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The state of cancer research in Asia
Prof David Virshup shares in this interview, the state of cancer research across the globe, and the latest developments in this space in Singapore and Asia.

Professor David Virshup is director of the programme in cancer and stem cell biology at the Duke-NUS Medical School in Singapore. His laboratory studies Wnt signaling and circadian rhythms. In 1981, he received his medical degree from Johns Hopkins University School of Medicine (JHUSOM). We spoke to Virshup, to understand his motivation behind doing research and the state of cancer research in Asia.

Virshup always knew he wanted to be a doctor growing up. His father was a doctor, and he knew he was going to follow his father’s footsteps. But, he did not fathom a career in science until he attended Beloit college, enrolling in Chemistry. It was there that he began his laboratory research journey as a chemistry undergraduate. With the research experience he had, he went on to enrol in JHUSOM, where he could combine both passion for medicine and research.

At JHUSOM, as part of the requirements for medical students, Virshup was looking for laboratories to conduct research. He shared that he was not drawn to any specific field of research at that time. Dr William Zinkham, a pediatric haematologist, had an interesting project that happened to attract him and he chose to be mentored under Dr Zinkham. This started his clinical journey and specialisation in pediatric oncology. He completed his clinical training in pediatrics and pediatric hematology/oncology at Johns Hopkins. His research training was in the departments of pediatrics, cell biology and anatomy, and molecular biology and genetics at Johns Hopkins.

After JHUSOM, Virshup’s research and discovery took him to different places. He was professor of paediatrics and oncological sciences and also the first Willard Snow Hansen presidential professor of cancer research at the University of Utah. He was also an investigator at the Huntsman Cancer Institute, prior to his joint appointment at Duke-NUS Medical School and Duke University.

Cancer research

While spending the majority of his time on laboratory-based research, he is also a practicing pediatric oncologist. On his views on the state of cancer research in Asia now, Virshup says that there is more interest in this field as the population ages and people are becoming wealthier. He shares that, “Cancer is primarily a disease of aging. If the average life expectancy of your population is 70, cancer is a huge problem. If the average life expectancy of your population is 50, cancer becomes a smaller problem. Cancer is increasingly common in Asia as a sign of success because it means we are not dying of other diseases like infectious diseases and heart diseases, which can be cured and prevented”.

Because Asia is becoming more affluent, he believes it has the resources to start doing more research in cancer. Currently, Asia accounts for about 60 per cent of the global population, contributing 44 per cent of all cancer cases, and 51 per cent of global cancer mortality. Global cancer burden is projected to increase dramatically in Asia. There is thus an urgent need to focus on developing improved treatment for cancer patients, particularly for patients in Asia. Virshup empathises, “Research is necessary and of utmost importance because cancer is a disease that is important for those who live in Singapore, Asia, and other parts of the world”.

Clinical trials

Virshup shares that there are many challenges faced in conducting clinical trials in Asia. Costs of conducting clinical trials are expensive, and is a big problem in Singapore. “The cost of taking care of a patient has always been the same, but it’s how we allocate the cost, that makes it expensive for the patient”.

Virshup says researchers have the responsibility to put more patients on clinical trials. He wishes that more clinical trials will be funded in Singapore but to do that, we need to figure out a way of getting the costs down. “If the government can mandate a particular cost structure for research clinical trials, they could potentially facilitate bringing the costs in line”.

Collaborating with the best

Virshup says apart from funding, it is important to collaborate with the best people. People who are doing great science, naturally seek out the best collaborators, and the best collaborations happen around the world.

He cited an example where a team of cancer researchers from Asia won the prestigious American Association for Cancer Research (AACR) Team Science Award in March 2018, an award that honours researchers for their global impact on cancer research. The winning team was an international collaboration led by a Singapore team from Duke-NUS Medical School, National Cancer Centre Singapore, Genome Institute of Singapore, with collaborators from Japan, Taiwan and Thailand. This was the first time an Asian team has won the AACR Team Science Award.

The team's research focused on cancers that are prominent in Asia but less studied in the West, including gastric cancer, Asian-prevalent lymphomas such as natural killer T-cell lymphomas, bile-duct cancers, and cancers associated with exposure to aristolochic acids (AA). Their research was timely and pertinent because these cancers represent a huge number of cancers in Asia and there is a high unmet need for improved treatments for patients.

Prior to their work, little was known about these cancers. Their work helped to identify new genes and pathways, which if disrupted may represent new avenues for further therapies. For example, the team identified major genetic abnormalities in stomach cancers, a leading cause of global cancer death, and were able to translate these findings into clinical trials targeting these abnormalities. They also showed how parts of DNA affected by carcinogens can be used as screening tools to identify previously undetected carcinogen exposures.

Their research has also informed government policies. For instance, the research on AA, a compound found in certain traditional herbal medicines, revealed a potential role for AA exposure in the development of liver cancer. This finding increased public awareness of the risks of AA exposure and led regulatory agencies to announce stricter policies on the use of AA-containing plants.

The collaboration has led to discoveries and contributed to the knowledge and understanding of Asian cancers. Working as a team, there will be more meaningful and impactful progress compared to working individually.

Lab work

In Singapore, Virshup's lab at the Duke-NUS Medical School is studying the Wnt signalling pathways which are highly conserved pathways important in stem cell maintenance, cell proliferation, cancer and development. Focusing on Wnt biogenesis and understanding the pathways in normal and disease states, can help find a way to therapeutically target all Wnts by drugging a key step in early Wnt biogenesis. This has led to Virshup’s lab developing a targeted therapy cancer drug, ETC159, a porcupine inhibitor, which is now in phase 1 of clinical trials, in Singapore and the US.

Virshup says he is extremely excited to be part of the drug development process and grateful to have the opportunity to work with the experimental therapeutic centre of A*STAR on this project.

Lab = soccer

If he could akin his lab, its work and the members, Virshup described his lab as soccer team. “We have many people playing different roles. The important thing is to pass things back and forth and try as many shots on goal as you can. As soon as you make a goal, you start all over again”.

Right now, only 1 in 10 grants are being funded by the government. There are many challenges to face in cancer research but Virshup’s advice to aspiring researchers in Asia is, “If you love it and you're good at it, you may be that 1 in 10. Science is a career that is fun when it works, and depressing when nothing works. But the highs are higher than anything else I know”.

This interview was conducted by Lim Guan Yu.

Click here for the complete issue.

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EDITORS' CHOICE  
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APBN Editorial Calendar 2018
January:
Obesity / Outlook for 2018
February:
Searching for the fountain of youth
March:
Women in Science - Making a difference
April:
Digestive health in the 21st century - Trust your guts
May:
Dental health - The root to good health
June:
Cancer - Therapies and strategies for better patient outcomes
July:
Water management / Vaccination
August:
Regenerative medicine / Biotech start ups
September:
Digital healthcare / 3D printing
October:
Bones / Breast cancer
November:
Liver health / Top science research nations & institutions
December:
AIDS / Breakthrough of the year/Emerging trends
Editorial calendar is subjected to changes.
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