Singapore scientists have proposed an alternative approach to the ‘one size fits all strategy’ and moved an important step closer to personalizing the treatment of stomach cancer.

A collaborative research team, led by Duke-NUS, has shown that a new, individualized approach to classifying tumors improves the prediction of how long patients will survive.

  Rather than focus on structural differences, the researchers subdivided tumors by their activation of oncogenic signaling pathways – a method which opens new avenues for tailoring treatments.

Associate Professor Patrick Tan, who spearheaded the research, said that a clinical trial could be underway as early as next year to test whether the theory translates into practice. Patients could be stratified by tumor type and treated with the appropriate “cocktail of different pathway inhibitors”, he said.

“The challenge in treating patients with cancer, particularly the big ones like lung, colorectal and stomach cancer, has been that historically we have tried to adopt a one size fits all approach. But as we begin to know more about the molecular makeup of these cancers, we realize that there is a tremendous amount of individuality,” he said.

“This paper is a first step in approaching this problem and proposing a molecular taxonomy of how we could go about looking at it. Now we can try to tackle what makes one group different from another group, and establish whether these differences suggest ways that we can treat and manage them differently,” he said.

The researchers used genetic profiling techniques to characterize tumors from 301 stomach cancer patients in Singapore, Australia and the UK. They identified three different oncogenic pathways which, according to Associate Professor Tan, are switched off in 70% to 80% percent of gastric tumors. Future studies could identify other subgroups to create a comprehensive classification system, he said.
Associate Professor Patrick Tan examining results from a recent genomic experiment.
Stomach cancer is the second leading cause of cancer death worldwide and is particularly common in Asia. The world’s highest rates of stomach cancer are seen in Japan and China, while in Singapore it is the fourth leading cause of cancer death.

Progress in personalized treatments for stomach cancer has been slower than for lung and breast cancer, said Associate Professor Tan, noting that much of the pioneering work was done in the US and Europe where stomach cancer is less common.

“The fact that it is still early days for research into this disease represents a huge opportunity for us at Duke-NUS to use these concepts and apply them to stomach cancer. Anything we can do to impact this disease will hopefully make some contribution on a global scale,” he said.

The research, published in the October edition of the Public Library of Science Genetics, was funded by the National Medical Research Council as part of its Translational and Clinical Research program. The 5-year project brings together researchers from institutions across Singapore to look at all aspects of gastric cancer.