Innovations in Cancer Therapy

Dr. Oon Chern Ein, Associate Professor, Molecular Oncology, University of Science Malaysia in an interaction with Raja Ramya, Correspondent, Higher Education Review magazine shared her views on how precision medicine is transforming cancer diagnosis and treatment outcomes in Malaysia today, the role of molecular profiling and genomic testing in enabling targeted cancer therapies in Malaysian healthcare settings and more.

Dr. Oon Chern Ein is an Associate Professor at Universiti Sains Malaysia (University of Science Malaysia), specializing in molecular oncology and cancer therapeutics. She holds a DPhil in Medical Oncology from University of Oxford and has conducted postdoctoral research at Karolinska Institutet. Her work spans drug discovery, bioengineering, and industry collaborations, with patented innovations in anti-cancer therapies.

How is precision medicine transforming cancer diagnosis and treatment outcomes in Malaysia today?

Precision medicine represents a significant shift in healthcare, as it customizes treatment based on an individual’s genetic composition, environment, and lifestyle. Rather than treating all patients with a specific cancer in the same manner, treatment decisions are guided by each patient’s molecular profile.

This change is particularly pertinent in Malaysia since breast, colorectal and lung cancers are the predominant cancer causes in our cancer burden. Since the early 2000s, precision oncology has gradually transformed treatment outcomes.

Tamoxifen is historically one of the first treatments that was developed with the goal of attacking a particular molecular marker; the estrogen receptor in breast cancer. It is known as an early form of targeted therapy although it is commonly referred to as hormone therapy.

Trastuzumab (Herceptin), a targeted therapy, became available in the world in 1998, marking the modern age of targeted therapy. It works on the overexpressed receptor, HER2, on a section of breast cancer. Although it was accepted globally previously, it was formally accepted in Malaysia in 2015. Molecular diagnostics including HER2 and EGFR testing have gradually become an integral part of treatment ever since then, especially following infrastructure augmentation and the advent of biosimilars, which made treatment more affordable.

What role do molecular profiling and genomic testing play in enabling targeted cancer therapies in Malaysian healthcare settings?

Molecular profiling and genomic testing are absolutely central to precision oncology. Targeted therapies cannot be prescribed effectively or cost-efficiently without identifying actionable mutations, meaning mutations that drive cancer growth and progression.

For example, in lung cancer, EGFR mutations are detected in approximately 40–50% of Malaysian non-small cell lung carcinoma (NSCLC) patients. This is a significant proportion compared to some Western populations. Patients with these mutations respond well to EGFR tyrosine kinase inhibitors.

KRAS and NRAS mutations, which occur in approximately 30–40% of Malaysian colorectal cancer patients, respectively, assist in predicting resistance of some anti-EGFR-based therapies. In a similar fashion, HER2 and BRCA mutations are used to select therapies and stratify patients with breast cancer.

Recent research from Sunway Medical Centre revealed that actionable mutations were present in up to 65% of the NSCLC patients, a fact that demonstrates the high potential of biomarker-guided treatment protocols.

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Which recent innovations in targeted treatments show the most promise for improving survival rates among common cancers in Malaysia?

Among Malaysia’s top cancers, lung cancer stands out. Despite the fact that survival rates are rather low, a significant percentage of patients have actionable mutations.

Recent studies indicate that approximately 65% of NSCLC patients had actionable mutations and EGFR mutations were detected in 57 - 60% of instances. EGFR-targeted therapies are especially effective in our environment.

However, it is important to note that there is a difference in the implementation of the same in healthcare systems. The access is not the same between the public and the private hospitals and the urban and rural areas which influences real-life consequences.

What challenges does Malaysia face in making precision oncology accessible and affordable across healthcare systems?

Cost remains the most significant challenge. Though biosimilars have lowered the cost of some medications, such as Trastuzumab, many families still incur substantial out-of-pocket expenses. Not only does the treatment of cancer entail the cost of medication but also diagnostics, hospital care, non-medical expenses and loss of productivity.

Genomic testing is possible in Malaysia and next-generation sequencing (NGS) has shown good performance with median turnaround time as low as three days in certain studies. Nevertheless, it is not always easy to scale access across hospitals and regions.

There is also a significant public–private divide. The public hospitals are run under subsidized programs but some of them might experience budget limitations that restrain quick implementation of new technologies. Access may be broader in private hospitals, but costs are often borne directly by patients.

Also, the presentation of the disease is often late, which may restrain the efficiency of the specific treatments.

How are AI, big data, and bioinformatics accelerating cancer research and personalized treatment strategies in Malaysia?

Malaysia’s multi-ethnic population, comprising Malay, Chinese, Indian, and Indigenous communities, makes genomic research especially critical. Genetic variation affects pattern of diseases, response to treatment and pharmacogenomics.

To address this, Malaysia introduced MyGenome in 2024. The goal of this project is to sequence 10,000 Malaysian genomes and create a national reference genome to represent our ethnic diversity. It is anticipated that the project will result in a full database in 2028 but interim datasets may be available as early as 2026.

Through genomic data mining and AI-powered bioinformatics analysis, the researchers will be able to recognize cancer-related mutations more precisely and alleviate doubts about ambiguities due to Eurocentric genomic references. This supports a shift from generalized treatment regimens to more specific, population-relevant approaches.

What opportunities exist for collaboration between Malaysian research institutes, hospitals, and global partners?

Malaysia provides good prospects of teaming in precision oncology. National programs such as MyGenome are aimed at linking research centers and hospitals to other global organizations.

Malaysian researchers are actively participating in international genomic medicine and cancer biology collaborations. The country also participates in ASEAN and APEC health initiatives focused on genomic medicine and cancer therapy.

Collaboration with biotechnology and pharmaceutical firms could be used to establish novel and sophisticated sequencing technologies and precision oncology systems in the Malaysian health care sectors. Local expertise is further reinforced by training and fellowship in international cancer centers.

Looking ahead, how can Malaysia strengthen its cancer research ecosystem to lead in precision oncology in Southeast Asia?

Malaysia is well positioned to play a growing role in the landscape of precision oncology in Southeast Asia. Other national programmes like MyGenome continue to increase the national genomic data and aid in the future use of precision medicine. Clinical research infrastructure which is facilitated by Clinical Research Malaysia (CRM) allows the involvement in multinational clinical trials and early phase clinical trials bringing the local patients closer to accessing specific treatments at an earlier stage.

The further development of the national cancer registry and the enhancement of online reporting systems will reinforce the generation of real-world evidence. Increasing the capacity in biobanking and translational research will also increase the capability of Malaysia in validating biomarkers and diagnostics research.

With sustained investment in skills development, robust data governance, and strategic partnerships, Malaysia can position itself as a trusted and influential contributor to precision oncology in the region.