‘Gov’t appears to be determined, but is missing an important point’
Paik Soon-myung
Director of Avison Biomedical Research Center in Yonsei University’s Severance Hospital
Paik Soon-myung is a renowned cancer expert. One of his most notable achievements is the development of Oncotype DX, a diagnostic test that can help women avoid the unnecessary agony of chemotherapy.
The Korean government should focus more on generating reliable clinical data, which will be the key to the new era of precision medicine, a renowned cancer expert said. “The government appears to be determined to support those involved in the emerging area, but it is missing an important point,” Paik Soon-myung, director of the Avison Biomedical Research Center in Yonsei University’s Severance Hospital, said in an interview. “It’s great that the government is trying to support researchers and easing regulations to help Korea take leadership in the field. However, the most important thing is to establish an integrated system in which genomic data for all cancers diagnosed in the country can be collected, because such data will be enormously valuable in the near future.” Precision medicine, which refers to the customization of treatment according to a patient’s genetic characteristics, is expected to change the treatment of some of the most challenging diseases. In the field of cancer, change has already begun. If doctors know which genes are involved in particular cancer cells, in theory, they can block the growth of the cells by interfering with the specific molecules involved. In other words, they can block cancer cells’ possible avenues of genetic escape to prevent the cancer from spreading, thereby eliminating the need to use chemotherapy, which also kills normal cells. This idea is behind targeted cancer therapies. Some drugs aimed at specific cancer-causing mutations, such as Glivec for chronic myeloid leukemia and Herceptin for some types of breast cancer, have proved to be great successes. “Because common targets have already been explored, pharmaceutical companies now have to develop drugs for rare targets that are present in less than 5 percent of each cancer type,” Paik said.
“So data for rare cancer mutations are expected to become more valuable.” He believes any country that can provide reliable genetic data for all cancers diagnosed in its territory will have a major advantage in attracting global pharmaceutical firms, which need such information to develop new drugs. “Let’s say 1 percent of breast cancer patients show a similar mutation. To develop a drug for them, a pharmaceutical company has to test 10,000 patients to collect 100 samples,” he said. “Cost and effort to screening patients to identify candidates for clinical trials has become the major bottleneck for the industry. This is why private companies are reluctant to develop cancer drugs for rare mutations.” Major hospitals in Korea recently started making their own systems for data collection and analysis, but Paik believes an integrated, state-led system can make the job much faster and cheaper. “It does not mean that the government should build huge buildings. It could just make a database network and implement regulations to keep the sampling environment consistent among different hospitals,” he said. Earlier this month, an international team of researchers sequenced the DNA of tumors and normal tissues from 560 breast cancer patients to identify mutations in 93 genes, and published the results in the journals Nature and Nature Communications. As more countries open their eyes to the potential value of such research efforts, competition for data collection as well as precision medicine in general is expected to accelerate. In 2016, the U.S. government decided to invest $215 million into the Precision Medicine Initiative, a research project U.S. President Barack Obama launched a year ago. Of the budget, according to the National Institutes of Health, $130 million was allocated to build a national, large-scale research cohort, and $70 million was allocated to lead efforts in cancer genomics as part of PMI for Oncology. “I have heard that other developed nations such as France and Japan have also started such projects,” Paik said. “It is important for Korea to act fast to take leadership in the new era. This is an opportunity.”
Avoiding unnecessary chemotherapy
Chemotherapy is brutal. It attacks healthy tissues along with cancerous ones, causing excruciating pain in patients. But the worst part of chemotherapy is when it doesn’t work for some patients. The different genetic makeup of cancer cells influences their responses to the treatment, and doctors are uncertain whether certain drugs will work. One of Paik’s most notable achievements is the development of Oncotype DX, a diagnostic test that can help women avoid the unnecessary agony of chemotherapy. About half of all breast cancer patients are diagnosed as node-negative, estrogen receptor positive, which means that cancer cells are not found in their lymph nodes. Among them, only 15 percent is unlikely to respond well to hormonal treatment and therefore has to receive chemotherapy to prevent cancer recurrence after surgery. Until just 12 years ago, it wasn’t possible to identify who belong to the 15 percent, and all patients had to receive chemotherapy. Oncotype DX, which was developed by Paik in 2004, can predict the patient’s risk of relapse within 10 years of diagnosis by measuring the activities of 21 genes within a tumor. “Today, more than 70,000 American patients with the condition receive an Oncotype DX test every year,” Paik said. “Since the development of Oncotype DX, about 10 similar test devices have been developed.” “In terms of providing ways to avoid treatments that won’t work, one can say Oncotype DX introduced the concept of precision medicine to the field of breast cancer.” Paik, who studies cancer biomarkers both at Yonsei University and the NSABP Foundation in the United States, said he is now working to develop different versions of Oncotype DX for gastric, colorectal and rectal cancers, after having proved that chemotherapy does not work for patients with certain types of the cancers. “While doing so, I also want to develop new cancer drugs based on our findings about the diseases’ biomarkers and characteristics,” he said. “The most important thing about targeted cancer therapies is to find targets to aim at. This is the main thing that we have done and will continue to do.”
‘Korea needs to understand the value of data’
Despite Korea’s world-class surgeons and researchers, its influence on the world’s biomedical community isn’t yet significant. “This is mainly because the country hasn’t produced any original work that influenced the global biomedical field profoundly,” he said. “Original work comes from original data. Korea needs to invest more resources into generating and analyzing data to reach the next step.” Paik said one of his long-term plans is to build research infrastructure for cancer at Yonsei University College of Medicine, from which he graduated in 1981. “Since I left Korea in 1982 to study in the United States, I have never thought that I would die outside Korea,” he said. “I’m glad to be back finally and to work to improve on what the country is lacking.”