AsianScientist (Nov. 13, 2018) – By Tan Min-Han – Nothing is more precious to a cancer patient than time. As a medical oncologist and clinical geneticist, I know the importance of early cancer diagnosis. Once the cancer diagnosis is known, oncologists need to quickly make the right treatment decisions so that patients have more time for treatments to work.
To make these decisions, oncologists need to ask: What subtype of cancer are we dealing with? What are the mutations driving the malignancy? Which therapy is most likely to have the greatest impact? Oncologists depend on their medical training and experience to help. However, tools that give more clarity on these questions—within a shorter time—go a longer way towards improving patient outcomes.
I founded Lucence Diagnostics to create these tools. The word ‘lucence’ encompasses the ideals of lucidity, illumination and hope—ideals that I seek to realize for fellow oncologists and the patients we treat.
Building a blood test for cancer
The technology developed at Lucence is the first blood test that can detect and monitor cancer-causing genes and viruses for multiple cancers with one draw of blood. Our liquid biopsy test, LiquidHALLMARK™, focuses on cancers that are more common in Asia such as breast, colon and lung cancers. Cancer in Asia accounts for more than half of the global incidence of cancer.
Liquid biopsy is different from tissue biopsy—the current gold standard for diagnosing cancer—which involves an invasive process of surgically removing tumor tissue from the body. The non-invasive nature of liquid biopsy, as well as the high speed and low cost of sample analyses, allow oncologists to quickly make the right treatment decisions, and patients to start their treatments sooner.
What LiquidHALLMARK™ looks out for are fragments of DNA shed by the tumor into the blood. By piecing together these DNA fragments, we can glean important information about the tumor. My analogy for this is to imagine the tumor as a book that has been torn apart and flushed down a wash basin—we are on the other side of the pipe collecting fragments of the pages and reassembling the content of the original book.
Data in the DNA
As you can imagine, the reassembly process is impossible to perform manually. Every patient sample contains thousands of DNA fragments shed by the tumor, each of varying lengths. Some of these fragments overlap. We therefore rely on analytics and machine learning to decipher where one ‘sentence’ ends and another begins. This allows oncologists to provide timely treatment to patients by selecting the right drugs for them and sparing them the need to go through possibly futile treatments with toxic side effects.
Our use of these digital technologies extends beyond just reassembling DNA from cancer cells. We also integrate information about the patient, the stage of the disease and available treatments into our assessment. This is reminiscent of the oft-told parable of the blind men trying to identify an elephant by touch.
The elephant represents the healthcare problem we are trying to solve—cancer. Diagnostic tests, clinical examinations and treatment interventions address different parts of the problem, yet each approach by itself can mislead, just as each blind man gave an inaccurate account of the creature he was touching. It is by consolidating data from a wide variety of sources and putting them through a data analysis pipeline that we can provide oncologists with the clinical intelligence to make the best treatment decisions for their patients.
Not just any startup
Having founded a MedTech startup that combines laboratory analysis and digital analytics for cancer diagnostics, I am well aware of the high standards that the healthcare sector must conform to. This is for good reason: our patients trust us to use safe tests and to provide sound advice. It is our ethical responsibility to uphold that trust.
Robust as liquid biopsy already is, it currently complements tissue biopsy as the widely accepted benchmark for cancer management rather than replace it.
But oncologists owe it to their patients to stay informed about new technologies. This is why Lucence initiated the first national genomic tumor board in Singapore involving all the public and private sector hospitals. The board brings together oncologists, geneticists, pathologists and bioinformaticians for discussions on how we can better use genetics to improve treatment options for real cancer patients.
Another reason for the relatively slow uptake of new technologies in the medical domain is the fact that the practice of medicine is founded on a long history of common and shared experience. These traditions are something that emerging technology does not easily displace. Even now, machine learning and artificial intelligence fall short of clinical standards in many areas of healthcare. However, I am optimistic that we are making progress. The day will come when machines make judgements that are as good as physicians’. When that happens, our patients will be the biggest beneficiaries.
It takes a village
Because of the relatively long gestation periods for inventions in the MedTech industry, having a supportive ecosystem for research, development and commercialization of deep technologies is critical. I think the value of a large public sector agency with a single-minded focus on creating commercialization and industrial opportunities for healthcare innovation cannot be overstated.
Such agencies support the creation of important intellectual property, which can then be commercialized. It is important for the public and private healthcare organizations in Singapore to be aligned for the national interest. Subsequently, it is up to the private sector to deliver products and services in a scalable way to the region and to the rest of the world.
This is what we are striving to achieve at Lucence—we want to deliver the technology we have developed to the world, for the benefit of patients and physicians. As we continue to develop and validate our technology, we envision a future with fewer preventable deaths, fewer futile treatments and better patient outcomes.
Medical Technology is one of SGInnovate’s three focus areas in its Deep Tech Nexus strategy. SGInnovate has invested in numerous MedTech startups as it believes Singapore has the resources and capabilities to solve problems that will impact the world.
Asian Scientist Magazine is a content partner of SGInnovate.