SINGAPORE - Singapore’s fight against cancer has received another boost, with $50 million in national grant funding awarded to two research teams aiming to better understand, diagnose and find precise treatments for two common cancers – lymphoma and colorectal cancer. 

The focus is on treating individuals with the right treatment at the right time, instead of a one-size-fits-all approach, which does not take into account variables that influence a person’s cancer development and response to treatment. 

One of the teams is studying Asian-centric lymphomas to find cost-effective and innovative treatments, while the other will develop new approaches to screen, detect and treat colorectal cancer. They will receive $25 million each. 

This was announced on May 24 at the National Cancer Centre Singapore (NCCS), which is a key player in the two five-year research programmes. 

Lymphomas are the fifth most common cancer in Singapore, with more than 5,000 new cases diagnosed between 2017 and 2021. Colorectal cancer is the most common cancer affecting both men and women, with 12,239 new cases diagnosed in that period. 

The lymphoma research, which comes under the Symphony 2.0 (Singapore Lymphoma Translational Study 2.0) research programme, is a continuation of a decade’s worth of work by the same group. 

Lymphoma develops when white blood cells, called lymphocytes, grow out of control. It is not a single disease. 

“There are more than 80 types of lymphoma, and because of this, it results in difficulties in making a diagnosis and also treatment. In addition to that... certain types of lymphomas predominate in the West while certain types of lymphomas predominate in the East,” said the lead principal investigator of Symphony 2.0, Professor Lim Soon Thye, who is also the chief executive of NCCS. 

For instance, in Asia, 15 per cent to 20 per cent of all lymphomas are classified as Natural Killer/T-cell lymphoma, or NKTCL, compared with 5 per cent to 10 per cent in Western countries. The survival rates for this aggressive lymphoma are poor as it remains less studied, is poorly understood, and has limited treatment options. 

Symphony 2.0 will build on its work “to address unmet needs in Asian-centric lymphomas and improve patient outcomes”, said the team. Its key projects include establishing a Lymphoma Atlas centralising patient data for research, and determining effective drug combinations for lymphoma patients in clinical trials using artificial intelligence (AI). 

For colorectal cancer, which kills around 80 patients a month, the research team hopes to come up with more non-invasive screening tests and find better ways of detecting and treating the cancer. 

Dr Goh Hak Su, who in 1989 established the department of colorectal surgery at the Singapore General Hospital, the first of its kind in Singapore and the region, said that cases of colorectal cancer have increased over the years, and too few people go for screening and follow through with it. 

Screening methods include a test to detect blood in the stools and colonoscopy, a procedure that uses a long, flexible tube to look inside the colon. Colonoscopy is the most effective method, as pre-cancerous polyps that are found during a screening can be removed. But the procedure has to be done under sedation, and comes with a much higher cost. 

Hence, one of the research programme’s goals is to come up with new non-invasive blood and stool tests and new AI-enabled endoscopy methods to complement current screening methods, said Associate Professor Iain Tan, a senior consultant at NCCS and the Goh Hak Su Professor in colorectal surgery. 

“Can we detect them early enough, not just with colonoscopy alone, but perhaps with stool tests and blood tests?” 

Prof Tan, who is the clinical chair and corresponding principal investigator of the Colo-Script research programme, said they chose the name because every single cancer has a beginning, and there is a script for the cancer as it begins and develops. 

“As we understand this script, we will be able to have subtype-specific research that will allow us to understand how cancers behave, how to diagnose them and how to treat them,” he said. 

Colorectal cancer is now treated largely as one disease, though there are two major subtypes. Patients with high-risk polyps are more likely to progress to advanced-stage disease, for which the cure rate is less than 10 per cent, he said. 

However, patients may be diagnosed late because they did not undergo screening, or because their type of flat polyps may have been missed during a scope. 

The two research programmes involve multiple institutions, including the Agency for Science, Technology and Research, National University Hospital, and Singapore General Hospital.