Aim for personalised treatment of cancer

AFTER reading the article on treating cancer with tumour profiling, “Choosing the right drug” (The Star, Dec 23, 2018), I felt compelled to share my own experience in beating cancer. It’s a terrible disease and I hope my letter will inspire cancer patients to keep their hopes up. Treatments for cancer have significantly advanced over the years but sadly, some current care options are still failing too many patients.

In 2011, I went for a gastroenteritis test, which surprisingly revealed that my Prostate-Specific Antigen (PSA) level was high. After further tests and a biopsy, it was confirmed that I had prostate cancer.

For anyone who has looked after a cancer patient or is a patient himself, the news would have hit him like a tonne of bricks. It was no different for me. Shock, disbelief, desperation and hopelessness – not necessarily in that order – hit me and I was in a constant roller coaster of emotions in the early days following my diagnosis.

Most general physicians look at themselves as caregivers but never as a patient. As a doctor, the table had turned on me and accepting my cancer diagnosis was difficult at first. I was now the patient and speaking to an oncologist about available treatments and my treatment course.

With the support of my family and friends, I was able to slowly accept my situation and move towards the trajectory to treat the cancer effectively. I went to Singapore to meet a urologist and we decided to proceed with robotic surgery. I was travelling back and forth to Singapore for treatment and it was both exhausting and expensive.

As it started to take a toll on me, I went to Penang to take hormonal therapy where the goal was to reduce male hormone levels in my body or to stop these hormones from affecting the prostate cancer cells. Years passed and things were progressing as well as could be expected.

Then one day in 2016, I couldn’t breathe easily and felt that something was terribly wrong. True enough, the chest X-ray and thoracentesis scan revealed that I had developed lung cancer. It was devastating news to my family and me.

I then deliberated with my oncologist on further treatment options to treat the lung cancer. In many tumour lineages like the one I had, the accepted gold standard of treatment is chemotherapy where the intent is to cure, control or ease the symptoms suffered by cancer patients (palliation) with systemic, cytotoxic therapies after having surgery.

Unfortunately for me, chemotherapy rendered some unfortunate side effects which took a great toll on my health. I felt like I was close to the end of my life. I suffered nausea and vomiting, fatigue and headaches for more than a week but eventually recovered.

It became evident as well that in treating cancer, there is no such thing as a “one-size-fits all” approach.

In 2018, following further research and discussions with my oncologist, we decided on a new approach to treat my cancer after some lines of therapy, which also entailed tumour profiling.

Being a relatively new approach that many cancer patients may not have heard of, tumour profiling is a form of testing that classifies a tumour based on its genetic make-up to help diagnose and treat the disease with precision medicine.

Tumour profiling can help identify treatments that offer the highest chances of success for individual patients at a specific stage of their cancer.

For this purpose, a tissue sample of my cancer was sent to the United States for testing. State-of-the-art and high-quality tumour profiling tests examine the DNA, RNA and proteins of cancer cells, looking for mutational alterations. The results can support the physician in finding the best treatment strategy for individual patients.

Two weeks after sending the tissue sample, my report arrived, giving my oncologist meaningful insights into the tumour biology of my cancer and helped him to recommend a personalised treatment for me.

It was very timely as my cancer had taken a turn for the worse and progressed. This time, I had good luck as the targeted medicine which was chosen due to the findings of the test worked for me. Within a short period of time, I could feel the improvement myself. I felt hopeful once again and was optimistic of battling my cancer and beating it once and for all!

When diagnosed with cancer, I hope more patients, together with their oncologists, would have the chance to explore new approaches to treatment.

Understanding the specific and complex tumour biology, personal experience and a trusted relationship between the doctor and the patient are critical success factors to enhance cancer care.

Cancer treatment needs a comprehensive approach to battle the disease and improve outcomes for patients. Tumour profiling can potentially help, as it gives oncologists predictive, prognostic and therapeutic information on a person’s diagnosis to significantly treat for better outcomes.

As with all things new, treatment can be quite expensive, but I was fortunate to be able to finance my own treatments.

As a patient and general physician, I also hope institutions like insurance companies will include comprehensive diagnosis platforms like broad tumour profiling in their coverage to enable cancer patients to access personalised, precise and targeted treatments, immune therapies and clinical trials.

As a medical practitioner

and now a cancer patient, I

believe that with the ever evolving medical technology and science, it’s our responsibility to guide patients with reliable, up-to-date and

correct information about opportunities and limitations so that they and their loved ones may take informed decisions for their

diseases.

DR T

Former general physician

Taiping