CANCER Research Malaysia and the Clinical Investigation Centre (CIC) of University Malaya Medical Centre (UMMC) have launched a clinical trial called AUROR , in a study with the National University Hospital Singapore, to test if checkpoint immunotherapy is effective in treating breast cancer in Asian patients.
Cancer cells produce invisibility cloaks to hide from our immune system's "checkpoints", allowing them to grow and spread.
Checkpoint immunotherapy activates the immune system to recognise cancer cells as cells that should be killed, and this approach has already resulted in long-term remission for melanoma, lung, and other cancers, but its effect on breast cancer is still understudied.
"Checkpoint immunotherapy has so far shown to be promising in treating an aggressive form of breast cancer, called triple negative breast cancer, but it is clear that not all patients benefit from this type of treatment. Through research at Cancer Research Malaysia, we now know that more than half of Asian women inherit a genetic variant (called APOBEC3B), and in these women, breast cancers tend to have a lot of damaged DNA, which suggests that their tumours are more likely to respond to checkpoint immunotherapy explains Cancer Research Malaysia chief scientific officer, Professor Datin Paduka Dr Teo Soo Hwang who led the genomics study.
This genetic variant she adds is four times more common in Asians compared to Caucasians and this unique clinical trial is being launched to test whether checkpoint immunotherapy can indeed improve the treatment response for breast cancer patients with this genetic variant, and this could lead to a new treatment regimen for Asian breast cancer patients.
The success of this clinical trial could result in a better standard of care for Asian breast cancer patients and bring us a step closer to personalised medicine.
"In this era of precision medicine, we now know that understanding which patients respond to which treatments is critical in our effort to save lives," says consultant oncologist and principal investigator of the AUROR Trial at UMMC, Associate Professor Dr Ho Gwo Fuang.
Previously, much of the knowledge about precision medicine was built based on research on Caucasian patients, and it is a milestone for Malaysia to be launching this first clinical trial that is based on genetic markers which are common in Asian women, made possible by research conducted here.
THE LACK OF ASIAN REPRESENTATION
Asians are seldom represented in cancer research. Take breast cancer for example – doctors are now able to determine the type of cancer a patient has and what treatment might work for her.
This was made possible with the mapping of the human genome done with the analysis of thousands of breast cancer samples from countries such as the US, UK and Canada.
Unfortunately, of the thousands of cancer cell samples analysed, less than 5 per cent were from women of Asian descent.
This means that there are still gaps in our understanding of cancers affecting Asians; in knowing how Asian genes affect our risk to disease as well as our response to treatments.
Put simply, we test treatments based mainly on Caucasian profiles, and hope they will work equally well on Asians.
While this works in most cases, Cancer Research Malaysia believes we can do better. This means ensuring Asians are included in the global fight against cancer by conducting research on niche cancers often found in the Asian population.
"This is the first clinical trial launched in Asia to test a feature of breast cancer using a genetic marker that is more common in Asians. We are working on more such clinical trials and hope that more Malaysians will support the work we do," says co-lead of the genomics programme at Cancer Research Malaysia, Dr Pan Jia Wern.