Public Version - National Cancer Centre Singapore

Page A4
In Focus
SALUBRIS
October / November 2008
A Cure at what Price?
– Searching for Personalised Yet Affordable Medicine
For five years, Prof Huynh The Hung
from the Laboratory of Molecular
Endocrinology in National Cancer
Centre Singapore (NCCS) and his team
have been working towards a noble dream.
They embarked on a journey to
come up with a personalised and yet
affordable medicine to treat cancer.
While personalised medicine is not
new, most researchers are focused on
looking for a treatment or drug that
works in treating cancer.
What sets this project apart is that the
cost of therapy for the patient, should the
treatment require more than two or three
drugs, is another key consideration.
Hence, Prof Huynh has to strike a
tough balance, which could possibly
explain why researchers often ignore the
question of cost.
This project entails taking tissues from
a tumour of, for example, a liver cancer
patient for implantation into the liver of
six to eight mice. These SCID mice, as
they are known, are immuno-deficient
and they are commonly used as hosts for
normal and malignant tissue transplants.
This process is known as surgical
orthotopic implantation and is believed
to be available only in NCCS for research
on hepatocellular carcinoma (HCC).
The tumours are then allowed to grow
in the mice while the team maps out
several treatments for them using a
combination of not more than three
different drugs. These drugs are then
administered to the mice as they would
be to the patients. The mice are then
monitored to gauge the response of the
different drugs or combinations of drugs
using the CT and PET scans.
In doing so, it gives the team an idea
of the combination of drugs that would
work best for the respective patients
whose tissues were grown in the mice.
However, due to the underlying liver
disease, not all patients are able to
donate their tumour tissue for making
xenografts and not all the HCC tissues
from the patients will successfully grow
in mice for drug testing. Furthermore,
many patients may not have enough
time to wait for the test results or be
able to finance the surgical orthotopic
implantation procedure or the drugs
recommended. In these cases, Prof
Huynh may still be able to find
effective solutions by comparing the
protein profile and/or gene signature
of the affected patient with other
patient-derived HCC xenografts in his
therapeutic programme database to
look for similarities and therapeutic
regimens. Following this, he may also
be able to recommend less expensive
drugs that are likely as effective.
Recently, NCCS joined hands with
AstraZeneca, an Anglo-Swedish
pharmaceutical firm, to test drugs to
combat HCC. The combination of drugs
being tested by the team is almost infinite.
Apart from testing new compounds
periodically provided by pharmaceutical
companies, they may also combine the
new compounds with existing drugs to
see if better results can be attained. And
even though Prof Huynh and his team
now primarily deal with liver cancer,
results of their work could potentially be
used on other solid tumours.
It was not smooth sailing for
Prof Huynh when he first embarked
on his research. In fact, it drew
a lot of flak from the research
community as tissues from patients
were implanted and grown under
the skin of the mice.
But his persistence has finally paid
off. With the new technique of
surgical orthotopic implantation,
many pharmaceutical companies
have been approaching him to do
pre-clinical testing for their new
drugs. Hopefully, in the near
future, this will result in patients
having access to drugs that are
personalised yet affordable.
By Carol Ang