New drug saves man from cancer death sentence
Man had given up on life after being diagnosed with end-stage lung cancer. But trial drug shrinks his cancerous cells
June 1, 2011, is a date he will always remember.
That was the day the 62-year-old, who wanted to be known only as Mr Lim, lost all hope after he was given the death sentence by a doctor.
Diagnosed with end-stage lung cancer, doctors said he had one year to live if he went for chemotherapy regularly.
Mr Lim was ready to give up.
"It was the most miserable day of my life," the unemployed man said in Mandarin.
But in 2013, a miracle happened. Mr Lim's symptoms disappeared and his condition is now well-controlled, thanks to a drug called Ceritinib.
He was part of a clinical trial for the drug. It targets ALK (anaplastic lymphoma kinase)-positive non-small cell lung cancer, which Mr Lim has.
In April, the drug was approved by the Health Sciences Authority for those who were previously on another type of drug, said consultant oncologist at the National Cancer Centre Singapore (NCCS), Dr Daniel Tan, at a press conference yesterday.
Speaking to The New Paper yesterday, Mr Lim, a bachelor who lives alone in a one-room rental flat in Chai Chee, recalled his shock at his diagnosis.
He had gone to consult a doctor for breathing difficulties and a swollen leg.
"I don't smoke or drink. How did I get lung cancer?
"When I knew I had only a year to live at most, I didn't want to live any more.
"I thought that there was no point going for chemotherapy if I was going to live just one more year," said Mr Lim.
He grudgingly went for a second appointment at the NCCS after his younger sister persuaded him.
That was when Dr Tan suggested Crizotinib, the only drug option then. The other option was chemotherapy.
But the drug did nothing to alleviate Mr Lim's condition.
At the peak of his illness, Mr Lim was producing six to seven 250ml bottles of phlegm and sputum (a mixture of saliva and mucus).
"When I was out with my friends, I carried a bottle with me so I could spit into it.
"I just pretended that I was drinking water when I needed to spit as I was afraid others would judge my condition," he revealed.
Mr Lim was also plagued by severe breathing difficulties. He would be out of breath during conversations, and could stay out for only three hours at most, before rushing home to hook himself up to a ventilator.
A year later, Dr Tan asked Mr Lim to be part of a clinical trial for Ceritinib.
Initially, he thought little of this new treatment option.
"For me, the lung cancer didn't hurt. It was the lower quality of life that disturbed me," he explained.
But six days later, he realised that he stopped spitting phlegm and sputum, and was no longer huffing and puffing.
A year later, he was told that most of his cancer cells had shrunk.
"I was so surprised. The tumours in my lungs shrank so much that one day the doctors said it was difficult to measure how big they were," Mr Lim said with a laugh.
He is still unemployed due to his leg ailment, and is surviving on government handouts of $450 every month.
He has been sharing his story at various events organised by NCCS.
"The doctors saved my life.
"Now, it's my turn to help others," he said.
The doctors saved my life. Now, it's my turn to help others.
- Mr Lim on sharing his story at National Cancer Centre Singapore events
Drugs like this 'promising' for disease control
The new drug Ceritinibcan be prescribed only for patients who have ALK (anaplastic lymphoma kinase)-positive non-small cell lung cancer, and have either grown resistant or are intolerant to the existing drug Crizotinib.
Making up 8 per cent of the lung cancer cases, this cancer is characterised by its abnormal gene arrangement.
Crizotinib, which was approved 1½ years ago, is a targeted drug therapy that stops this gene mutation from happening and prolongs survival.
But the new drug on the market, Ceritinib, is 20 times more potent. Results from clinical trials show that Ceritinib, when used on patients who have taken Crizotinib before, can help stabilise tumour growth for a median period of 17 months, and prolong overall survival by a median period of 49 months or about 4 years.
The drug was approved by the Health Sciences Authority in April after the conclusion of early-phase clinical trials involving nine countries, including Singapore, with the National Cancer Centre Singapore (NCCS).
Out of the 246 patients involved in the clinical trials, 19 are Singaporeans.
It took four years for Ceritinib to be approved, three years faster than its predecessor Crizotinib.
This is significant in the face of low success rates when it comes to oncology drug development, something NCCS' Dr Daniel Tan, consultant oncologist, called a "major issue".
From January 1995 to September 2007, 82 per cent of the drug developments failed, he said.
As the lead investigator for one of the clinical studies on Ceritinib, Dr Tan said it was gratifying to see the drug from its early trial stages to approval.
"I think certainly, the results that we have now are quite promising in terms of duration of (disease) control.
"I think this is the trend of things to come, the hope that if we begin to now have a few of these drugs lined up, each with different characteristics... we can start to transform a lot of these advanced cancers into a more chronic kind of disease without compromising quality of life too much."
...we can start to transform a lot of these advanced cancers into a more chronic kind of disease without compromising quality of life too much.
- Dr Daniel Tan, oncologist, on how new drugs would help cancer patients