Melvin Lee Kiang Chua

Melvin Lee Kiang Chua
National Cancer Centre Singapore | nccs · Department of Head and Neck and Thoracic Cancers Radiation Oncology

MBBS, FRCR, PhD FAMS

About

290
Publications
28,988
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6,018
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Introduction
I am a Clinician-Scientist, and Principal Investigator of the Tan Chin Tuan Laboratory of Optical Imaging, Photodynamic and Proton Beam Therapy – Precision Radiation Oncology Program at NCCS. My research is focused on: 1) novel phase II and III clinical trials in nasopharyngeal (NPC) and prostate cancers (PCa); 2) to explore “Big Data” science to build precise risk stratification models; and 3) to apply molecular genomics for biomarker discovery to translate to better treatments.
Additional affiliations
May 2015 - July 2020
Duke-NUS Medical School
Position
  • Professor (Associate)
February 2015 - November 2016
The Princess Margaret Hospital
Position
  • Researcher
April 2013 - present
National Cancer Centre Singapore
Position
  • Consultant
Education
May 2009 - June 2013
University College London
Field of study
  • Oncology and Radiation Biology
November 2008 - April 2013
Royal College of Radiology
Field of study
  • Clinical Oncology
July 1997 - May 2002
National University of Singapore
Field of study
  • Medicine and Surgery

Publications

Publications (290)
Article
The majority of newly diagnosed prostate cancers are slow growing, with a long natural life history. Yet a subset can metastasize with lethal consequences. We reconstructed the phylogenies of 293 localized prostate tumors linked to clinical outcome data. Multiple subclones were detected in 59% of patients, and specific subclonal architectures assoc...
Article
Purpose To investigate for a prognostic index (PI) to personalize recommendations for salvage intensity-modulated radiotherapy (IMRT) in patients with locally recurrent nasopharyngeal carcinoma (lrNPC). Methods Patients with lrNPC from two academic institutions (Sun Yat-Sen University Cancer Center [SYSUCC-A; n = 251 (training cohort)] and Nationa...
Article
Epidemiological trends during the past decade suggest that although incidence of nasopharyngeal carcinoma is gradually declining, even in endemic regions, mortality from the disease has fallen substantially. This finding is probably a result of a combination of lifestyle modification, population screening coupled with better imaging, advances in ra...
Article
Prostate tumours are highly variable in their response to therapies, but clinically available prognostic factors can explain only a fraction of this heterogeneity. Here we analysed 200 whole-genome sequences and 277 additional whole-exome sequences from localized, non-indolent prostate tumours with similar clinical risk profiles, and carried out RN...
Article
Background: Intraductal carcinoma (IDC) and cribriform architecture (CA) represent unfavorable subpathologies in localized prostate cancer. We recently showed that IDC shares a clonal ancestry with the adjacent glandular adenocarcinoma. Objective: We investigated for the co-occurrence of "aggression" factors, genomic instability and hypoxia, and...
Article
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Background The evidence of early treatment for radiation-induced brain necrosis (RN) in head and neck cancer survivors remains insufficient. This study aimed to determine whether early anti-RN treatment was associated with lower mortality. Methods In this cohort study, we utilized data from the Study in Radiotherapy-related Nervous System Complica...
Article
Objective: The NEAR trial is a single-arm phase II trial investigating the efficacy of neoadjuvant apalutamide and radical prostatectomy in the treatment of D'Amico intermediate- to high-risk prostate cancer. This publication focuses on health-related quality of life (HRQoL) during 12 weeks of neoadjuvant apalutamide treatment. Methods: From 201...
Article
Full-text available
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of prostate cancer was published in 2020. It was therefore decided, by both the ESMO and the Singapore Society of Oncology (SSO), to convene a special, virtual guidelines meeting in November 2021 to ada...
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Background/Purpose A systematic review and meta-analysis were performed to better understand the benefits of particle beam therapy for nasopharyngeal cancer (NPC) treatment. The survival outcomes and toxicity of primary and recurrent NPC patients treated with proton or carbon ion beam therapy were investigated. Method PubMed, Scopus, and Embase we...
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The current understanding of genetic susceptibility factors for nasopharyngeal carcinoma (NPC) is still incomplete. To identify novel germline variants associated with NPC predisposition, we analysed whole-exome sequencing data from 119 NPC patients from Singapore with a family history of NPC and/or with early-onset NPC, together with 1337 Singapor...
Article
This commentary draws attention to the financial toxicities associated with cancer in low‐ and middle‐income countries from the perspective of Southeast Asia. It describes interventions at patient–provider, hospital, health care system, and national levels that may mitigate financial toxicity in the region and in similarly resourced parts of the wo...
Article
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Despite the conventional view that a truly random V(D)J recombination process should generate a highly diverse immune repertoire, emerging reports suggest that there is a certain bias toward the generation of shared/public immune receptor chains. These studies were performed in viral diseases where public T cell receptors (TCR) appear to confer bet...
Article
Background The treatment of radiation-induced brain injury (RI) caused by radiotherapy for head and neck cancer is challenging. Antiangiogenic therapy is a promising treatment. Apatinib is an oral tyrosine kinase inhibitor (TKI) that selectively inhibits vascular endothelial growth factor receptor (VEGFR) 2. We aimed to assess the efficacy and safe...
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Background Androgen deprivation therapy (ADT) and radiotherapy (RT) are the mainstay treatment for localized prostate cancer and recurrence after surgery. Cardiovascular (CV) toxicity of ADT is increasingly recognized, and the risk relates to pre-existing risk factors and ADT modalities. Despite ethnic differences in the prevalence of CV risk facto...
Article
273 Background: The Decipher 22-gene genomic classifier (GC) has been shown to predict for metastasis and survival in predominantly Caucasian and African-American men from Western cohorts. There is however little data on the clinical utility of GC in Asian prostate cancer (PCa). We investigated if GC prognosticates for metastasis-free survival (MFS...
Article
Aim: The second Asia-Pacific Advanced Prostate Cancer Consensus Conference (APAC APCCC 2020) gathered insights into the real-world application in the Asia-Pacific (APAC) region of consensus statements from the 3rd Advanced Prostate Cancer Consensus Conference (APCCC 2019). Methods: The 4-h our virtual meeting in October 2020 brought together 26...
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Background The COVID-19 has caused significant mortality and morbidity across the globe. Patients with cancer are especially vulnerable given their immunocompromised state. We aimed to determine the proportion of COVID-19 patients with cancer, their severity and mortality outcomes through a systematic review and meta-analysis (MA). Methods Syste...
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Objective: Treatment efficacy of androgen deprivation therapy with radical prostatectomy for intermediate- to high-risk prostate cancer is less well-studied. The NEAR trial is a single-arm, phase II investigation of neoadjuvant apalutamide monotherapy and radical prostatectomy (RP) in the treatment of D'Amico intermediate- and high-risk prostate c...
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Purpose A two-stage genome-wide association study was carried out in head and neck cancer (HNC) patients aiming to identify genetic variants associated with either specific radiotherapy-induced (RT) toxicity endpoints or a general proneness to develop toxicity after RT. Materials and methods The analysis included 1780 HNC patients treated with pri...
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In the ongoing COVID-19 pandemic, simple, rapid, point-of-care tests not requiring trained personnel for primary care testing are essential. Saliva-based antigen rapid tests (ARTs) can fulfil this need, but these tests require overnight-fasted samples; without which independent studies have demonstrated sensitivities of only 11.7 to 23.1%. Herein,...
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The cover image is based on the Discussion of Paper JUPITER-02 trial: advancing survival for recurrent metastatic nasopharyngeal carcinoma and next steps by Melvin Chua et al., https://doi.org/10.1002/cac2.12248.
Article
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Aims Ultra-hypofractionated radiotherapy (UHF-RT) is widely utilized in men with localized prostate cancer (PCa). There are limited data in Asian cohorts. We report the outcomes of a single-arm, phase II trial of UHF-RT from an Asian center. Methods We recruited men with histologically confirmed, nonmetastatic localized PCa. UHF-RT regimens were 3...
Article
In the past 100 years, external beam energy for the treatment of cancer has continually evolved. Two main modes have been developed. The first is radiotherapy which involves using x-ray, gamma, and proton beams to cause ionizing damage. The second is photodynamic therapy, which uses photons to activate photosensitizers to generate reactive oxidatin...
Article
Background and purpose This study aims to identify the optimal high-risk candidates for clinical trials in locoregionally advanced nasopharyngeal carcinoma (NPC). Materials and methods Non-metastatic NPC patients (n = 9468) were included. Recursive partitioning analyses (RPA) were performed to generate risk stratification. Receiver operating chara...
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Introduction A multi-disciplinary approach has often been advocated to improve the delivery of oncological care, as compared to a mono-disciplinary and linear approach. Our study elucidates the clinical and patient-reported outcomes from a urologic-oncology multi-disciplinary team (MDT) clinic in a regional general hospital. Materials and Methods...
Article
Purpose/Objective(s) Nasopharyngeal carcinoma (NPC) is a distinct head and neck cancer that is associated with Epstein-Barr virus (EBV). Its histomorphology is characterized by epithelial carcinoma that is admixed with immune cells. This cellular pattern concurs with whole exome sequencing (WES) profiles of NPC that reveal several recurrent mutatio...
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Background: The objective of this study was to construct a risk classification system integrating cell-free Epstein-Barr virus (cfEBV) DNA with T- and N- categories for better prognostication in nasopharyngeal carcinoma (NPC). Methods: Clinical records of 10,149 biopsy-proven, non-metastatic NPC were identified from two cancer centers; this comp...
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Nasopharyngeal carcinoma (NPC) is a malignant epithelial tumor, most commonly located in the pharyngeal recess and endemic to parts of Asia. It is often detected at a late stage which is associated with poor prognosis (5-year survival rate of 63%). Treatment for this malignancy relies predominantly on radiotherapy and/or systemic chemotherapy, whic...
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Background Weekly toxicity assessments for patients undergoing head and neck (HN) radiotherapy are essential to ensure that acute side effects are appropriately managed in order for patients to complete their treatment in a safe and timely manner. The incorporation of Advanced Practice Radiation Therapist (APRT) led treatment reviews has been repor...
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Despite improvements in radiotherapy, radioresistance remains an important clinical challenge. Radioresistance can be mediated through enhanced DNA damage response mechanisms within the tumour or through selective pressures exerted by the tumour microenvironment (TME). The effects of the TME have in recent times gained increased attention, in part...
Article
Purpose/objective: Risk-stratification for post-prostatectomy radiotherapy (PORT) using conventional clinicopathologic indexes leads to substantial over- and under-treatment. Better patient selection could spare unnecessary toxicities and improve outcomes. We investigated the prognostic utility of unfavorable subpathologies intraductal carcinoma a...
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Objective Our aim was to compare the clinical outcomes of patients treated with bevacizumab combined with corticosteroids and those with bevacizumab monotherapy from a radiation-induced brain necrosis (RN) registry cohort (NCT03908502).Methods We utilized clinical data from a prospective RN registry cohort (NCT03908502) from July 2017 to June 2020....
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Objective To report the long-term clinical outcomes of low-risk (LR) and intermediate-risk (IR) prostate cancer patients treated with low-dose-rate brachytherapy (LDR-BT) and external beam radiation therapy (EBRT). Patients and Methods Men with biopsy-proven low- and intermediate-risk prostate cancer received EBRT and LDR-BT in an Asian academic c...
Conference Paper
Nasopharyngeal carcinoma (NPC) is an endemic disease prevalent in East Asia and germline variants that confer risk for NPC have previously been identified. However, NPC patients have contrasting phenotypes at presentation that are associated with disparate risks of relapse. We hypothesize that there exist germline variants that are associated with...
Conference Paper
p>Radiotherapy (RT) is a primary treatment modality that is used in 50% of cancer patients. Clinically, tumor radioresistance poses a challenge to achieve complete anti-tumor response following conventional photon-RT. Diverse mechanisms have been proposed to underpin radioresistance. However, targeting these aberrant pathways to overcome tumor radi...
Article
6005 Background: We conducted a multicenter, randomized controlled phase III clinical trial (NCT02143388) to investigate the efficacy and toxicity of adjuvant capecitabine (AC) in addition to concurrent cisplatin and radiotherapy (CCRT) compared to CCRT alone in high-risk locoregionally advanced nasopharyngeal carcinoma (LANPC) patients. Methods: E...
Article
Introduction Head and neck reconstructive surgery using a flap is increasingly common. Best practices and outcomes for postoperative radiotherapy (poRT) with flaps have not been specified. We aimed to provide consensus recommendations to assist clinical decision-making highlighting areas of uncertainty in the presence of flaps. Material and method...
Conference Paper
Radiotherapy represents a main treatment modality for cancers. However, a subset of tumors manifest resistance to radiotherapy. Mechanistically, this is opined to occur via selection of de novo radioresistant (RR) clones and subsequent adaptation leading to an aggressive tumor phenotype. To better understand the molecular processes underpinning thi...
Conference Paper
Many primary tumor sub-regions have low levels of molecular oxygen, termed hypoxia. Hypoxic tumors are at elevated risk for local failure and distant metastasis, but the molecular hallmarks of tumor hypoxia remain poorly defined. To fill this gap, we quantified hypoxia in 8,006 tumors across 19 tumor types. In ten tumor types, hypoxia was associate...
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Background There is no standard-of-care for recurrent, metastatic nasopharyngeal carcinoma (rmNPC) after first-line chemotherapy. Here, we report the efficacy and safety data of apatinib in rmNPC patients. Methods Thirty-five biopsy-proven rmNPC patients received apatinib at 500 mg/day under a compassionate access programme. Primary end-point was...
Article
(Max 250 words) Despite numerous advances in cancer radiotherapy, tumor radioresistance remain one of the major challenges limiting treatment efficacy of radiotherapy. Conventional strategies to overcome radioresistance involve understanding the underpinning molecular mechanisms, and subsequently using combinatorial treatment strategies involving r...
Article
249 Background: A 22-gene GC has been proposed to refine risk stratification of localized PCa by conventional NCCN criteria, and this may potentially influence treatment recommendations. Nonetheless, majority of studies looking at the utility of GC were conducted in White and non-White men from Western cohorts. We therefore investigated the associa...
Article
Purpose Re-irradiation for locally recurrent nasopharyngeal carcinoma (NPC) is challenging as prior radiation dose delivered in the first course is often close to the tolerance limit of surrounding normal structures. A delicate balance between achieving local salvage and minimizing treatment toxicities is needed. However, high-level evidence is lac...
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Full-text available
Background Germline ATM mutations are suggested to contribute to predisposition to prostate cancer (PrCa). Previous studies have had inadequate power to estimate variant effect sizes. Objective To precisely estimate the contribution of germline ATM mutations to PrCa risk. Design, setting, and participants We analysed next-generation sequencing da...
Article
Importance The coronavirus disease 2019 (COVID-19) pandemic has burdened health care resources and disrupted care of patients with cancer. Virtual care (VC) represents a potential solution. However, few quantitative data support its rapid implementation and positive associations with service capacity and quality. Objective To examine the outcomes...
Article
PURPOSE The aim of this joint guideline is to provide evidence-based recommendations to practicing physicians and other healthcare providers on definitive-intent chemoradiotherapy for patients with stage II-IVA nasopharyngeal carcinoma (NPC). METHODS The Chinese Society of Clinical Oncology (CSCO) and ASCO convened an expert panel of radiation onc...
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Full-text available
Nasopharyngeal cancer (NPC), endemic in Southeast Asia, lacks effective diagnostic and therapeutic strategies. Even in high-income countries the 5-year survival rate for stage IV NPC is less than 40%. Here we report high somatostatin receptor 2 (SSTR2) expression in multiple clinical cohorts comprising 402 primary, locally recurrent and metastatic...
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Full-text available
A commercial deep learning (DL)-based automated segmentation tool (AST) for computed tomography (CT) is evaluated for accuracy and efficiency gain within prostate cancer patients. Thirty patients from six clinics were reviewed with manual-(MC), automated-(AC) and automated and edited (AEC) contouring methods. In the AEC group, created contours (pro...