SINGAPORE – Researchers here have received a $25 million grant to work on tackling lung cancer in Asian patients across all stages – from risk prediction and early detection of those who are at risk, to personalised treatments of patients at more advanced stages of the illness.

They want to gain a deeper understanding of why the disease – the deadliest cancer globally and one that kills three people each day in Singapore – behaves differently in Asian patients.

Unlike in Western countries, where lung cancer is mainly linked to smoking, nearly half of Singapore’s lung cancer patients have never smoked. Many have non-small cell lung cancer, a type of the cancer that is often driven by mutations in a gene known as the EGFR.

While the advent of targeted therapies in the past two decades has improved survival rates, most patients develop drug resistance within nine to 15 months, causing relapses. Even early-stage patients face relapse risks after surgery.

The question is why.

The $25 million grant comes from the Ministry of Health’s National Medical Research Council.

It will fund a project called Clarion, which stands for Conquering Lung Cancer across All Stages with Research and Innovation. Clarion will build on more than a decade of research undertaken by a multidisciplinary team led by the National Cancer Centre Singapore (NCCS). The team also includes researchers from A*Star and the National University Cancer Institute, Singapore.

At a media briefing at NCCS on July 15, Professor Daniel Tan, a senior consultant in NCCS’ Division of Medical Oncology, said lung cancer is a major challenge because some 60 per cent of cases are picked up in the late stages of the disease.

To date, it is not yet clear which group of people is at a higher risk of developing lung cancer, apart from those with a family history of the cancer. Studies elsewhere have shown that pollution can be one of the non-smoking-related triggers of lung cancer, Prof Tan said.

The researchers want to find out who is at risk of the cancer in order to identify the right groups for screening, as well as find out which groups will progress to having a more severe form of the disease, and which ones will not, said Associate Professor Tam Wai Leong, deputy executive director of the A*Star Genome Institute of Singapore.

Around two years ago, the national lung cancer research group launched Solstice, Singapore’s first local lung cancer screening study to screen family members of lung cancer patients using low-dose computed tomography scans.

The new grant will enable the group to expand this study.

A screening study done in Taiwan found that about 2 per cent of 12,000 non-smokers who were screened had lung cancer. The study’s findings suggested that a family history of lung cancer among first-degree relatives significantly increases the risk of lung cancer.

While the results of Solstice are not ready, the lung cancer research team has achieved other milestones.

These include discovering new biomarkers that explain drug resistance, and introducing comprehensive molecular profiling for lung cancer patients, allowing doctors to tailor treatments based on the genetic and molecular characteristics of the cancer.

The group also set up Singapore’s first multidisciplinary lung cancer clinic, where specialists collaborate to design personalised treatment plans for complex cases.

The team’s research serves up hope to Asians, particularly those who have never smoked but are at risk of lung cancer – like homemaker Tiffany Khor, 46.

Ms Khor did not notice any symptoms of the disease until she started experiencing breathlessness and a persistent cough following the birth of her second child 10 years ago.

An X-ray showed that her entire left lung was filled with fluid and that she had low oxygen levels.

At that point, she was told that she had Stage 3B lung cancer that had spread to her diaphragm.

Ms Khor stopped her chemotherapy treatment after only two sessions.

“I didn’t know how long I would live, so I decided not to waste any more time undergoing treatment. I wanted to spend the rest of my time with my children,” she told the media at NCCS.

After undergoing genomic and molecular testing, she was found to have ALK-positive non-small cell lung cancer, which could be treated using targeted therapy.

However, she decided to seek alternative therapy until early 2016, when she was too weak to decline treatment.

At NCCS, scans showed that her cancer had spread to her brain, which meant her cancer had progressed to Stage 4. She went on targeted therapy and had home hospice care.

In late 2023, when scans showed that her cancer had spread to the lining of her brain and spinal cord, her husband Josh Yong became desperate for a solution.

He researched different clinical trials and came across the NVL-655 drug, which was cleared by the Food and Drug Administration for clinical trials in the US in May 2024.

Mr Yong found out from his wife’s oncologist that Singapore was one of the sites in a multi-country trial for the oral chemotherapy drug and had her enrolled in the Alkove-1 trial in June 2024.

Results have been very positive, with scans showing that the tumours in Ms Khor’s spine and traces of the cancer from her brain lining have disappeared.

Her cancer is now under control. Mr Yong said his wife has never been better mentally and physically since she was diagnosed with the cancer.