Breakthrough S$25 Million Grant Fuels Lung Cancer Innovations in Singapore

Singapore's biomedical research landscape has received a major boost with a S$25 million grant awarded to a collaborative team led by the National Cancer Centre Singapore (NCCS). This funding, from the National Medical Research Council (NMRC) Open Fund - Large Collaborative Grant, supports the CLARION programme—Conquering Lung cancer Across all stages with Research and InnovatiON. The initiative targets lung cancer in Asian patients, addressing unique biological differences that make the disease more aggressive and harder to treat in this population.

Lung cancer remains Singapore's leading cause of cancer death among men, accounting for 24.6% of male cancer fatalities, and the third for women at 15.9%. With incidence rates rising—over 53,000 cases recorded from 1968 to 2021—and 81% diagnosed at advanced stages, the need for tailored strategies is urgent. This grant promises to accelerate progress from risk assessment to survivorship care.

Lung Cancer Burden in Singapore and Asia: A Call for Action

In Singapore, lung cancer tops cancer mortality lists, with age-standardized incidence rates among the highest in Southeast Asia at 231 per 100,000. Globally, Asia bears 60% of lung cancer deaths, but local trends show distinct patterns: higher proportions of never-smokers, especially women, and late-stage diagnoses at 78-83%.

Unlike Western populations where smoking drives most cases, Asian patients exhibit different genomics. Epidermal Growth Factor Receptor (EGFR) mutations—key drivers amenable to targeted therapies like tyrosine kinase inhibitors (TKIs)—occur in 40-60% of Asian non-small cell lung cancer (NSCLC) cases versus 10-15% in Caucasians. Never-smokers comprise up to 50% in East Asia, linked to second-hand smoke, air pollution, and genetic factors.

This disparity underscores CLARION's focus, building on over a decade of groundwork to bridge gaps in prevention and care.

The CLARION Programme: Comprehensive Approach Across Disease Stages

Launched with initial NMRC support in May 2025 and boosted by this grant in July, CLARION spans the lung cancer continuum. Its five thematic pillars include:

• Risk prediction models using AI and genomics for high-risk identification.
• Early detection via low-dose CT (LDCT) screening tailored for Asians.
• Biomarker discovery to personalize treatments.
• Mechanisms of drug resistance, especially in EGFR-mutated cases.
• Novel therapies and survivorship support for better quality of life.

The programme integrates clinical trials, computational modeling, and patient data from major institutions.

Leadership and Higher Education Ties Driving Excellence

Prof Daniel SW Tan, Head of Medical Oncology at NCCS and Associate Professor at Duke-NUS Medical School, leads CLARION. A clinician-scientist with expertise in thoracic oncology and drug development, Prof Tan heads the Experimental Cancer Therapeutics Unit and chairs the Asian Thoracic Oncology Research Group (ATORG).

Partners span academia and research: Duke-NUS (affiliated with National University of Singapore, NUS), Nanyang Technological University (NTU) collaborators via A*STAR, National University Cancer Institute Singapore (NCIS) under NUHS, and Genome Institute of Singapore (GIS). These ties exemplify Singapore's higher education ecosystem fostering translational research.Explore research positions in these dynamic environments.

For aspiring academics, programmes like this highlight opportunities at higher-ed jobs in oncology and genomics.

Unique Challenges of Lung Cancer in Asian Patients

Asian lung cancers differ biologically: higher EGFR prevalence (63.8% in some Singapore cohorts), adenocarcinoma dominance, and never-smoker bias. In Singapore, only 38% meet Western screening criteria (e.g., NLST: heavy smokers), missing high-risk never-smokers.

Environmental factors like haze pollution and cooking fumes contribute, alongside genetics. CLARION aims to develop Asia-specific risk models, potentially expanding screening to non-smokers with family history or biomarkers.

Revolutionizing Screening and Early Detection

Current low-dose CT screening reduces mortality by 20% in smokers, but Asian adaptations are needed. CLARION tests LDCT feasibility in Singapore's at-risk groups, integrating blood-based biomarkers for non-invasive detection.

Step-by-step: 1) Identify high-risk via polygenic scores and lifestyle data; 2) LDCT with AI triage; 3) Biomarker confirmation (e.g., ctDNA for EGFR). Pilot studies show 1.1% detection in Asian never-smokers. This could shift 80% late diagnoses earlier.

Biomarkers and Precision Medicine Frontiers

CLARION leverages A*STAR GIS for multi-omics: genomics, proteomics. Past collaborations identified Asian-specific drivers. New models predict risk beyond smoking, e.g., PRS for adenocarcinoma.

• EGFR exon 19 del/21 L858R: 90% of mutations.
• Uncommon variants for novel TKIs.
• TMB lower in never-smokers, guiding immunotherapy.

Benefits: Tailored screening, fewer false positives.

Overcoming Treatment Resistance Mechanisms

Resistance plagues EGFR therapies after 9-13 months. CLARION dissects pathways using organoids and AI simulations via A*STAR IHPC. Prof Tan's work on T790M-negative resistance informs next-gen inhibitors.

Real-world: Singapore trials show PD-L1 as prognostic in early EGFR NSCLC.

Emerging Therapies and Clinical Trials

Innovation includes adaptive trials for combination therapies: TKIs + ADCs, immunotherapies. CLARION's ECRU accelerates from bench to bedside. Global impact via ATORG.ATORG site.

Enhancing Survivorship and Quality of Life

Beyond cure, CLARION addresses post-treatment: digital health tools, psychosocial support. Singapore's holistic model integrates with higher ed training for multidisciplinary care.

Career Opportunities in Singapore's Biomedical Research Hub

This grant signals booming prospects at Duke-NUS, NUS, NTU. Roles in genomics, trials abound. Check university jobs and Singapore listings for postdocs, faculty.

Photo by K8 on Unsplash

Future Outlook: Transforming Global Lung Cancer Care

By 2030, CLARION eyes 20% mortality drop via integrated care. Ties to RIE2030 amplify impact. For researchers, it's a gateway to professor ratings and collaborations. Singapore positions as Asia's oncology leader.