Two months after Chinese New Year last year, Mr Tan was told he had just weeks to live but the use of pembrolizumab by Dr Tan to treat his
cancer turned things around and has kept Mr Tan alive for eight months and counting.
Last year, Mr Tan Teng Keong was
on the losing end of a battle with
cancer.
Just two months after Chinese
New Year, after failing five different
treatments for a rare form of
lymphoma called natural killer
T-cell lymphoma, his doctor said
there was nothing else that could
be done. Mr Tan was told he had
just weeks left to live.
“I told my wife that it’s better to
stop,” said the 52-year-old of his
multiple treatments. “Although it
wasn’t painful, it felt like you were
trying for nothing.”
It was his wife, Mrs Tracey Tan,
who persuaded him and his doctor
to give it one final shot in May.
This last-ditch attempt, involving
a drug not designed to fight this cancer,
has kept Mr Tan alive for eight
months and counting.
It is possibly the first time that
the drug, known as pembrolizumab,
has been used to treat this specific
variant of blood cancer or lymphoma,
said Dr Daryl Tan, who is
Mr Tan’s doctor.
Pembrolizumab is typically used
to treat lung cancer and a type of
skin cancer. It is not, however, approved
for use against the cancer
that Mr Tan had.
“There was no evidence (that it
would work), not even an anecdotal
report,” recalled Dr Tan, who is a
haematology specialist at Raffles
Cancer Centre. “I told them that
there could be hope, but to prepare
for the worst anyway.”
Although lymphoma as a whole is
among the top 10 most common
cancers for both men and women
here, the natural killer T-cell variant
makes up only 5 per cent of all
cases. If discovered early, its cure
rate is between 30 and 40 per cent.
If detected late, as in Mr Tan’s case,
it is nearly zero.
Dr Tan, who is also research director
at Raffles Hospital, said he
chose the drug because his understanding
of the biology behind it
led him to believe it might work.
Clinical trials ongoing at the time
showed encouraging results when
the drug was used against
Hodgkin’s lymphoma–another variant
of lymphoma that seemed to attack
the body in similar ways.
At the point of administering the
medication, Mr Tan was bedridden.
“His immune system had started to
attack his body,” said Dr Tan.
“He was in very bad shape. He
was going into multi-organ failure
and the disease had spread to his
bone marrow, liver and spleen.”
With nothing to lose, Mr Tan was given the medication – a single injection
– before he was sent home
to wait for death. But a week and a
half later, he was able to walk. Two
weeks later, a scan showed that all
the cancer was gone.
“I was quite sceptical that it
would work because of my previous
experience with relapses,” Mr Tan
recalled. “I thought it was just transient.”
Mr Tan now has to go for repeat
injections every three weeks, each
of which costs more than $10,000
and is covered by his insurance.
Dr Tan has worked with his counterparts
in HongKong and South Korea
to treat patients like Mr Tan
with the drug. Eight people – including two more from
Singapore – have
been successfully treated so far.
The findings will be published in
prestigious international journal
Blood next month.
Dr Tan is also working with other
specialists at healthcare institutions
here – such as the National
Cancer Centre Singapore (NCCS) –
to dig deeper into the genetics behind
this particular cancer.
Professor Lim Soon Thye, who
heads the medical oncology division
at NCCS, said that the type of
lymphoma that Mr Tan had caused
very high levels of a certain protein
to be produced in the body.
“We want to understand, at the
fundamental level, the processes
that lead to an increase in this protein,”
Prof Lim said. “And in the process,
we could predict who might respond
best to which drugs.”
Mr Tan, who could barely walk
eight months ago, is now in remission
and back to full-time work as
an assistant general manager with
an electronics company.
He told The Straits Times that he
has always lived an active life and
plans to return to windsurfing.
“It seems like I’m quite back to
my normal self,” Mr Tan said.
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