Speech by A/Prof Benjamin Ong, Director of Medical Services, Ministry of Health, at the 8th Asia-Pacific Primary Liver Cancer Expert (APPLE) Meeting, 14 July 2017

Professor Pierce Chow, Hosting Chairman for the 8^th Asia-Pacific Primary Liver Cancer Expert Meeting,

Distinguished guests,

Ladies and gentlemen,

Good afternoon. 

Introduction

1    It is my pleasure to join you today for the 8^th Asia-Pacific Primary Liver Cancer Expert (APPLE) Meeting. This is the first time the event is hosted in Singapore. To our guests from overseas, a warm welcome to Singapore.

2    The first APPLE meeting was held in 2010 as a consortium of three countries - South Korea, Japan and China. The objective was to create a platform for expert discussions on liver cancer treatment and therapy.  At the 4^th APPLE meeting in 2013, the APPLE Association was established with more countries to promote the scientific advancement and education of liver cancer management in the Asia-Pacific region. It aimed to lay the foundation for the region to overcome the knowledge differences In managing this condition.

3    As doctors practising in Asia, it is imperative that we develop an in-depth understanding of diseases in Asia Liver cancer is a prime example, and is a very important Asian-centric cancer. I am glad to see concerted collaborative efforts by Asian doctors in this direction. 

Liver Cancer Globally and Locally

4    Liver cancer is the second leading cause of deaths from cancer globally, with an estimated number of 788,000 deaths in 2015^[1].

5    In Singapore, liver cancer is the fourth most common cancer in males and the third leading cause of cancer deaths in the period from 2011 to 2015. In female Singapore residents, while liver cancer was not amongst the 10 most common cancers during the same period, it was the fourth leading cause of cancer deaths. Between 2011 and 2015, liver cancer accounted for 12.6% and 6.4% of all cancer deaths in males and females, respectively^[2]. 

Efforts to Prevent Liver Cancer

6    There are known preventable risk factors for liver cancer which include hepatitis B infection, heavy alcohol use, diabetes and obesity.

7    Hepatitis B vaccination was included in the National Childhood Immunisation Programme in 1987, and since 2005, at least 95% of our children complete the full course of hepatitis B vaccination by 2 years of age^[3].

8    To further reduce the risk of liver cancer in the population, it is important to educate and encourage the public to lead a healthy lifestyle such as eating healthily, exercising regularly, and moderating alcohol consumption.

Translational and clinical research in liver cancer

9    Since 2001, Singapore has been investing in research and in research infrastructure. Under the Singapore Research, Innovation, and Enterprise (RIE) 2020 plan, cancer is one of the five therapeutic areas identified as national priorities, and liver cancer is one of the cancer types that the cancer research community has recognised as a key focus area for Singapore.

10    The Ministry of Health (MOH), through the National Medical Research Council, has provided significant funding to support both basic as well as clinical research in liver cancer research over the years.

11    Last year, Professor Pierce Chow from the National Cancer Centre Singapore (NCCS) received a grant of $7.5mil for a Translational and Clinical Research (TCR) Flagship Programme in Precision Medicine in Liver Cancer across an Asia-Pacific Network.

12    In 2015, Professor Lim Seng Gee from the National University Health System was awarded $25mil for his TCR Flagship Programme on eradicating chronic Hepatitis B^[4]. Patients with chronic Hepatitis B infection are at higher risk of developing liver cancer, hence this is an important risk factor to address. 

Outcomes of liver cancer research done locally

13    I am happy to share with you today some outcomes from local research efforts in liver cancer.

14    Through the NMRC Bedside and Bench Grant hosted at NCCS, Professors London Lucien Ooi and Hui Kam Man^[5]identified a three-gene signature that can potentially be used in clinical settings for the surveillance of liver cancer in high risk individuals to identify patients at an early stage of the disease.

15    Through the NMRC Clinician Scientist – Senior Investigator Award hosted at NCCS, Professor Pierce Chow embarked on the SIRveNIB Phase III study. This study that compared the efficacy of selective internal radiation therapy (SIRT) versus Sorafenib (a standard drug used to treat advanced liver cancer^[6]) was completed and the results were recently presented at the American Society of Clinical Oncology Annual meeting in June 2017. This investigator initiated trial involved 27 centres in 11 countries of the Asia-Pacific Hepatocellular Carcinoma Trials (AHCC) Group, Singapore Clinical Research Institute and Sirtex Medical Ltd. The results showed that selective internal radiation was not superior to Sorafenib with respect to overall survival, but patients treated with it had a significantly better tumour response rate, fewer total number of adverse events and severe adverse events. This provided robust Phase III data that an alternative therapy with much fewer adverse effects is available for patients with locally advanced liver cancer 

The future of liver cancer research- funding and research translation

16    MOH and other national funding agencies such as the National Research Foundation and the Agency for Science, Technology and Research will continue to support worthy projects in the area of liver cancer through various grant programmes that fund basic science and translational and clinical research.

17    Besides funding research, MOH will also be working closely with the National Health Innovation Centre to look into research in the healthcare clusters that have good health impact. Work is still in progress, but we hope to better support researchers and clinician-scientists to translate their research findings into innovations that can be taken up in the healthcare system, and benefit Singaporeans. 

Conclusion

18    Over the next three days, we will hear from delegates from the Asia-Pacific on topics ranging from prevention to treatment methods for liver cancer.

19    I would like to thank the organisers for the opportunity to grace this important event that sets out to improve liver cancer treatment, which will benefit patients regionally and internationally. I wish you all a fruitful time ahead and a successful conference.

^[1]Source: WHO’s World Cancer Factsheet 2017 

^[2] Source: NDRO’s Singapore Cancer Registry Annual Registry Report 2015 

^[3] Ministry of Health. Communicable Diseases Surveillance in Singapore 2015 Annual Report 

^[4] NMRC/CIRG/1346/2012- Targeting autophagy for cancer prevention and cancer therapy using an oncogene-driven hepatocellular carcinoma model in zebrafish 

^[5] NMRC/BnB/0009/2013- Validation of a novel blood-borne molecular signature (TNFAIP3, AREG and GIMAP5) for the identification of early human hepatocellular carcinoma in patients with chronic hepatitis B and at high-risk of developing HCC. 

^[6] NMRC/CSA/020/2010- Phase III Multi-Centre Open-Label Randomized Controlled Trial of Selective Internal Radiation Therapy versus Sorafenib in Locally Advanced Hepatocellular Carcinoma. AHCC protocol 06.