With about 150 children diagnosed with cancer every year, childhood cancers are the second leading cause of death in children in Singapore.

Brain and solid tumours account for almost 60 per cent of childhood cancers, but they are often under-recognised and diagnosed late due to their rarity and diversity. “In infants and toddlers, we see higher rates of tumours in growing organs, such as the brain, kidney, liver and nervous system,” said Dr Amos Loh, a senior consultant with the Department of Paediatric Surgery at KK Women’s and Children’s Hospital (KKH).

“Such tumours are notoriously difficult to manage and complex to treat,” said Dr Soh Shui Yen, Senior Consultant and Head of the Haematology/Oncology Service with KKH’s Department of Paediatric Subspecialties.

For these young patients, early detection is key.  

To improve clinical care, patient outcomes and research into brain and solid tumours in children, KKH collaborated with the Singapore-based charity VIVA Foundation for Children with Cancer and St. Jude Children’s Research Hospital in the United States to start the VIVA-KKH Paediatric Brain and Solid Tumour Programme in 2015.

Under the programme, novel molecular tests were designed to diagnose tumours more quickly and accurately, leading to potentially better and more precise treatments for these young patients.

Dr Amos Loh (left) and Dr Soh Shui Yen (right)

Improving treatment outcomes and extending regional reach

Today, these molecular tests offer a new ray of hope to young cancer patients.

“Previously, without these molecular tests, it was much harder to precisely diagnose these tumours, and patients often had to seek testing at overseas centres. Now, with such advanced in-house capabilities, we can facilitate the allocation of appropriate treatment more efficiently,” said Duke-NUS Clinical Associate Professor Kenneth Chang, a member of VIVA-KKH programme’s steering committee and Senior Consultant and Head of the Department of Pathology and Laboratory Medicine at KKH.

The service has been extended to other hospitals in Singapore and across Asia, benefitting even more patients.

Complementing the molecular tests, a molecular tumour board initiative was launched as part of the programme, which uses data from genetic tests to identify personalised treatments. Close to 60 KKH patients have benefitted from these multidisciplinary case discussions. They are among more than 250 children from Singapore and across Asia who have benefited from this personalised medicine initiative since its launch in 2018.

While KKH has trained international fellows in paediatric oncology for over a decade, the programme expanded its reach in 2018 by offering fellowships for training in paediatric surgery and pathology to countries such as Cambodia, China, Malaysia, Myanmar and Pakistan.
 

Furthering research on cancer in Asian children

Since its inception, the VIVA-KKH programme has also made notable advances in research.

Tapping on Duke-NUS Assistant Professor Joanne Ngeow’s expertise in studying cancer genetic risks in children, the programme collaborated with Ngeow at the National Cancer Centre Singapore to offer clinical cancer genetic testing to children and families suspected to be at risk of cancer predisposition syndromes.

“We were the first to describe the profile of cancer predisposition syndromes in Asian children with brain and solid tumours,” said Loh, who is also chairman of the VIVA-KKH programme steering committee.

Through the collaboration, the programme found that for patients suffering from brain and solid tumours, ten per cent were identified with verified mutations associated with genetic predisposition. And only half of them had known family histories of cancer.

“Childhood cancers are driven by genetic cues that have lost their normal regulation and control, but in general, these are mostly random events and are not often hereditary or genetically predisposed,” added Loh.

“As scientific knowledge continues to grow, we may uncover more about paediatric cancer predisposition syndromes. Nevertheless, it is still important to screen for genetic predisposition syndromes as they can have important bearing on family members and the patient,” he said.
 

The need for global collaboration

According to Loh, the programme also hopes to address the need for more knowledge of Asian childhood solid tumours, which are under-represented in existing research. A better understanding of various aspects, such as clinical outcomes, tumour biology and the socio-economic impact of paediatric cancer in Asian populations, will allow current evidence to be better applied.

“It is difficult to advance treatments for childhood cancers via clinical trials due to the diverse varieties of tumours and the small numbers of patients for each tumour type. More research and global collaboration will be helpful in expanding the understanding of these diseases, thereby improving patients’ outcome in the long run,” added Loh.

He believes that the combined research and education thrusts of the VIVA-KKH programme will have long-lasting benefits for the care and treatment outcomes of children with cancer.

“By increasing knowledge in childhood cancer through research, we can empower centres in Singapore and beyond to sustain continuous improvement in the level and quality of care delivered,” said Loh.

“The treatment for children with cancer needs to be readily accessible and managed such that there are milder and fewer side effects. Breakthroughs in research can definitely help with that,” agreed Soh, who is also a member of the VIVA-KKH programme steering committee. “A child who is cured of cancer has a whole life ahead of him or her. We hope to help more patients and seek better treatments with higher efficacy.”
 

Adapted by Drima Chakraborty and Chua Li Min from: Singapore Health May-June 2021 Issue (“Collaboration gives new hope for children with rare cancers” & “Cancer in Children” (Pages 6 and14))