Medical Professionals Version - National Cancer Centre Singapore

Medical Professionals Version - National Cancer Centre Singapore Medical Professionals Version - National Cancer Centre Singapore

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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

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

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