Cancer has been the leading cause of death in Japan since 1981 and this is compounded by the fact that the country has a hyper-aging society, which means that Japan will face a substantial increase in the number of elderly cancer patients, according to a review article by Matsuda and Saika published in the Annals of Cancer Epidemiology in 2018. Prof Yasushi Goto of the National Cancer Center Hospital in Japan shared with MobiHealthNews on some of the latest developments in precision oncology in Japan, the interest of pharmaceutical companies in targeted therapy and a nationwide cancer genome screening project named SCRUM. 

Q. Could you tell us more about your role at the National Cancer Center Hospital?

A. National Cancer Center Hospital (NCCH) is based in Tokyo, Japan and is the largest cancer center in the country. The other is national cancer center is located in Chiba, Japan. One of the special characteristics of NCCH – apart from the research institute hospital, is that we also do research for every kind of cancer activity in our hospital. We don’t only do clinics, but also genetic oncology, rare cancers.

My main work is at thoracic oncology which mainly covers lung cancer. I also am a member of Rare Cancer Center so I also cover, malignant mesothelioma, thymic cancer, neuroendocrine tumors, and all others. Since Japan has launched national genomic project, and National Cancer Center is playing the central role in this project, I am also joining Section of Knowledge Integration in Center for Cancer Genomics and Advanced Therapeutics.

Q. What are your observations on the development of precision oncology in the APAC region? How would you describe precision oncology in the most straightforward manner?

A. Testing for patients with cancer is prevalent in the APAC region. Compared to other countries, people in Asia are generally accustomed to genetic testing for precision medicine. Our capabilities may not be as advanced as the United States for full gene sequencing, perhaps because of cost issues, but we are catching up.

For precision oncology to develop further, more patients should be tested for genetic testing and target therapy. We are looking to putting in place a proper system to support this right now, especially in the rare cancer field.

There was a recent nationwide project in Japan called SCRUM, conducted by the National Cancer Center East Hospital. SCRUM is the first industry-academia collaboration nationwide cancer genome screening project. I believe early access to drugs is partly due to this project.

Q. Medtech or healthtech startups are also getting into the precision medicine space and seeing a lot of interest from investors. For instance, genomic medicine startup Lucence from Singapore recently raised $20 million in Series A funding. What opportunities do you see in these startups in terms of working together with hospitals such as the National Cancer Centre Hospital? Are there any notable startups in Japan in the precision medicine space?

A. In Japan, many pharmaceutical companies are looking at targeted therapy. Prominent companies include Daichi-Sankyo, Chugai, and Takeda. NCCH is currently working closely with Daichi-Sankyo, Takeda and Chugai.

The approval system is different between ‘blockbuster’ drugs and targeted therapy. If you only have one patient in Japan and globally there are only 20 or so – there can be a scenario where the drug is effective, but it is not approved in our country as there is only a single patient. This is why some pharmaceutical companies are looking at precision medicine.

Companies including Sysmex are also actively looking into the testing of panel sequencing. NCCH has also worked with Sysmex to make a cancer sequencing panel.

Q. The high incidence of cancer in modern societies is worrying and also very costly – how do you think precision oncology can help tackle some of these challenges?

A. Cost is a global issue, for both the development side (e.g. the pharmaceutical companies) and the consumption side (e.g. governments, individuals). We also need some basic infrastructure for precision oncology, to screen patients. Currently each drug needs its own testing. With many drugs that need to be tested, we need a platform to do panel sequencing in order to annotate any genetic changes in the patients for treatment.  

In Japan, we are now trying to make this infrastructure because the government recently approved the panel sequencing in 2019. This means that after standard therapy, every patient is able to test for panel sequencing. As more patients are screened, in this way I think cancer treatment will be improved in the future.  

Q. What do you think will be the key developments and breakthroughs in precision oncology in the next 3-5 years?

A. There will be no blockbuster development, but there will be steady progress in the detecting genetic changes earlier in the next 3-5 years. Some of the topics at the ESMO Asia Congress 2019 in Singapore were on advancements in detecting mutations/previously overlooked genes. Since we are able to find these abnormalities earlier, we now have new anti-cancer agents to target them.