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COMMENTARY

Can precision medicine keep Singapore ahead in advanced care?

SINGAPORE is known the world over for its efficient healthcare system. In fact, the nation nearly tied with Hong Kong in Bloomberg's global healthcare efficiency index, narrowly missing out on the No 1 spot by a 1.7 point margin.

For Singaporeans, access to excellent medical facilities and innovative treatments means longer life expectancy and better quality of life. For the industry, this has also opened doors to a booming medical tourism opportunity as more patients from neighbouring South-east Asian countries have begun to look to Singapore as a preferred destination for advanced medical care.

Medical tourism brought an estimated US$994 million into the nation's economy in 2014 and more than half a million overseas patients continue to seek treatments every year. Unsurprisingly, Singapore was ranked first in Asia in US-based International Healthcare Research Centre's Medical Tourism Index 2016.

As Singapore looks to hold on to its leadership position globally - not only for its citizens but to serve the region as a whole - what more could it be doing to be a leader in medical innovation? One area that I have been watching very closely in my line of work is precision medicine and how it fundamentally changes our understanding and approach to treating cancers.

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In the past - and even in many cases today - patients with cancer were often presented with a "one-size- fits-all" approach (such as chemotherapy). We are used to cancer being categorised mainly according to its location in the body (such as breast, lung, liver) - with treatment depending on the tumour location and the stage of the disease.

GENOMIC ALTERATIONS

However, now the medical community is quickly realising that cancer is far more complex than a single disease. For example, even if a tumour is in the same location for two patients, the genetic make-up of the tumours may be different as each cancer can be caused by multiple types of changes in its genome, known as genomic alterations or mutations. These genomic alterations make each cancer unique to the individual patient. Based on this critical knowledge, specialists can assign different care plans to each patient that are targeted to the specific genetic mutations of the tumour in their bodies and which can lead to far better patient outcomes.

Beyond treatment, genomic profiling can actually be used across the entire clinical spectrum - from cancer prevention and diagnosis to targeting the right treatment and, later, monitoring of prognosis. Late last year, a comprehensive genomic profiling test that assesses 324 of the most commonly mutated genes known to drive the growth of cancer was made available in Singapore. This test provides a wealth of information to support patients and doctors in treatment decisions.

Comprehensive genomic profiling (CGP) allows doctors to determine the unique genomic profile of each cancer, so that treatment can be personalised for each patient. In a personalised cancer treatment approach, doctors aim to select therapies that best target a patient's cancer to give them the best chance of survival and remission. While personalised medicine is still a developing field, research suggests that patients who receive personalised treatment in clinical trials experience better outcomes across a variety of different cancers. These outcomes were measured by response rate (how many people had a reduction in tumour size after treatment) and overall survival (how long each patient survived after treatment).

Patients who received personalised treatment had higher response rates and overall survival compared with those who received non-personalised treatment. Ideally, genomic profiling should take place as early as possible in a patient's treatment journey to allow doctors to explore the greatest number of available treatment options before the cancer progresses. This is especially so for advanced cancer patients, where getting the most effective treatment the first time is key. However, genomic profiling can also be performed together with, or after single-marker tests or hot spot next generation sequencing (NGS) panels. This is especially useful if the cancer has developed resistance to a prior type of treatment.

While Singapore is still miles ahead in terms of medical services, other countries too are developing improved medical facilities at a rapid pace. One potential area that Singapore may still continue to lead the pack is through its strides in comprehensive genomic profiling and precision medicine which will offer a truly patient-centred approach to cancer treatment in the years ahead.

  • The writer is Global Medical director at Foundation Medicine.