angiogenic trial for<br />
a Clinical Science Symposium on Personalised<br />
Medicine as part of the ASCO (American Society of<br />
Clinical Oncology) scientific meeting for 2008.<br />
By Dr Thng Choon Hua<br />
Senior Consultant,<br />
Dept of Oncologic Imaging,<br />
NCCS<br />
For a tumour to grow beyond 1mm,<br />
it will need to develop its own blood<br />
supply. Otherwise, there would be<br />
insufficient oxygen and nutrients<br />
to support its growth. Thus, the<br />
process of developing new blood<br />
vessels, or angiogenesis, is required<br />
for tumour growth and metastasis.<br />
Consequently, angiogenesis has been<br />
the target of drug development and<br />
recently, several drugs have been<br />
developed to specifically target<br />
pathways of angiogenesis. These<br />
drugs result in static tumour growth<br />
when they are effective. However,<br />
unlike cancer drugs, which usually<br />
result in reduction in tumour size on<br />
conventional radiological imaging,<br />
many of these anti-angiogenic agents<br />
do not directly result in reduction of<br />
tumour size. DCE MRI has recently<br />
been used as a biomarker to assess the<br />
effects of this class of anti-angiogenic<br />
drugs. DCE MRI parameters reflect<br />
tumour blood flow and capillary<br />
permeability as the net effect of these<br />
changes result in an increase in signal<br />
when the tissue and its supplying<br />
large artery is repeatedly scanned at<br />
short intervals (four seconds) after<br />
administration of gadolinium contrast.<br />
The team used a model developed<br />
by engineers from the Nanyang<br />
Technological University that can<br />
quantify blood flow, capillary<br />
permeability, fractional intravascular<br />
volume and fractional interstitial<br />
volume from DCE MRI data. This new<br />
technique is an improvement over the<br />
current accepted technique.The new<br />
model (Distributed Parameter Model)<br />
separately calculates blood flow and<br />
permeability whereas the current<br />
accepted standard (ktrans and IAUC)<br />
reflects both parameters.<br />
Working together with oncologists<br />
from the <strong>National</strong> University Hospital<br />
and physicists from the <strong>Singapore</strong><br />
General Hospital, the team applied<br />
the new model to DCE MRI performed<br />
for a first-in-man Phase I trial of an<br />
anti-angiogenic agent and found<br />
that DCE MRI correlated with drug<br />
concentration, time to progression and<br />
predicted early or late progression.<br />
The results are promising and set the<br />
stage for more studies to determine<br />
if DCE MRI after a single course of<br />
expensive anti-angiogenic therapy<br />
can predict response and patient<br />
benefit. This may allow oncologists<br />
a “trial of anti-angiogenic therapy”<br />
in future.<br />
PS (ml/100g/min)<br />
40.0<br />
35.0<br />
30.0<br />
25.0<br />
20.0<br />
15.0<br />
10.0<br />
5.0<br />
0.0
Page C4<br />
Spotlight<br />
SALUBRIS<br />
October / November 2008<br />
Phase II Study of<br />
Weekly Docetaxel<br />
As Salvage Therapy for Disseminated<br />
Nasopharyngeal Carcinoma<br />
Summary of study<br />
Nasopharyngeal cancer (NPC) is largely an Asian disease and is<br />
characterised by its greater propensity to systemic dissemination<br />
when compared with other head and neck cancers. About<br />
5% to 8% of the patients will present with distant metastases<br />
at the outset 1, 2 . Despite improvement in outcome of patients<br />
with locally advanced stage III/IV disease, with the addition of<br />
platinum-based chemotherapy as combined modality therapy<br />
with radiation, systemic failure continues to be a problem 3, 4 .<br />
It is a well established fact that NPC is a chemo-responsive<br />
disease. Over the past decade, our group has established the<br />
activity of several third generation cytotoxics in NPC including<br />
paclitaxel, gemcitabine and irinotecan. 5-7<br />
The efficacy of docetaxel in NPC has<br />
not been studied previously and our group<br />
reported the results of our Phase II trial<br />
conducted in NCCS of single agent weekly<br />
docetaxel as a salvage regimen<br />
for disseminated NPC in this year’s<br />
ASCO Annual Meeting held in Chicago<br />
from 30th May to 3rd June 2008. This is the<br />
first study that confirmed the single agent<br />
activity of docetaxel in heavily pretreated<br />
patients with disseminated NPC.<br />
The best overall response rate of 37%,<br />
median progression free survival of 5.8<br />
months and the median overall survival<br />
of 12.8 months is encouraging, given that<br />
the majority of our patients were late in<br />
the course of refractory and progressive<br />
metastatic disease.<br />
It is noteworthy that the durable responses<br />
seen in those who received partial remission<br />
lasted a mean of 7.9 months. Our study<br />
activity compares favourably with other<br />
active third generation cytotoxics now in<br />
routine use by many Asian centres.<br />
The mean number of cycles of<br />
docetaxel received was 3.4 (range<br />
1 to 6). Of note is the low incidence<br />
of grade 3 or 4 hematologic<br />
toxicity and zero incidence of<br />
neutropenic fever. In general,<br />
docetaxel was well tolerated with<br />
fatigue and anemia being the<br />
commonest Grade 3 toxicity.<br />
In conclusion, the use of docetaxel<br />
in combination with other active<br />
agents for first line therapy in patients<br />
with disseminated NPC should be<br />
given due consideration given the<br />
limited efficacy of current regimens.<br />
Incorporating docetaxel in novel<br />
combinations with other active<br />
agents may provide the much needed<br />
improvement for patients with<br />
disseminated NPC. Moreover, it is<br />
also worthwhile including docetaxel<br />
in future clinical trial schedules<br />
for primary treatment of locally<br />
advanced stage III/IV disease, which<br />
is still plagued by distant failures.<br />
By Dr Joanne Ngeow 1 , Dr Leong<br />
Swan Swan 1 , Dr Darren Lim 1 ,<br />
Dr Toh Chee Keong 1 , Dr Gao Fei 2 ,<br />
A/Prof Balram Chowbay 3 ,<br />
Dr Tan Eng Huat 1<br />
1<br />
Dept of <strong>Medical</strong> Oncology, NCCS<br />
2<br />
Division of Clinical Trials and<br />
Epidemiological Services, NCCS<br />
3<br />
Division of <strong>Medical</strong> Sciences, NCCS<br />
References:<br />
1. Fong KW, Chua EJ, Chua ET, et al.<br />
Patients profile and survival of 270<br />
computer tomograph-staged patients with<br />
nasopharyngeal cancer treated at the<br />
<strong>Singapore</strong> General Hospital. Ann Acad Med<br />
<strong>Singapore</strong> 1996; 25: 341-6.<br />
2. Heng DM, Wee J, Fong KW et al. Prognostic<br />
factors in 677 patients in <strong>Singapore</strong> with<br />
nondisseminated nasopharyngeal carcinoma.<br />
<strong>Cancer</strong> 1999; 15: 1912-20.<br />
3. Wee J, Tan EH, Tai BC et al. Randomized<br />
trial of radiotherapy versus concurrent<br />
chemoradiotherapy followed by adjuvant<br />
chemotherapy in patients with American Joint<br />
Committee on <strong>Cancer</strong>/International Union<br />
against cancer stage III and IV nasopharyngeal<br />
cancer of the endemic variety. J Clin Oncol<br />
2005; 23: 6730-8.<br />
4. Chan AT, Teo PM, Ngan RK et al. Concurrent<br />
chemotherapy-radiotherapy compared<br />
with radiotherapy alone in locoregionally<br />
advanced nasopharyngeal carcinoma:<br />
progression-free survival analysis of a phase<br />
III randomized trial. J Clin Oncol 2002; 20:<br />
2038-44.<br />
5. Au E, Tan EH, Ang PT. Activity of paclitaxel<br />
by three-hour infusion in Asian patients with<br />
metastatic undifferentiated nasopharyngeal<br />
cancer. Ann Oncol 1998; 9: 327-9.<br />
6. Foo KF, Tan EH, Leong SS et al. Gemcitabine<br />
in metastatic nasopharyngeal carcinoma of<br />
the undifferentiated type. Ann Oncol. 2002;<br />
13: 150-6.<br />
7. Poon D, Chowbay B, Cheung YB, Leong<br />
SS, Tan EH. Phase II study of irinotecan<br />
(CPT-11) as salvage therapy for advanced<br />
nasopharyngeal carcinoma. <strong>Cancer</strong>. 2005;<br />
103: 576-81.
NCCS Activities In and<br />
Around the Community<br />
Page A5<br />
Community<br />
SALUBRIS<br />
October / November 2008<br />
Public Forum<br />
Advances in <strong>Cancer</strong> Research and Treatment<br />
28th June 2008<br />
HDB Convention <strong>Centre</strong> (HDB Hub), Auditorium<br />
A well-attended forum where<br />
NCCS medical oncologists, Dr Toh<br />
Han Chong and Dr Tan Min-Han,<br />
together with research scientist,<br />
Mr Johnson Ng, of Biochip<br />
Devises Pte Ltd, shared with<br />
audiences on the cancer research<br />
and treatment advancements.<br />
The forum, which was conducted in<br />
two sessions (Mandarin and English),<br />
highlighted topics such as:<br />
• Importance of Research in State-ofthe-Art-<strong>Cancer</strong><br />
Treatments<br />
• New Experimental Therapies<br />
• Converting Research to Bedside<br />
Treatment<br />
LIVER CANCER AWARENESS MONTH<br />
Liver cancer is the 4th most common cancer among men and ranks number two in terms of fatality.<br />
“Even so, there is potential hope for cure if individuals go for early detection and appropriate intervention,” said<br />
Prof London Lucien Ooi, Chairman of Liver <strong>Cancer</strong> Awareness Month (Liver CAM) also Deputy Director and Senior<br />
Surgical Oncologist at NCCS.<br />
Thus, to educate and update the public, general practitioners (GPs) and specialists on the disease, treatment<br />
options and prevention, NCCS held a public forum and sharing sessions with the medical professionals in<br />
conjunction with the 1st Liver CAM held in September 2008.<br />
Public Forum<br />
Liver <strong>Cancer</strong> and You ~<br />
Prevention and Treatment<br />
6th September 2008<br />
HDB Convention <strong>Centre</strong> (HDB Hub), Auditorium<br />
About 850 participants<br />
attended the English and<br />
Mandarin forum and found<br />
out more about liver cancer<br />
and related issues such as<br />
hepatitis B, which may lead<br />
to liver cancer.<br />
MEDICAL FORUM<br />
LIVER CANCER AND GPS ~ TREATMENT<br />
OPTIONS AND CASE STUDIES<br />
20th September 2008<br />
MAKING SENSE OF LIVER<br />
CANCER MANAGEMENT<br />
27th September 2008<br />
Some 60 GPs benefited from a medical update on liver cancer<br />
when they attended the special forum organised as part of this<br />
year’s Liver CAM. A roundtable discussion session was also held<br />
with specialists in the field.
Page A6<br />
People<br />
SALUBRIS<br />
October / November 2008<br />
Award Winners, New<br />
Appointments and More...<br />
NCCS Shares Limelight at<br />
Scientific Meeting<br />
Pictured below, from left to right:<br />
Dr Joanne Ngeow (right), Dr Ang<br />
Mei-Kim, Dr Ho Gay Hui (right) and<br />
Mr William Chin Wei Lim (left).<br />
Three doctors and a Research Officer from <strong>National</strong> <strong>Cancer</strong><br />
<strong>Centre</strong> <strong>Singapore</strong> (NCCS) each walked away as winners at the<br />
<strong>Singapore</strong> General Hospital (SGH) 17th Annual Scientific<br />
Meeting which was held from 25th to 26th April 2008 at the<br />
College of Medicine Building.<br />
Staff from Outram Campus, namely,<br />
SGH, NCCS, <strong>National</strong> Dental<br />
<strong>Centre</strong>, <strong>National</strong> Heart <strong>Centre</strong>,<br />
<strong>National</strong> Neuroscience Institute SGH<br />
Campus, <strong>Singapore</strong> <strong>National</strong> Eye <strong>Centre</strong><br />
and Duke-NUS Graduate <strong>Medical</strong> School<br />
were invited to submit an abstract of their<br />
work to compete in 13 award categories.<br />
Dr Joanne Ngeow, Registrar of the<br />
<strong>Medical</strong> Oncology Department<br />
clinched the Young Investigator’s<br />
Award (Clinical) with her paper on<br />
“PET/CT versus Conventional CT<br />
Scans and Bone Marrow Biopsy in the<br />
Initial Staging of Lymphoma Patients:<br />
A Comparative Analysis”.<br />
Her department colleague, Dr Ang<br />
Mei-Kim, an Associate Consultant,<br />
won the Best Poster (Clinical) prize<br />
for her work which featured “A<br />
Promising New Chemoimmunotherapy<br />
Regimen for Advanced Hepatocellular<br />
Carcinoma”.<br />
Dr Ho Gay Hui, Senior Consultant of<br />
the Surgical Oncology Department,<br />
took home the second prize in<br />
the Best Oral Paper (Clinical). Her<br />
winning paper “<strong>Cancer</strong> Miss Rate in<br />
Women Under 30 Who Undergone<br />
Excision Biopsy of Clinically Benign<br />
Breast Lumps without Preoperative<br />
Ultrasonography”.<br />
The Best Oral Paper (Scientist) prize<br />
was awarded to Mr William Chin<br />
Wei Lim, Research Officer of the<br />
Laboratory of Photodynamic Diagnosis<br />
and Treatment in the <strong>Medical</strong> Sciences<br />
Division, for his paper on “Membrane<br />
Transport Enhancement of Chlorin<br />
e6 – Polyvinylpyrrolidone and its<br />
Photodynamic Efficacy on the Chick<br />
Chorioallantoic Model”.
Congratulations to All!<br />
Page A7<br />
People<br />
SALUBRIS<br />
October / November 2008<br />
SINGAPORE<br />
YOUTH AWARDS<br />
2008<br />
On 6th July 2008,<br />
Dr Tan Min-Han received<br />
the <strong>Singapore</strong> Youth<br />
Award (SYA), Science and<br />
Technology category, from<br />
Deputy Prime Minister Prof<br />
S. Jayakumar at the Istana.<br />
The SYA recognises and commends<br />
contributions by youths who excelled<br />
in their respective fields and served<br />
the community in one way or the other.<br />
Dr Tan Min-Han, an Associate Consultant<br />
of the <strong>Medical</strong> Oncology Department,<br />
NCCS, is also a dedicated researcher whose<br />
work focuses on kidney cancer. He shuttles<br />
between the laboratory and clinic where<br />
he hopes the knowledge gained about<br />
the disease can be translated to treating<br />
his patients. Despite his busy schedule,<br />
he would still spend time with the junior<br />
doctors, medical students and even junior<br />
college students to give them guidance.<br />
Healthcare Humanity Award<br />
Given out in year 2003 as the<br />
Courage Award after the SARS<br />
(Severe Acute Respiratory<br />
Syndrome) outbreak in <strong>Singapore</strong>, the<br />
Healthcare Humanity Award, as it is now<br />
known, recognises outstanding healthcare<br />
workers who go the extra mile in caring<br />
and comforting the sick and the infirmed.<br />
Dr Joanne Ngeow, Registrar of the <strong>Medical</strong> Oncology<br />
Department, NCCS, is one of the six doctors, to receive the<br />
award from President S.R. Nathan at a presentation ceremony<br />
held on 26th May 2008 at the NTUC <strong>Centre</strong> Auditorium.<br />
Winners of the award are recognised for demonstrating values<br />
such as courage, extraordinary dedication, selflessness,<br />
steadfastness in ethics, compassion as well as humanity.<br />
PROMOTIONS<br />
Name<br />
Dr Chua Eu Tiong<br />
A/Prof Koong Heng Nung<br />
Dr Fong Kam Weng<br />
Dr Tan Yu Meng<br />
Dr Wong Zee Wan<br />
Dr Preetha Madhukumar<br />
Dr Teo Ching Ching Melissa<br />
Dr Quek Hong Hui Richard<br />
Dr Ng Chee Hui Raymond<br />
Dr Soong Yoke Lim<br />
Dr N. Gopalakrishna Iyer<br />
Dr Ang Mei-Kim<br />
Dr Tan Min-Han<br />
Dr Ngo Su-Mien Lynette<br />
Title<br />
Head, Radiation Oncology<br />
Head, Surgical Oncology<br />
Deputy Head, Radiation Oncology<br />
Senior Consultant, Surgical Oncology<br />
Senior Consultant, <strong>Medical</strong> Oncology<br />
Consultant, Surgical Oncology<br />
Consultant, Surgical Oncology<br />
Consultant, <strong>Medical</strong> Oncology<br />
Consultant, <strong>Medical</strong> Oncology<br />
Associate Consultant, Radiation Oncology<br />
Associate Consultant, Surgical Oncology<br />
Associate Consultant, <strong>Medical</strong> Oncology<br />
Associate Consultant, <strong>Medical</strong> Oncology<br />
Associate Consultant, <strong>Medical</strong> Oncology
Page A8<br />
NCC Foundation<br />
SALUBRIS<br />
October / November 2008<br />
NCC Foundation:<br />
Why We Do What We Do<br />
A leader once asked a<br />
group of executives during<br />
a corporate retreat: How do<br />
you make this organisation an<br />
interesting place?<br />
This is an established company<br />
in the service sector striving to<br />
renew itself. Someone replied:<br />
To be interesting, you have to<br />
be interested.<br />
In present terms, the primary functions of the NCC Foundation are to raise and manage<br />
funds for the NCC Research Fund (NCCRF), the <strong>Centre</strong>’s registered charity and its<br />
flagship fundraising and grant-making channel. NCCRF provides seeding and bridging<br />
funds for strategic research needs at the institution. Fundraising and grant making are<br />
thus the operative functions of the Foundation. Yet it is not just about money.<br />
The NCC Foundation will be<br />
celebrating its first birthday soon.<br />
You may have seen our posters<br />
around – in the lifts, beside the business<br />
office, by the clinics; you may have<br />
heard of or even participated in our<br />
fundraising and outreach events –<br />
‘Circle of Life’, ‘Light of Life’, ‘Muffins<br />
Monday’ and our national event, the<br />
‘Run For Hope’ in October. You sensed<br />
our interest, but how does one define<br />
this Foundation?<br />
It is really about the idea of giving. Essentially, the Foundation hopes to facilitate giving<br />
as part of <strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> <strong>Singapore</strong>’s (NCCS) cultural fabric. Giving can come<br />
in various forms – of treasures, talents and time. There are grateful patients who donate<br />
regularly, and there are others who leave significant bequeathment; there is a painter who<br />
shares her talent in support of our cause; there is a warmhearted baker who donates fresh<br />
pastries regularly; and there are staff who volunteer their time and efforts in our events.<br />
These are all actual examples of giving which took place, and the Foundation hopes to<br />
provide a holistically meaningful platform for all such practical and symbolic gifts.<br />
Moving ahead, the Foundation will consolidate its bedrock and put in place programme<br />
structures where different forms of giving can benefit the myriad areas of research, education<br />
and patient welfare. Naturally, we work alongside the crucial support of various departments.<br />
At this juncture, as the Foundation’s first birthday meets the 10th year anniversary of NCCS,<br />
we would like to say a big ‘Thank You’ to one and all who have guided us in our modest<br />
beginning. We look forward to your continuous goodwill in our journey ahead.<br />
By Eugene Sng<br />
Programme Director, NCC Foundation<br />
Editorial Advisors<br />
Dr Kon Oi Lian<br />
Prof Soo Khee Chee<br />
Executive Editors<br />
Ms Carol Ang<br />
Ms Adeline Teo<br />
Mr Sunny Wee<br />
Contributing Editors<br />
Dr Lim Soon Thye<br />
Dr Wong Nan Soon<br />
Members, Editorial Board<br />
Ms Audrey-Anne Oei<br />
Ms Sharon Leow<br />
Ms Flora Yong<br />
Salubris<br />
is produced with you in mind. If there are other topics related to cancer<br />
that you would like to read about or if you would like to provide some<br />
feedback on the articles covered, please email to salubris@nccs.com.sg.<br />
<strong>National</strong> <strong>Cancer</strong> <strong>Centre</strong> <strong>Singapore</strong><br />
11 Hospital Drive <strong>Singapore</strong> 169610<br />
Tel: (65) 6436 8000 Fax: (65) 6225 6283<br />
www.nccs.com.sg Reg No 199801562Z