A Primer on Singapore’s Cancer Clinical Trial Landscape

By Dr Huren Sivaraj

Medical Oncologist. CEO and Co-founder Oncoshot Pte Ltd

Singapore’s already punching above its weight

As a practising oncologist and the CEO of Oncoshot, conversations about cancer clinical trials are part of my daily grind. Many of these discussions centre around improving efficiencies within the different cancer landscapes in Asia and I can go out on a limb to state that Singapore’s ecosystem is comparable to that of the top trial-conducting countries around the world.

Here is an overview of how Singapore’s cancer trial landscape compares with global figures and specifically the US- based on clinical trial registry figures from the National Institute of Health (US) (1):

Image 1: ?Why Singapore's Cancer Trial Landscape Is Comparable To Leading Trial Countries

[* Analysis based on trial status information within clinical trials.gov (1) and Globocan (2). Data correct as of 15 Oct 2019. ** Reference dataset from clinicaltrials.gov does not cover smaller sponsored studies and investigator-initiated studies registered within individual countries.]

For this, we used a very simplistic metric of ‘ratio of the number of Cancer Patients to every Cancer Clinical Trial available’. There’s a dearth of data and comparison analytics in published literature so we will need to take this metric as merely a convenient starting point for discussion. The metric reflects the density of clinical trials within a geographical area and a lower patient-to-trial ratio represents an increased likelihood of clinical trial access for individual patients (based on several assumptions such as patient demand exceeding clinical trial supply etc).

While the absolute number of cancer clinical trials in Singapore (70 cancer trials) is small compared to the US - the largest trial conducting country in the world - Singapore still has a disproportionately large number of high-quality trials accessible to its population of cancer patients. The ratio of 1014 patients to every active cancer clinical trial suggests that cancer patients in Singapore may have a higher chance of trial access compared to patients in the US and many other parts of the world. From an ecosystem perspective, Singapore already presents itself as an attractive country for the conduct of clinical trials.

Singapore’s strong focus on Cancer Clinical Trials

Published data suggest that Oncology accounts for at least 30% of all ongoing global clinical trials (3). A review of Singapore’s registry figures (from Health Sciences Authority) (4) indicates that cancer clinical trials account for 53% of all registered clinical trials here. I believe these numbers reflect a collective emphasis and growth mindset amongst Oncology stakeholders who recognise that Singapore has both an increasing demand for clinical trial options in addition to Oncology expertise and necessary trial-conducting capabilities for the successful conduct of such trials.

The Various Stakeholders Within Singapore’s Cancer Clinical Trials Ecosystem

Image 2: Key public and private stakeholders within Singapore’s Cancer Clinical Trials Ecosystem

Singapore’s cancer trial ecosystem is supported by the active participation of several important institutional stakeholders, including:

1. Public Institutes

a. Public cancer institutes (Tertiary/Quaternary Care Providers) such as the National Cancer Centre Singapore and National University Cancer Institute Singapore account for a large proportion of ongoing cancer clinical trials. These two centres are supported by a large team of Oncologists and Clinical Research Co-coordinators, and have existing work processes that support the efficient setup and conduct of clinical trials at scale.

b. Public Hospitals (Secondary Care Providers) participate mostly in non-interventional cancer clinical trials. However, if they have existing clinical support, they may extend to interventional trials.

2. Private Cancer Centres

Private cancer centres which have traditionally focused on delivering standard therapies are now increasingly building trial conducting capabilities to offer more options to patients in the private sector.

3. Research Organisations

Organisations consisting of academic research organisations such as Singapore Clinical Research Institute (SCRI) which supports public institutes in the conduct of Investigator Initiated Trials, and Contract Research Organisations such as IQVIA which are mainly focused on delivering support to Pharma sponsored clinical trials.

4. Corporations

Several Biotech and Oncology Pharmaceuticals are regionally headquartered in Singapore. These companies have structured and efficient processes to launch trials for the Southeast Asian region and consider Singapore to be a market entry point for the introduction of new therapies into the region at large.

5. Government Organisations

Health Sciences Authority (HSA) serves as the regulatory authority for the proper conduct of clinical trials and is the approving authority for new therapies in Singapore.

National research agencies such as the National Medical Research Council (NMRC) also support investigators from the public institutes for funding of clinical research that need to be pursued without the involvement of industry.

Snapshot of the current trial landscape and my thoughts on improving the status quo

During my discussions with clinical trial ecosystem partners such as the various cancer service providers, government agencies, industry partners as well as our investors, a frequent discussion point is that of the scale and distribution of clinical trials within the Singapore landscape. Given the siloed nature of clinical trial recruitment and the differing interests of industry vs academic stakeholders, there is a lack of local data that covers the collective interests of all stakeholders. We provide an overview of such figures in Singapore for the first time here.

Image 3: Number of cancer clinical trials conducted across healthcare institutions in Singapore

[* Analysis based on the accuracy of trial status information within clinicaltrials.gov (1). Data correct as of 15 Oct 2019. ** Reference dataset from clinicaltrials.gov does not cover smaller sponsored studies and investigator-initiated studies registered within Singapore alone.]

Today, public cancer institutes conduct the majority of clinical trials. The others are conducted in trial-ready private oncology practices. While National Cancer Centre and NCIS have over 40 on-going clinical trials each, the number of trials conducted by organisations like Raffles Hospital, Gleneagles, ICON Cancer Centre and Oncocare are smaller. Lack of manpower and workflow constraints in the scale of public institutes typically impact the ability of these private cancer care centres to conduct clinical trials. It would be tremendously beneficial for stakeholders and patients when private cancer centres are empowered to conduct more clinical trials, and patients within the private sector can also easily access clinical trials within the broader landscape.

Even as Singapore’s clinical trial landscape continues to grow, there is significant room for improvement in terms of patient screening, enrollment and overall timely completion of clinical trials. The exact figures within the Singapore trial landscape may not be available. However, experts estimate clinical trial participation rates here to be similar to countries such as the US (less than 8%) despite the presence of an ecosystem of stakeholders. The inability of patients and oncologists to recognise suitable trials in realtime is potentially a key reason for low participation rates in these cancer clinical trials. And the question remains – how we can do better to improve the identification of trials for cancer patients within Singapore beyond what the ecosystem is already delivering.

In the next article, I’ll share deeper insights into the question of how clinical trials are currently identified for the individual cancer patient and the role that patient-to-trial matching platforms play in potentially reducing the time and opportunity cost currently required for trial screening and enrollment.

References:

1.      U.S. National Library of Medicine - Clinicaltrials.gov

2.      International Agency for Research on Cancer - https://gco.iarc.fr/tomorrow/home

3.      2017 Clinical Trials Roundup by Informa's Pharma Intelligence

4.      Health Sciences Authority (Singapore) PRISM - https://eservice.hsa.gov.sg/prism/ct_r/enquiry.do?action=getAllTherapeuticArea

About Oncoshot:

Oncoshot is a Cancer Collaborative Platform built around an AI-algorithm to match a cancer patient profile with an extensive and specialised database of Cancer Clinical Trials from across the world. Connect with our Oncology Network of leading Oncologists if you need help with exploring clinical trial options or wish to seek access to therapies within Asia. Get started now by creating a profile.