image: Associate Prof Melvin L. K. Chua, Prof Liu Jian Jun, and Associate Prof Thomas Loh Kwok Seng (Copyright: A*STAR’s Genome Institute of Singapore) view more
Credit: A*STAR’s Genome Institute of Singapore
A team of researchers led by A*STAR’s Genome Institute of Singapore (GIS), along with the National University Cancer Institute, Singapore (NCIS) and National Cancer Centre Singapore (NCCS), was awarded the prestigious Open Fund-Large Collaborative Grant (OF-LCG), which is supported by the National Research Foundation,
Singapore (NRF) and administered by the Singapore Ministry of Health’s National Medical Research Council (NMRC), to establish an integrated research programme to improve the early diagnosis and survival rate of patients with nasopharyngeal cancer (NPC).
Commonly referred to as nose cancer, NPC occurs in the upper part of the throat, behind the nose. It is the second most common cancer in adult males in Singapore between the ages of 40 to 49 years. It affects people of Chinese ancestry, particularly from Southern China, as well as the Malay and indigenous Southeast Asian populations.
Due to non-specific symptoms of NPC and clinical silence of early-stage tumour, the majority of NPC patients tend to be diagnosed with late-stage disease, with less than 10% of patients diagnosed at Stage 1. This has a bearing on prognosis and treatment for NPC patients—for those at a more advanced stage at diagnosis, poorer survival rates are expected and those who recover face up to a 40% chance of a relapse. If found and treated at an early stage, NPC survival and cure rates are usually higher, with 10-year survival rate of above 90% for patients with Stage 1 tumour.
Targeting the Epstein-Barr virus
NPC is consistently associated with Epstein-Barr virus (EBV) infection, but it still unclear why only some individuals, particularly the Southern Chinese, develop NPC, while over 90% of world population are infected by EBV. An early study1 by the team revealed that specific EBV high-risk strains are driving NPC development in populations from Southern China. However, it is unknown if this is also occuring in other NPC-endemic regions, such as Southeast Asia.
This new research programme aims to develop EBV-centric strategies to enable effective population screening for early diagnosis of NPC and advance personalised treatment. The programme will focus on three collaborative studies: (1) Genome sequencing analysis studies to uncover EBV risk strain(s) that drive NPC development in Southeastern Asian populations.
(2) A screening programme in the community that will evaluate the effectiveness of EBV high-risk strains, serology, and circulating DNA as biomarkers to identify individuals who are at high risk of developing NPC. Clinical evaluation and subsequent follow-up of these individuals will enable the early diagnosis of NPC.
(3) A multi-arm platform clinical trial named RIBBON (tReatment optImisation By eBv stratificatiOn in Npc), which will test several individualised strategies in patients with Stage 2-4 and recurrent-metastatic NPC using their EBV DNA test results.
Prof Liu Jian Jun, Distinguished Institute Fellow at A*STAR’s GIS, and leading Principal Investigator of this research programme, said, “The discovery of EBV risk strains as a genetic determinant for NPC development has greatly unlocked opportunities to explore new strategies that can transform the clinical management of NPC. The success of this collaboration will improve the effectiveness of early-stage diagnosis and personalised treatment for NPC patients in Singapore as well as Southeast Asia.”
Associate Prof Thomas Loh Kwok Seng, Senior Consultant, Department of Otolaryngology – Head & Neck Surgery, National University Hospital (NUH) and Division of Surgical Oncology, NCIS, said, “We have shown the effectiveness of screening in first-degree relatives of NPC patients. This timely programme will allow us to extend screening to the at-risk population in the community between the ages of 40 to 60 years, to identify and effectively treat early stage disease.”
Associate Prof Melvin L. K. Chua, Head and Senior Consultant, Department of Head and Neck and Thoracic, Division of Radiation Oncology at NCCS, said, “Our NPC research programme is a long-awaited opportunity for investigators from surgery, oncology, genomics and immunology, and health service research to come together to address urgent gaps in personalised treatments for a cancer that predominantly affects Asian men who are in the prime of their lives. As ~30% of patients relapse following chemotherapy and radiotherapy, there is a great need for more effective drugs.”