The cutting edge of cancer care

Several times, as in several times before our visit to the Roche Singapore Technical Operations site, our guides reminded our group of media people from around Asia about the do’s and don’ts of the visit. Do wear pants and comfortable shoes (no heels); do come in your “naked” glory, that is, no makeup, no perfume, no lotions, no nail polish; do come prepared to don protective gear—steel-toed boots, hooded overalls, goggles; don’t take photos or videos; and most important, do be in good health during the tour.

This was because the plant we were touring is no ordinary factory or lab. It is the first “biologics” manufacturing site in Asia, with Roche being “the first company in Singapore to produce US FDA licensed bio therapeutics using recombinant DNA technologies.”

“Biologics” is defined by the US FDA as “complex mixtures that are not easily identified or characterized,” and are mainly sourced from natural sources, “human, animal or microorganism” and may be “produced by biotechnology methods and other cutting-edge technologies.”

Biological products, the US FDA added, “tend to be heat sensitive and susceptible to microbial contamination” so “it is necessary to use aseptic principles from initial manufacturing steps, which is also in contrast to most conventional drugs.”

That explained the extraordinary caution taken in touring us journalists around the plant. (We were told we were the first media people allowed into the facilities.) This, even if most of the time we were walking along corridors and simply peeking through picture windows through which we could glimpse gleaming machinery and whirring devices.

Despite the inconvenience involved in our visit, I for one felt privileged by this opportunity to view first-hand the manufacture of drugs that “often represent the cutting-edge of biomedical research and, in time, may offer the most effective means to treat a variety of medical illnesses and conditions that presently have no other treatments available.”

This possibility holds particular promise in the treatment of cancer. A diagnosis of cancer is often dreaded news in most parts of the world, regardless of the site of the cancer, the economic and social standing of the patient, and where the patient lives. Time was when a positive diagnosis was seen as a “death sentence,” after which only a long, painful and frightening process of healing — mainly through chemotherapy and radiation — could be expected.

But as speakers at the recent 2017 Roche Pharma Asia-Pacific Press Day in Singapore stressed again and again, the overall cancer picture is getting rosier, thanks in large part to more accurate diagnosis and drug and biologic treatments that are not just targeted at specific types of cancer, but can also be “customized” to suit the needs and circumstances of individual patients.

To be sure, the landscape is still shrouded in shadow. Chee Hew, senior principal for Asia-Pacific of the Economic Intelligence Unit, said that cancer is the second-leading cause of death in the region, accounting for 15 of every 100 deaths.

The “top five” cancers in this part of the world, she said, are lung, gastric, liver, colon, and breast. But for women, breast cancer is the most common and most deadly of all cancers, and the fastest spreading, too, with the number of cases “doubling from year to year,” said Hew. There are many reasons for this. Among them, the “uneven standards of care” where the lack of health insurance from state sources means “most cancer care is self-paid.” In Asia, too, the public must endure a “slower approval process for new drugs” which, in the Philippines, the current Dengvaxia scare can only lead to further delays for all drugs, including cancer treatments and vaccines.

Hew also pointed to the “lack of awareness” among the public in general, which in many cases leads to delayed diagnosis (and treatment). Overall, she said, patients, their families and their caregivers must deal with the “stigma of cancer,” with fear, shame, apprehension and despair overtaking any hope still remaining.