Mr Ng Chao Mo underwent surgery after being diagnosed with liver cancer in 2005. More than a year later, he found that the cancer had returned and there were two tumours in his right lung. He then took part in a clinical trial and has remained well for the last two years.

Efforts to draw drug companies here to conduct trials for new medicines are paying off, with a record 286 trials started last year.

By Salma Khalik

Since 2004, the Health Sciences Authority (HSA) has approved 200 or more new trials every year, involving 2,000 to 3,000 people altogether.

One in three of last year’s record haul of trials was for cancer treatment, reflecting the focus of big pharmaceutical research in recent years. Others included drugs for heart, eye, gut and brain problems.

Doctors initiate just a quarter of trials here, with drug companies behind the rest.

The companies need the findings of the trials to be accepted by health authorities in the United States and in Europe, where patients’ buying power makes the US$1 billion (S$1.4 billion) spent in developing a new drug worthwhile.

Professor Soo Khee Chee, head of the National Cancer Centre (NCC), says that drug companies are increasingly drawn to Singapore because of the high standards of medical practice, technological expertise, and government support, which mean that trials can be conducted with speed and efficiency.

Quoting an industry axiom, Prof Soo says that it costs a drug company US$1 million for each day’s delay in reporting results and receiving approval from the regulators.

Singapore’s growing reputation in the field helped convince Quintiles, a company dedicated to conducting clinical trials, with 23,000 employees around the world, to open its new regional headquarters at the Science Park last month. It is double the size of its previous facility.

Dr Anand Tharmaratnam who heads clinical development for Quintiles in the Asia-Pacific region, expects the company to double the 250 employees it has here within the next five to 10 years, to meet the growing demand for its services.

Dr Jerry Chng, Bayer Schering Pharma’s medical director here, said the number of clinical trials his company does here has roughly doubled each year, from just two in 2006 to 14 this year. It has already seven lined up for next year.

The reason, he said, is that “Singapore offers excellent possibilities”. GlaxoSmithKline, which has been conducting trials here for more than a decade, has committed to about $2 million worth of on-going trials here, primarily in vaccines and cancer.

New hope for patients

Every year, thousands of patients take part in trials because it gives them new hope when all other options have failed, say doctors participating in such trials – which most public hospitals do.

One such patient who signed up is a middle-aged man suffering from a form of blood cancer. He could not tolerate Glivec, the primary drug for such illness, and reacted badly to the second-line drug as well, which he took for nine months.

But a new leukaemia drug was being tested and his doctor got him into the trial. “He is now responding well to the new drug and feeling much more upbeat”, said a cancer centre spokesman.

This same trial might also have saved the life of a trainee doctor from India. Suffering from a form of leukaemia, in 2005 he was given less than two years to live. His doctor contacted Singapore General Hospital, where the trial was being conducted, to ask if the patient could be included.

Today, the 29-year-old is living a normal life, and preparing for his final medical exams.

Professor Soo said people who take part in trials almost always do better than those who do not participate.

There could be many reasons for this, including their psychological make-up, he said, since people willing to be part of a trial tend to be more “gung-ho”, with more fighting spirit.

The better outcome could also be because they are more closely monitored, which is a requirement of trials. Finally, the new treatment or drug could directly contribute to their survival.

Aside from giving them access to experimental drugs, taking part in trials gives patients treatment options they might not otherwise be able to afford, as they do not need to pay for their medication.

Dr Toh Han Chong, head of medical oncology at NCC, said all liver cancer patients in trials are given a new drug called sorafenib – which is expensive and only marginally beneficial for most. At $5,000 a month, it gives most patients two to three months longer to live.

But it is able to shrink the cancer tumour in a lucky 3 per cent of patients.

While the treatment’s cost is seen as far outweighing its benefits, it is nevertheless the only new liver cancer drug that has been produced in the past three decades, said Dr Toh. “So we do a lot of trials with sorafenib,” he said.

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Trial saved his life, cancer now stable

If not for a clinical trial, Mr Ng Chao Mo, 68, might not have survived his liver cancer, which had also spread to his lungs.

Given just months to live, he had little hesitation when his oncologist offered him the chance to take part in a trial for a drug to treat his cancer. The six-month treatment would have cost $30,000, far beyond the means of the retired lorry driver.
 
Taking part in a clinical trial meant he would get it free. Since he was given the drug Avastin plus rapamycin* in the trial at the National Cancer Centre, his cancer has stopped growing and he has remained well for the past two years.

After Mr Ng was diagnosed with liver cancer in 2005, he underwent surgery, followed by radiotherapy and chemotherapy to kill the remaining malignant cells.

More than a year later, during a regular screening, he found that the cancer had returned. This time, there were two tumours in his right lung.

His oncologist, Dr Toh Han Chong, told him it was caused by his liver cancer spreading.

Because of the location of the tumours, they could not be operated on. His best option was a new drug that has proven extremely good for only about 3 per cent to 4 per cent of patients.

But at $5,000 a month, it was beyond him, and his Medisave account was already depleted.

“I don’t have the money. I’m a pauper,” he said in Mandarin.

So when Dr Toh asked if he was willing to take part in a clinical trial, he grabbed the chance.

Throughout the treatment, he suffered few side effects, apart from a bit of gum pain and constipation.

Now, life goes on as normal. He has lived alone, since his divorce three years ago. His son lives with his former wife, and his two daughters are married.

He moved into a studio apartment for the elderly in Tampines a year ago. He shops at the nearby supermarket, cooks his own meals, and spends his time reading, or doing calligraphy and Chinese painting – a hobby he picked up 11 years ago. The results of his efforts adorn his neat sixth-floor unit. Mr Ng is fatalistic about life.

“I’m very happy the cancer is stable,” he said. “If it does come back, then it can’t be helped.”  

*Note: The original article, published on 25 Dec 2009, stated that Mr Ng was on an Avastin trial. A file correction was requested.