A Significant Milestone in Improving the Access of Malaysians to Comprehensive Genomic Profiling

Recently, Roche Pharmaceuticals and Roche Diagnostics cemented a partnership with Premier Integrated Labs with the signing of a memorandum of understanding (MOU). This MOU is effective from November 2023.

The objectives of this partnership include improving patient access to comprehensive genomic profiling or CGP as well as promoting greater awareness and understanding of CGP among Malaysians.

MS HENG CHAI YIN
General Manager
Roche Diagnostics (M) Sdn Bhd

“While awareness and understanding are crucial, our ultimate goal is to ensure that CGP is accessible to all patients in Malaysia. It is about providing every patient with the best possible chance for an accurate diagnosis and tailored treatment plan,” says Ms Heng Chai Yin, the General Manager of Roche Diagnostics Sdn Bhd.

WHAT IS COMPREHENSIVE GENOMIC PROFILING (CGP)?

With a single test, comprehensive genomic profiling (CGP) can analyse a broad panel of genes that is known to drive cancer growth. This type of testing produces comprehensive patient reports with broad and deep assessments of the possible underlying cancer drivers.1

HOW CGP PLAYS A KEY ROLE IN PRECISION MEDICINE

Precision medicine involves the use of personalized treatments for an individual with regards to a disease.2

Different people can respond differently to the same medication for the same disease, and there are many possible factors that are responsible for these differences.

Hence, a big part of precision medicine involves the identification of these differences through investigative methods such as in the image below.

Click on the image for a larger, clearer version. CGP falls under omics. Hence, it is one of the important procedures that provide healthcare professionals with the necessary data to design the best personalized treatments for their patients.
HOW CGP CAN IMPROVE THE PRECISION OF CANCER TREATMENT IN MALAYSIA
MS DEEPTI SARAF
General Manager
Roche (Malaysia) Sdn Bhd

According to Ms Deepti Saraf, CGP holds the key to unlocking the full potential of personalized medicine. It allows us to explore the genetic makeup of individuals, thereby enabling more precise and tailored treatment approaches.

Let’s look at lung cancer as an example.

How CGP could improve treatment for lung cancer and benefit both the patient and the oncologist. Click the image for a larger, clearer version.
CGP IS DIFFERENT FROM CONVENTIONAL GENOMIC TESTS

Ms Deepti Saraf points out that, unlike those genomic tests in the market that let you know about your genes and ancestry, CGP is more of a diagnostic tool that empowers doctors, especially oncologists, to create the most optimal personalized treatments for their patients based on available data.

EN HAREEFF MUHAMMED
Chief Executive Officer
Premier Integrated Labs

En Hareeff Muhammed brings up that, with the wealth of genomic data obtained through the use of CGP, databases can be created to analyse which treatments would work best for different groups of patients.

This goes back to Ms Deepti Saraf’s statement that CGP allows healthcare professionals to design the best personalized treatments for their patients. They can do this by using the information found in the database to help shape their decisions.

“It’s not just useful for the patients and saves time,” En Hareeff elaborates. “It also supports doctors in making better decisions.”

This is an educational article brought to you by


References:

  1. Foundation Medicine. (n.d.). Why comprehensive genomic profiling? https://www.foundationmedicine.com/resource/why-comprehensive-genomic-profiling
  2. König, I. R., Fuchs, O., Hansen, G., von Mutius, E., & Kopp, M. V. (2017). What is precision
    medicine?. The European respiratory journal, 50(4), 1700391. https://doi.org/10.1183/13993003.00391-2017
  3. Omics-based clinical discovery: Science, technology, and applications. (2012, March 23). In C.M. Micheel, S.J. Nass, & G.S. Omenn (Eds), Evolution of translational omics: lessons learned and the path forward (p. 33). National Academies Press (US). https://www.ncbi.nlm.nih.gov/books/NBK202165/
  4. Tan, J., Hu, C., Deng, P., Wan, R., Cao, L., Li, M., Yang, H., Gu, Q., An, J., & Jiang, J. (2021). The predictive values of advanced non-small cell lung cancer patients harboring uncommon EGFR mutations-the mutation patterns, use of different generations of EGFR-TKIs, and concurrent genetic alterations. Frontiers in oncology, 11, 646577. https://doi.org/10.3389/fonc.2021.646577
  5. American Lung Association. (2022, November 17). EGFR and lung cancer. https://www.lung.org/lung-health-diseases/lung-disease-lookup/lungcancer/symptoms-diagnosis/biomarker-testing/egfr

Can the World Truly Be Free of Fear of Cancer in the Next 25 Years? Experts Believe So

WORDS LIM TECK CHOON

On 5 September 2023, Siemens Healthineers hosted Creating a World Without Fear of Cancer: A Critical Dialogue, a panel discussion for local healthcare experts and leaders to share their thoughts on whether the world can indeed be free of fear of cancer within the next 25 years.

This may seem odd at the surface as cancer cases continue to rise—indeed, the number of cases in Malaysia is projected to double by 2040!

However, we are also seeing a rise in technological innovations that allow for more precise and earlier detection of cancer, as well as more effective forms of treatment through customized therapy that capitalizes on recent breakthroughs in genetics, immunotherapy, and more.

Hence, it is possible that, over the next 2 decades, we will see a shift from cancer as a ‘death sentence’ to a manageable long-term or chronic disease with higher survival rates. In other words, a world without fear of cancer.

We managed to get a front row seat at this panel discussion, and we’re pleased to share the highlights with you.

WHO’S AT THE PANEL DISCUSSION?
  • Fabrice Leguet, Managing Director of Siemens Healthineers Southeast Asia
  • YB Dr Kelvin Yii, Special Advisor to the Health Minister
  • Serena Yong, CEO of Regency Specialist Hospital
  • Professor Ricky Sharma, Global Head of Clinical Affairs at Varian
  • Ranjit Kaur, former President and current board member of Reach to Recovery International (RRI)
HIGHLIGHTS OF THE PANEL DISCUSSION
FEATURED EXPERT
YB DR KELVIN YII LEE WUEN
Special Advisor to the Minister of Health
  • “The National Strategic Plan for Cancer Control aims to make cancer prevention, management, and control accessible and affordable through partnerships with stakeholders,” says YB Dr Kelvin Yii. “The goal is to reduce the cancer burden, promote understanding of cancer, encourage prevention and early diagnosis to alleviate patient fears.”
  • The backbone to this effort is the Public Private Partnerships (PPPs) that involve strategic partnerships between government and private hospitals.
  • Current, most of the medical innovations for cancer diagnosis and management are centred around private hospitals, thus putting them out of reach of many Malaysians, especially those in the B40 group.
  • Through PPP, efforts such as government hospital patients getting follow-up treatments at private hospitals can be made possible while still at a reasonable cost partly funded by the Ministry of Health Malaysia.
  • Dr Kelvin admits that funding is a significant challenge at the moment.
FEATURED EXPERT
PROFESSOR RICKY SHARMA
Global Head of Clinical Affairs
Varian Medical Systems
  • “Cancer is a disease that can evolve and mutate to evade treatments,” Professor Ricky Sharma states. “The importance of patient data cannot be understated, as well as patient experiences of treatment from country to country.”
  • He underscores the importance of using patient data to deliver a personalized patient experience. “It has to be from a holistic point of view,” he elaborates. “We need to be asking important questions from the patients’ perspective: ‘Is treatment accessible? Are patients being treated with the respect they deserve? How and where are clinical decisions being made and the treatments being administered?'”
  • In light of the objectives set by the Ministry of Health Malaysia, such as the digitalization of all their healthcare facilities by 2030, Professor Ricky Sharma believes that this would allow for more accessible healthcare to people of all economic status, regardless of location.
  • For example, he cites the use of a virtual cockpit, which allows a healthcare professional to deploy customized treatment plans, analyze and provide results of imaging tests, etc to multiple hospitals without having to physically travel to those places. This would save time and improve productivity and efficiency.
  • Furthermore, digitalization of the medical workplace would allow for more flexible work hours for the staff, which is an effective way to reduce burnout. He and Ranjit Kaur bring out the fact that the medical profession has one of the highest suicide rates in the world, and this move to digitalization would help reduce the prevalence of burnout and mental issues that could help reduce such tragedy.
FEATURED EXPERT
FABRICE LEGUET
Managing Director
Siemens Healthineers Southeast Asia
  • Fabrice Leguet believes the next step in comprehensive cancer care will be to move beyond today’s fragmented cancer care landscape towards a more integrated approach.
  • He cites the shift of cancer screening from tertiary hospitals to general practitioners’ clinic as an example of such an approach. Having screening services available to clinics, especially at more rural areas of Malaysia, would go a long way in increasing the number of cancer cases detected at an early stage and, hence, the chances of better treatment outcomes and fewer deaths.
  • “By partnering with healthcare providers, we accelerate the transfer of knowledge in oncology across clinical, technical and managerial fields and fast-track the adoption of integrated innovative technologies across the continuum of cancer care,” he says.
  • “While we leverage our access to global best practices and the latest technological innovations, we take a ‘fit for purpose’ approach, where solutions are adapted to the local context in close collaboration with our partners in the region,” he adds.
  • He further says, “Every strategic partnership, every technological innovation, and every collaboration with policy makers will bring us one step closer to creating a world without fear of cancer.”
FEATURED EXPERT
SERENA YONG
Chief Executive Officer
Regency Specialist Hospital
  • Serena Yong shares that the private medical healthcare sector welcomes the partnership with the Ministry of Health via PPP programmes.
  • “By integrating insights from different fields, we can achieve more diverse and effective outcomes,” she states.
  • “Patient well-being at the heart of our mission,” she goes on to add, “so this partnership expedites the integration of connected health solutions, ensuring swifter access to care. Moreover, it facilitates the expansion of teleconsultation services and the implementation of predictive analytics on a broader scale, ultimately contributing significantly to our patients’ journey toward improved health outcomes.”
FEATURED EXPERT
RANJIT KAUR
Former President and Current Board Member
Reach to Recovery International (RRI)
  • In spite of technological advances, Ranjit Kaur reiterates the importance of community support and holistic approaches that emphasizes the patient’s emotional well-being alongside their medical treatments.
  • “In a world where technology drives improvement in various aspects of our lives, we must also prioritize empathy, timely care access and comprehensive support systems for patients, not only in Malaysia but worldwide,” she says. “Each patient journey is often daunting and worrisome, but by paying greater attention to these details, we can help individuals look beyond their diagnosis and find confidence in their ability to overcome cancer.”
  • Given that the oncologists in Malaysia are still concentrated in urban areas such as the Klang Valley, Ranjit highlights the efforts of the Ministry of Women, Family and Community Development to provide very affordable lodging for families that have to travel to these urban areas for a family member’s cancer treatments. She calls for the Malaysian government to look into providing more similar assistance and services to enable Malaysians from outside of urban areas that are traveling long distances for cancer treatments.
  • She and YB Dr Kelvin Yii agree that the government of Malaysia should prioritize the Ministry of Health in the yearly budget. Ideally, the Ministry of Health should be getting the most, if not the lion’s share of, the annual budget to allow PPP programmes to make healthcare treatments, especially for cancer, accessible to all Malaysians regardless of race, gender, and socioeconomic status.

IFPMA Launches New Video to Share How Innovative Ideas Are Changing Cancer Care for the Better

WORDS LIM TECK CHOON

#AlwaysInnovating is an initiative by the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA), which aims to share with the world the expertise, collaboration, and perseverance involved in transforming ideas and innovations into real-world medicines and vaccines.

We’re pleased to share with you the latest film and expert insight from #AlwaysInnovating, in which an animated guide called Sparky will explain how decades of dedicated cancer research and innovation have paved the way for a reimagined approach to cancer care bringing fresh hope to people with cancer as well as their carers.

HERE’S THE VIDEO

FOR MORE INFORMATION

Click here to access the IFPMA webpage to learn the sobering statistics of the cost of cancer of our lives and how, driven by this cost, the pharmaceutical industry is driving innovation across all areas of medicine to delivering new medicines to those in need. Link opens in a new tab.

Asia Pacific Women’s Cancer Coalition Releases Important Data on Women’s Cancers

WORDS LIM TECK CHOON

The Asia-Pacific Women’s Cancer Coalition recently launched a report called Impact and Opportunity: The Case for Investing in Women’s Cancers in Asia Pacific.

WHAT’S IN THE REPORT?

Published by the Economist Impact and supported by the pharmaceutical company Roche, this report presents a detailed examination of the burden of women’s cancer, specifically breast and cervical cancer, in 6 countries in the Asia Pacific region: India, Indonesia, Malaysia, the Philippines, Thailand, and Vietnam.

The report includes detailed snapshots of the breast and cervical cancer burden, incidence, and mortality in each of the 6 countries mentioned above. Readers will access the following information:

  • Current cancer care capacity status
  • Existing policies and planning
  • Prevention and screening measures
  • Diagnosis and resource capacity
  • Quality of treatment and access
  • Levels of awareness and education about breast and cervical cancer

The report furthermore identifies the gaps and opportunities for relevant stakeholders to improve the provision of assistance to women dying from these cancers every year in Asia Pacific.

THE MALAYSIAN SNAPSHOT

The full-size images may not display properly on certain desktop devices due to technical limitations.

If you experience this issue, to get the full-size image (warning: these images are huge), click on each thumbnail and then save the image or open it in a new tab.

THE REPORT IS ONLINE—READ IT HERE!
Click here for the full report at the Asia-Pacific Women’s Cancer Coalition website. The link leads to a PDF file.

Seeking the Light at the End of a Cancer Treatment Journey

WORDS LIM TECK CHOON

Khariza Abdul Khalid has a blessed life. At 47, she is the Executive Director of Gamuda Land and a mother of 3 precious children.

However, it was not always rosy for Khariza, for in 2012, the discovery of an unusual bulging on her left stomach led to a diagnosis of stage 3 non-Hodgkin’s lymphoma.

Non-Hodgkin’s lymphoma is a type of cancer that starts in the lymphatic system—a network comprising our lymphatic vessels, lymph nodes, lymphoid organs, lymphoid tissues, and lymph fluid. When one develops this cancer, their white blood cells grow in an abnormal manner, forming tumours throughout the body.
A SHOCK, THEN COMES DETERMINATION

“I was scared, worried, nervous,” recalls Khariza, “but I was informed that I would have to go through chemotherapy.”

Fortunately, her husband and parents were very supportive, acting as the rock for her to stay strong and supported throughout her cancer treatment journey.

Her parents even stepped in to care for her children during the period.

A LONG JOURNEY

“I had to go for 6 cycles of chemotherapy and a bone marrow transplant,” Khariza shares with us.

Each cycle took place in a month, and she would, depending on her health condition, have 2 weeks of rest or staying in the ward for 3 to 4 days.

During this period, she took a year leave from work.

“I’m grateful for the support from not only my family, but also my employer and colleagues,” she tells us.

Additionally, she is also grateful for the compassionate care, understanding, and support she received from the doctors, nurses, and other hospital staff during her treatment journey.


“Don’t worry too much,” Khariza advises others that are embarking on their cancer treatment journey. “It is not an easy road, but you will get through this!”


A HOPEFUL FUTURE

By the end of the 6th cycle, Khariza received the news that she had been hoping to hear: her cancer cells had been eliminated.

She would undergo immediate bone marrow transplant, to replace bone marrow damaged during chemotherapy and to regenerate her immune system.

These days, Khariza is feeling more like her old self.

“I am blessed,” she says. “I am feeling heathier and more energetic too, as I have added exercises and workouts into my daily routine.

Not taking life for granted anymore, she also devotes more time to bond with her family and friends.

A Cancer Expert Explains What You Should Know About Wilms Tumour

WORDS LIM TECK CHOON

FEATURED EXPERT
DR ENI JURAIDA ABDUL RAHMAN
Consultant Paediatrician, Paediatric Haematologist, and Paediatric Oncologist
Sunway Medical Centre

Wilms tumour is the most common type of kidney cancer affecting children, usually those that are under 5 years old,” says Dr Eni Juraida Abdul Rahman.

FACTS ABOUT WILMS TUMOUR
  • It is also called Wilms’ tumor or nephroblastoma. The name Wilms came from Max Wilms, a German surgeon that first described this cancer.
  • The tumour is the result of mutations of genetic materials in kidney cells, which typically occur after birth.
  • Usually only one kidney is affected, but in 5% to 7% of cases, it can be found in both kidneys.
WHAT CAUSES WILM TUMOUR?

Just like with most cancers, we still haven’t found the exact causes for this cancer.

However, Dr Eni Juraida points out that there are certain genetic disorders that can increase a child’s risk of developing Wilms tumour, such as:

  • Aniridia, or the abnormal development of the iris of the eye due to genetic mutation, usually along chromosome 11 that led to deleted genes and hence missing genetic information.
  • Hemihypertrophy or hemihyperplasia, a condition in which one side of the body or a part of one side of the body is larger than the other in an extent that is greater than what is considered normal.

“Patients with WAGR syndrome have a 45% to 60% chance of developing Wilms tumour,” says Dr Eni Juraida.  WAGR stands for: Wilms tumour, aniridia, genitourinary malformation, and range of developmental delays.

SYMPTOMS TO WATCH OUT FOR IN A CHILD
  • Painless swelling in the abdomen, occasionally noted by parents while bathing the child; the tumour may cause discomfort
  • Haematuria, or blood in urine
  • Hypertension or high blood pressure
  • Fever
  • Unusual loss of appetite, resulting in weight loss
  • Pain in the abdomen
  • Generally feeling unwell
  • Cough and shortness of breath
HOW IS WILMS TUMOUR TREATED?

Treatment options will depend on the stage of the tumour.

Surgery

The mainstay treatment, usually done upfront for stage I and II tumours and sometimes delayed for stage III, is a surgical procedure called nephrectomy. This surgery removes the affected kidney and hence the tumour from the child’s body.

In the rare cases when tumours are present in both kidneys, partial nephrectomy removing only the parts affected by the tumour will be performed to preserve as much of the kidneys as possible.

Chemotherapy

“Chemotherapy are medications that are given to kill cancer cells,” Dr Eni Juraida explains.

For stage I and II tumours, these medications can be given after a nephrectomy, to kill off any remaining cancer cells.

However, stage III tumours are much larger in size compared to stage I and II ones, and chemotherapy will be prescribed before a surgery to first shrink the tumour. This will allow the surgery to be carried out more safely.

Radiotherapy

This may be prescribed in some cases, usually for tumours that has spread to other organs such as the lungs or are not completely resolved via chemotherapy.

CAN WE HELP PREVENT THE DEVELOPMENT OF WILMS TUMOUR IN OUR CHILD?

“Since we don’t know the cause, it is difficult to have any preventive measure,” Dr Eni Juraida points out.

However, for children with WAGR syndrome, having them undergo a surveillance ultrasound of the abdomen on a periodic basis—such as every 6 months—can help detect Wilms tumour.

Not Sure What Immunotherapy Is? Get Your Answers From an Oncologist!

WORDS LIM TECK CHOON

FEATURED EXPERT
DR HAFIZAH ZAHARAH AHMAD
Consultant Clinical Oncologist
Sunway Medical Centre Velocity
IMMUNOTHERAPY IS A NEWER APPROACH TO TREAT CANCER, BUT WHAT EXACTLY IS IT?

According to Dr Hafizah Zaharah, immunotherapy is a pretty unique way to treat cancer, in that it uses the body’s own immune system to attack cancer cells.

“The immune system is like the police force of our bodies,” she says. “It is designed to protect the body against infections, illnesses, and diseases.”

The cells that make up our immune system. Click on the image for a larger, clearer version.

When it comes to faulty or mutated cells in our body, the immune system identifies and eliminates these cells before these cells become a significant threat to our healty.

However, the cells of our immune system may not be strong enough to kill cancer cells, according to Dr Hafizah. Sometimes, the cancer cells are able to fool our immune system by resembling normal cells or hiding themselves.

THIS IS WHERE IMMUNOTHERAPY COMES INTO THE PICTURE

“Immunotherapy can boost or change how the immune system works, so it can recognize and kill cancer cells,” explains Dr Hafizah.

For example, cancer cells originate from normal cells, so the immune system may still mistake them for normal cells.

“These cancer cells can push a ‘brake’ button on the immune cells, so the immune system would not attack them,” Dr Hafizah adds.

Now, a type of immunotherapy called checkpoint inhibitors can take the ‘brakes’ off the immune system, allowing it to now recognize and attack the cancer cells!

There are other types of immunotherapy, of course, and these treatments can be used for various cancers.

CANCERS THAT CAN RESPOND TO IMMUNOTHERAPY
  • Non-small cell lung cancer
  • Triple negative breast cancer
  • Head and neck cancer
  • Cervical cancer
  • Gastric cancer
  • Oesophageal cancer
  • Bladder cancer
  • Melanoma
  • Liver cancer
  • Renal cell carcinoma
  • Endometrial cancer
  • Colon cancer
WHAT IS IMMUNOTHERAPY LIKE?

According to Dr Hafizah, various immunotherapy agents are given as an infusion into a vein (a drip) typically once every few weeks.

These immunotherapy agents can be given to the patient all by itself, or in combination with targeted therapy or chemotherapy.

“For advanced stage cancer, immunotherapy treatment generally is given for 2 years, alongside close monitoring,” Dr Hafizah further says.

IS IT EFFECTIVE, THOUGH?

Although immunotherapy seems like the answer every person with cancer is looking for, Dr Hafizah warns that not all types of cancers will respond well to the treatment.

This is why, before embarking on immunotherapy, one will first undergo a specific biomarker test, such as the PD-L1 test, which will be carried out on a cancer specimen to ensure that the person will respond to the treatment.

ARE THERE ANY SIDE EFFECTS TO BE CONCERNED ABOUT?

“Generally, the treatment is well tolerated,” Dr Hafizah assures us.

However, just like with most types of treatments, side effects are possible. These include:

  • Feeling tired, skin rash, or muscle or joint pain
  • Rare side effects include allergic reactions such as dizziness, fast heart rate, face swelling, or breathing problems
  • Autoimmune reactions, which can lead to serious problems in the lungs, intestines, liver, hormone-making glands, kidneys, skin, etc