Abstract:

The availability of an expanding armamentarium of antibodies and small molecule inhibitors has transformed the way we practice oncology. By targeting key oncogenic genes and pathways, many solid tumors can now be therapeutically addressed in a more focused and clinically efficient manner. This revolution in oncology treatment, named targeted therapeutics or personalized medicine, has also deeply transformed the way we practice pathology. Indeed, correct stratification of patients often depends on the genotype profile of a single tissue-based biomarker. In particular, there are 5 main common solid tumors in the Asian context (gastrointestinal stromal tumors, breast cancer, gastric cancer, colorectal cancer and lung cancer), which have a key biomarker (c-kit, HER-2, KRAS/BRAF and EGFR), the genotype of which will indicate the likelihood of the response of an individual patient to a particular treatment option. The first part of this lecture will briefly review each of these tests, highlighting their Asian relevance when applicable, as well as the way they are changing the pathological classification of diseases.

The advert of personalized medicine poses a large number of challenges to the developing world. One of them is related to the cost of these new molecular diagnostic assays, and the cost of the novel therapies that are related to these tests. The lecture will try to analyze the role of the pharma industry and the national healthcare models in tailoring the use of these tests and these drugs. The second main challenge is related to the model of scientific and technological innovation that developing countries should pursue; this model cannot be a direct repetition of those followed in developed countries, and need to be original and aimed to the economic and ethnic reality of developing countries. Several examples will be provided to illustrate this case, suggesting that molecular diagnostics, personalized medicine and technological innovation can offer a window of opportunity for developing countries.  

Profile:Dr Manuel Salto-Tellez is Associate Professor (with tenure) in Pathology at the Yong Loo Lin School of Medicine, National University of Singapore (NUS), as well as Assistant Dean for Research. He is also Senior Consultant Pathologist in the National University Hospital (NUH-Singapore), Senior Research Scientist at the Oncology Research Institute (ORI-NUS) and Director of the Diagnostic Molecular Oncology Centre (NUS/NUH).(http://www.nuhs.edu.sg/html/pagetree/view_5904.html)