Fighting cancer with precision medicine
By focusing on each cancer case as unique to the individual, NUS researchers are hoping to improve the understanding, diagnosis, and treatment of cancer.
When it comes to cancer, no two patients are the same. So to improve the understanding, diagnosis, and treatment of cancer cases, the underlying science must be tailored to the individual. At NUS, researchers are exploring and innovating precision medicine techniques in order to rewrite the rulebook on cancer treatments.
Furthering the understanding with genomics
Genomics is the study of genomes – which can be described as a person’s unique instruction manual – containing all the information needed for daily functions and repair. By reading and analysing this instruction manual, scientists discovered that variations in genomes can influence whether a person develops a disease, how that disease progresses, and how they respond to medications.
Today, Professor Chng Wee Joo from the Cancer Science Institute of Singapore at NUS is pioneering the use of high-resolution global genomic techniques to identify drug targets, determine drug resistance, and improve disease prognosis in blood cancers. Using these techniques, his ultimate aim is for truly personal treatment with better patient outcomes.
“The study of genomics can allow us to stratify patients into different risk groups. This stratification can help decide on the intensity of treatment to be given to the patient,” Prof Chng explained. “Furthermore, the understanding of specific genetic abnormalities can identify patients that will benefit from specific drugs and treatments, as well as the doses of drugs to use. Fundamentally, this allows us to decide on the best drug and dosing for individual patients, and my lab has been at the forefront of this research for blood cancer over the last decade.”
Improving the diagnosis with liquid biopsies
So, a cancer patient can receive dramatically improved treatment by having their genome sequenced. But to sequence a patient's genome, typically a procedure called a tumour biopsy is performed. Professor Lim Chwee Teck from the Biomedical Institute for Global Health Research & Technology at NUS recently advanced an innovative way to sequence a patient's genome without this procedure.
Prof Lim's technique involves a miniaturised device that can efficiently detect and isolate cancer cells from blood. Based on an emerging technology called microfluidics, the device's methodology is simple, low-cost, and highly non-invasive. "The genetic sequencing can be performed on circulating tumour DNA strands or cancer cells obtained from blood. This is known as a liquid biopsy," Prof Lim explains. "This is less invasive and can be done more frequently than a tumour biopsy."
He continued, "With this technique, we can obtain real-time feedback as to the condition of the patient through frequent sampling and testing, something not possible with a highly-invasive tumour biopsy. Treatment can then be personalised based on this real-time feedback of the patient's response to therapy."
"Trials being conducted on patients are showing promise, and liquid biopsy and precision medicine could potentially disrupt how cancer is managed and treated," Prof Lim stated. This technology has been commercialised by an NUS spinoff – Biolidics Limited. It is FDA registered in the USA and China, and is being installed in 90 locations around the world. In December 2018, the company issued its first sale of stock to the public.
Refining the treatment with artificial intelligence
After the patient’s genome is effectively sequenced and a diagnosis is made, then treatment can proceed. However, because of the intricacy and individuality of cancer cases, treatments can be incredibly complicated to implement effectively. This is where cutting-edge artificial intelligence (AI) techniques can be employed.
AI could be used for treatment assistance, especially when a patient’s case is complex or rare, by quickly suggesting combinations of medicines based on their data. The drug types and dosages are likely to be appropriate and highly accurate as AI could access all the patient’s medical records and other related databases not just locally, but also around the world.
Professor Dean Ho from the Singapore Institute for Neurotechnology at NUS has developed a new platform called CURATE.AI to do just that. He plans to enable clinicians to identify drug synergies and optimise combination therapies for individual patients.
“Using drugs in combination is a cornerstone of many therapies, and the point is to achieve drug synergy,” Prof Ho explained. “With CURATE.AI, we have a way of uniquely correlating drug combinations with patient responses. This correlation allows us to create what we call a phenotypic map, which resembles a three-dimensional ‘mountain’, with the peak being the optimum efficacy.”
He continued, “CURATE.AI implicitly accounts for patient heterogeneity, which means that it is broadly applicable to many different diseases. It can also continuously optimize the drug and the dose for the patient over the entire duration of care.”
Innovative techniques such as genomics, liquid biopsies, and artificial intelligence are paving the way for personalised, precision medicine. In these ways and others, NUS thought-leaders are helping to understand, diagnose, and treat cancer with more efficacy than ever before.