• First-ever validated prognostic tool can identify nose cancer relapse patients who are likely to be cured by a repeat course of radiotherapy.
  • Prognostic tool is presently used in routine clinical practice. 
  • Research team is considering clinical trials to develop more effective treatments for patients in high-risk subgroups. 
Singapore, 11th April 2018

Scientists from the National Cancer Centre Singapore (NCCS) and Sun Yat-Sen University Cancer Center (SYSUCC) have developed a first-ever validated clinical tool that helps clinicians identify nose cancer (NPC) relapse patients who are resistant to a repeat course of radiotherapy (RT). This will be a first prognostic tool that allows for personalising treatment in this high-risk subgroup of patients with aggressive NPC, and is currently available for clinical use globally. 

The study was published in the Journal of Clinical Oncology. The prognostic web-based tool was co-developed with radiation oncology software provider, MedLever, and is presently being applied in routine clinical practice. It was named PRANCIS, which stands for Predicting Radioresistant Nasopharyngeal Carcinoma Survival. http://PRANCIS.medlever.com.

NPC, also known as nasopharynx cancer, is the 7th most frequent cancer in males in Singapore  and is commonest among Chinese. RT is the primary treatment for NPC. Following RT, 10-20% will unfortunately recur again in the nasopharynx. For the majority of these patients, the only chance for “cure” is a repeat course of RT, which is effective in about half of the re-treated cases. Among the non-survivors, half of these patients succumb due to severe radiation toxicities. There is therefore a critical need to optimise the process of patient selection to repeat RT. 

Led by Co-investigators, Dr Melvin Chua Lee Kiang, a consultant radiation oncologist at NCCS, and Professor Han Fei a radiation oncologist at SYSUCC, the two teams worked in close collaboration to develop PRANCIS to identify a favourable subgroup of patients who will benefit from repeat RT, while highlighting an adverse subgroup of patients who are at risk of repeat RT-induced morbidity and mortality. 

By entering a simple form comprising of five parameters relating to age, response to previous RT, and disease extent, PRANCIS is able to predict the probability of survival and treatment-related mortality of the patient following re-RT with 70% accuracy. This allows clinicians to classify patients into low-risk or high-risk, and therefore provide better treatment recommendations for these patients.  

Using PRANCIS, Dr Chua identified that his patient, 54 years old Mr Ong Seng Aik, falls in the borderline-to-high-risk subgroup, which means he only has a 20-50% chance of success if he were to undergo a repeat course of RT. This prognostic tool allowed Dr Chua to conduct a thorough discussion on the pros and cons of a repeat course of RT with Mr Ong using real-life data of previous patients who were treated at NCCS. Mr Ong feels that he is now able to make a better decision on the type of treatment he chooses to go for. 

This study involved the largest reported cohort of 558 locally recurrent NPC cases to date, who were recruited from NCCS and SYSUCC. To ensure the robustness of the tool such that it is applicable in the clinic, the team first built a model that was predictive of outcomes in a group of patients from SYSUCC, and subsequently showed comparable levels of predictive power in two other clinically heterogeneous cohorts from NCCS and SYSUCC using the exact same index. The fact that PRANCIS independently validated in multiple cohorts from different institutions supports its clinically utility. 

“While it is compelling that radiotherapy represents the only chance of cure for these patients, not everyone benefits from this approach. Our model thus represents the first validated approach to ‘precisely’ select suitable patients who will likely be cured with repeat RT,” explained Dr Chua, who is also an Instructor (Research Track) with the Oncology ACP, Duke-NUS through the NMRC Transition Award. 

“However, alternative treatments such as proton beam therapy or systemic chemotherapy or immunotherapy clinical trials could be recommended to patients in the high-risk subgroup. Novel clinical trials are certainly needed in this space. For these patients, we ought to consider more targeted forms of RT such as proton beam therapy or novel trials to combine immunotherapy and perhaps a lower dose of radiotherapy. These approaches may help reduce toxicities in our patients, and avoid excessive risks of death,” said Dr Chua.

“In addition to allowing clinicians to identify high-risk patients for alternative treatments, our prognostic model can also be used as a patient stratification or selection tool in future clinical trials for patients with locally recurrent NPC,” said Dr Tan Sze Huey, a co-investigator of the study and principal biostatistician at NCCS.

"Treatment for recurrent NPC is one of the more challenging scenarios in our daily practice. Our model allows the oncologists to make more informed decision and provide individualised care for our patients," said Dr Li You Quan, a co-investigator of the study and associate consultant radiation oncologist at NCCS.

This study was conducted with the support of the National Medical Research Council Singapore (NMRC) Transition Award, which funded Dr Melvin Chua as a Clinician-Scientist. 

About National Cancer Centre Singapore
National Cancer Centre Singapore (NCCS) provides a holistic and multi-disciplinary approach to cancer treatment and patient care. We treat almost 70 per cent of the public sector oncology cases, and they are benefiting from the sub-specialisation of our clinical oncologists.  NCCS is also accredited by the US-based Joint Commission International for its quality patient care and safety. To deliver among the best in cancer treatment and care, our clinicians work closely with our scientists who conduct robust cutting-edge clinical and translational research programmes which are internationally recognised.  NCCS will also launch its Proton Beam Therapy programme at its new centre. NCCS strives to be a global leading cancer centre, and shares its expertise and knowledge by offering training to local and overseas medical professionals. http://www.nccs.com.sg

About MedLever, Inc.
MedLever radiation oncology applications simplify workflow, enhance patient engagement, and promote clinical excellence. The MedLever Platform was built to collect and organise high-quality clinical data. The MedLever Platform and its applications are used in radiation oncology departments and clinics in the US and Asia. MedLever applications allow for seamless data flow, efficient data capture, and advanced decision support. For more information, visit www.medlever.com or email info@medlever.com. MedLever apps run equally well on both mobile devices and desktops. MedLever is based in Silicon Valley with offices in Singapore.

For media queries and clarifications, please contact:

Ms Rachel Tan
Manager, Corporate Communications
Office: 6236 9535
Email: rachel.tan.c.h@nccs.com.sg

Ms Gillian Tan
Senior Executive, Corporate Communications
Office: 6236 9529
Email: gillian.tan@nccs.com.sg