Meet the Singapore Specialist: Medical Oncologist Dr Tan Yew Oo

He was one of Singapore’s first medical oncologists and now in his late seventies, Dr Tan Yew Oo is one of the oldest practising oncologists, seeing cancer patients daily and striving to make a difference. Born in Malaysia, the father of two and now grandfather has enjoyed an enduring career that has taken him around the world, working in the United States and Canada, enabling him to witness the arrival of new therapies like molecular targeted agents and immunotherapies that have changed the treatment landscape and helped many patients with some cancers to live longer, with better quality of life.

Dr Tan loves his work and continues to inspire the next generation of oncologists to deliver best practice, evidence-based care.  His career has been marked with some wonderful highs – like the time a young mum given no chance to live defied all the odds. But there have also been some devastating lows because, he says simply, oncology and mortality are the ultimate levellers “and the day we are born, we are destined to die”. In the low times he turns to his faith – he is a practising Catholic – and encourages patients and their families to seek solace in any kind of spirituality. At this stage, Dr Tan has no plans to immediately retire, and predicts the next leap forward in oncology will come from new targeted immune-mediation agents being discovered for difficult to treat cancers and potentially, from the use of mRNA technology (made famous in the manufacture of COVID vaccines) to treat cancers.

 

In 2011, a young cancer patient Mary (not her real name) arrived in Dr Tan’s Singapore office.

He recalls their first consultation well. She was a mother with young children, who was living with advanced lung cancer. She was desperate to live longer, but it was clear to Dr Tan that time was fast running out.

Already, some of the region’s specialists had advised that the only option remaining for Mary was hospice care, to keep her comfortable. She had been advised to “prepare for the end”.

But Dr Tan did not want to give up. Every patient, he says, has their own story and he believes specialists must take a holistic approach, and consider all parts of a family network when treating patients. Mary was a mother and a breadwinner on whom her family relied.

So, as targeted therapies were beginning to emerge on the oncology treatment landscape, he ordered another biopsy, to try and determine if there was a ‘molecular driver’ igniting her cancer.

Doctors discovered this lady had an ALK (anaplastic lymphoma kinase) gene rearrangement, a genetic mutation in the DNA of lung cells that occurs when two genes fuse and the cancerous lung cells can replicate rapidly and spread to other parts of the body.

Dr Tan kept musing about this case, determined to find another treatment if it existed.

“If you find a molecular driver you can extend a patient’s life, a lot.”

He remembered studying a presentation at the annual American Society of Clinical Oncology conference, or ASCO, a convention attended by the world’s cancer specialists every year.

Data had been shared about a targeted drug called crizotinib that targeted ALK mutated lung cancer and was showing some success. He thought it was “worth a shot” for this lady and so decided to approach the drug company who marketed the therapy to see if they would consider supplying it on compassionate grounds, as there was nothing else left.

He recalls now, “And she had a fantastic response. It was amazing. She went into remission and has remained there for more than ten years. She remains on therapy but is very well and actively working. I warned her it might work for a couple of years and then the cancer would become resistant. It has not. When I first saw her, her children were still young. Now her daughters are married, and her husband has had a stroke and passed away. She was taking care of her elderly mother; now her mother has died. She has outlived them all. I use her as an example as to why we should never give up hope and why we must never stop trying to help patients.”

 

Dr Tan and Mary at a presentation in 2017

 

But Dr Tan concedes that for every success in oncology, there are many other patients who pass away despite the very best efforts, treatment and care.

“People often ask me, ‘Don’t you get depressed?’ But I believe that every patient who presents with advanced disease is a challenge, and everyone is unique in trying to overcome that challenge. Many times, you are able to prolong life and ameliorate suffering.”

And he knows that every family can be touched by cancer – even his own. Despite his vast experience, he admits even he feels helpless when it is close to home.

A 38-year-old nephew has been recently diagnosed with a rare lymphoma known as NK/T-cell lymphoma and requires treatment with “very intense chemotherapy and radiation” but has limited financial resources.

“I am trying to find ways to treat him where he is in Malaysia, or to find out how to bring him to Singapore in an affordable way. He is a bachelor, self-employed with a girlfriend and not from a rich family. He has a limited insurance plan. These are the things he is grappling with, and which many families grapple with. I am doing what I can and having a pathologist re-investigate his diagnosis so we can make sure we get the compass right to point in the right direction. I have made contact with a haematology colleague in my nephew’s hometown who is willing to follow the chemotherapy regime used successfully in Singapore. He has now started on this program. But when anyone is impacted by any kind of cancer, it is very hard and no family is immune.”

The gratitude Dr Tan inspires is acknowledged by patients who keep in touch at times like Christmas and Chinese New Year. Some patients have become personal friends and he has been invited to family weddings and anniversary celebrations. His own reward is seeing them continue successful, healthy lives where they can spend more time with their families.

At this stage, he has no immediate plans to retire. “I am an ancient old man who is trying to stay active mentally and physically,” he laughs. “I enjoy my work so much that I want to continue what I am doing. But I am now in my late seventies. It took me ten years of working in Singapore at the beginning of my career to have medical oncology recognised as a sub-specialty of internal medicine. At the time there were fewer than 10 anti-cancer agents and now there are hundreds. There has been an explosion in the number of cytotoxic drugs, anti-cancer hormonal agents, molecular targeted therapies, antibody drug conjugates and immune checkpoint inhibitors. There is still a long way to go to improve the outcomes of difficult to treat cancers like pancreatic, gall bladder and colorectal cancer, as well as sarcoma and brain tumours. “I have seen a lot already, but I hope to see the advent of new therapies such as CAR T-cell therapy or even gene therapies that will improve survival outcomes for these cancers.

“I am not ready to go and leave the exciting future just yet.”

*March 2022.
Besides patient care, Dr Tan has served many public healthcare bodies and institutions, including the MediShield Life Council (MSLC), the Anticancer Therapy Committee looking at cost containment, the SingHealth Cluster, MOH National Cancer Care Committee and the Proton Advisory Committee. He was awarded The Public Service Medal by the President of Singapore in 2020.



MedNews: 9 March, 2022

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MedNews

By Megan Brodie 2022

ST Boss is Comfortably Outnumbered

Carlo Montagner (centre) with some of ST’s female employees.

 

At homegrown pharma company Specialised Therapeutics, 82 per cent of employees are women, three in every four employees is aged over 40, and nine of the 12 executive team members is female.

Age, gender, and ethnicity are not a consideration when hiring, says CEO Carlo Montagner, who instead employs people that best fit with the values of the business he co-founded with his wife, Bozena Zembrzuski.

“We are not gender-quota focused, we are just focused on the needs of the business,” Montagner says. “When hiring, we focus on the values of a person and ask ourselves, ‘are those values consistent with the values of the company?’ That is paramount. Everything else is a distraction.”

While this perspective has resulted in Specialised Therapeutics’ (ST) workforce being heavily skewed towards females, Montagner is more than comfortable being among a minority of male employees at the company – and he thinks it is good for the business.

“Are we concerned that our workforce comprises too few men? No, it has never come up in any leadership discussions, or any other discussion,” Montagner says. “Those sorts of attributes are not a factor in our recruiting policy.

“We have just hired a woman over 60, meaning we now have three women aged over 60, and neither their age nor their gender was ever a factor in our decision making. We were purely focused on their talent and competencies.

“We have always sought the best candidates for a role regardless of gender, age or ethnicity. It is all based on merit.”

Montagner is not alone in Australian pharma in being a male leader who strongly supports women, although he credits three women in particular for helping shape his perspective: his wife Bozena, his mother, and Merck Healthcare CEO Belén Garijo.

Zembrzuski had her own successful pharma career when they founded ST, says Montagner, adding she was “very, very good at what she did”.

“There are a lot of decisions made that look on the surface like they have come just from me, but they have come after lengthy discussions and guidance from Bozena,” he adds.

Montagner says his mother was a great mentor and role model for him as she worked six days a week for 40 years running a factory while managing the family finances.

“She ran everything,” he says while with Garijo, he “inherited her as a boss” when they both worked at Aventis in the US.

“I had absolutely no issues and learned a lot from Belén in terms of drive, tenacity and real persistence in getting very difficult jobs done. I also learned about managing upwards because she was very good at managing the senior executives at Aventis, which at the time was a huge company.

“I have always had very strong women in my life so am extremely comfortable being in a situation where ST employs so many women. For me, it is normal.

“Women offer a degree of empathetic perspective that men sometimes don’t have. They also tend to be less ego-driven and more focused on the task. Speaking in general terms, men can be distracted by other factors that are not really at the core of the issue that needs to be resolved.”

With a career spanning three decades in the pharmaceutical industry, Montagner is not surprised the industry now employees more women than men and believes pharma “lends itself to attracting and retaining women in key roles”.

“It is a great industry for women to aspire to work in,”; he says. “You see women staying in the industry for pretty much their entire career – the age profile in our company reflects that.

“It is good for women to know that the statistics demonstrate this is an industry that really celebrates and supports people’s longevity. I would describe it as a highly-professional environment.”



Pharma in Focus: 10 February, 2022

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PHARMA IN FOCUS

By Christine Spiteri 10 February 2022

Who’s Mandated a Third Jab?

Specialised Therapeutics has made a third COVID-19 vaccine compulsory for all staff, to ensure a safe office environment for employees returning to work.

The team was told on Christmas Eve last year that booster shots for those who were eligible would be compulsory for going back to the office in 2022.

“We’re in the pharma industry, we understand how to interpret data and it was really becoming very obvious early in December that a booster was required – not only to protect against the emerging Omicron but also to protect against Delta,” CEO Carlo Montagner said.

“What I’ve said to all our staff is that we want to offer you the most controlled and safe workspace to operate in – much safer than you being at home, or going out to the supermarket.”

The mandatory third jab applies to all staff, including those working in the company’s offices located overseas, as well as visitors.

In addition, the Melbourne-based pharma is supplying employees with RAT tests, the results of which must be photographed with a timestamp and sent to HR prior to attending the office. Twice weekly tests are required of those in the office five days a week, once for those attending three days.

As well, social distancing has been increased by three to four times the minimum 1.5 metre rule and masks must be worn indoors at all times.

Mandatory office days

The Covid safety measures support a second mandate by the company that all core staff – about 20-25 employees – work from the office on Monday, Tuesday and Wednesday of every week.

Montagner said working remotely had slowed the company down. “Not having people together – at least the core group – makes communication difficult,” he said.

“I would say it’s 30 to 40 per cent harder to achieve the same outcome as working in the office together.

“It’s the simple things – you call somebody because you need to talk to them about something and you can’t reach them for whatever reason, then you need to follow up that call.

“Those sorts of incidental occurrences, every day of the week, happening multiple times in the day – soon you have this snowball effect and you have to work harder to reach the same outcome.”

“It’s time-consuming and tiring and fatiguing.”

Montagner said while staff were still allowed flexibility with their working hours plus Thursday and Fridays working from home, a complete ‘laissez faire’ approach to office attendance doesn’t work for pharma. “I think it’s a very short term philosophy to leave it up to staff to decide whether they come into the office or not,” he said.

“Yes, in some industries that would work. But in our industry where the logistics required to get a drug physically available in a chemist for a patient to access – it’s enormous.

“We need to remember we are working to produce an outcome that impacts people’s lives. For us we’re in the cancer space predominantly – and at the end of the day we have to make sure we have these drugs available for patients.

“That’s what it comes down to.”



World Cancer Day 2022

Rare Cancers Australia CEO Richard Vines discusses affordable access to specialist medicines. Click for more.

 



Skylark – WA oncologist Dr Andrew Dean shares his passion for aviation

As a young boy, Andrew Dean was fascinated with aeroplanes.  But the son of Liverpool publicans quickly realised that flying lessons were a lofty pursuit his family probably could not afford. It was many years later, after training first as a palliative care and internal medicine physician that the medical oncologist decided his sky-high ambition was finally within reach. At 36, he began thrice weekly flying lessons. Four months later, he was a qualified pilot. Now, in his pride and joy, a Cirrus with the number plates India Charlie Echo (or “the ICE baby”) he bypasses bustling freeways and heads as high as 17 and a half thousand feet above the clouds to visit patients every week in Geraldton, a regional WA town that’s a five hour drive from Perth but takes this skylark just over an hour. Andrew says the journey is great thinking time, constantly exhilarating and always breathtaking. That’s not to say he’s never had a worrying moment. In his glass-cockpitted, blue and silver pride and joy, he’s traversed Hamilton Island, Broome and Ayers Rock. Sometimes, he’ll even offer a lift to country patients who need to get to the city in a hurry. For the self-described “aviation geek”, this passion for all things airborne goes well beyond a hobby. Still, he muses, there are some definite parallels between treating cancer and flying planes. And, at the end of the day, the cancer patients he treats always bring him back to earth.

What sparked your aviation obsession?

I just loved flying, since I was a little boy. I didn’t do anything about it because I probably couldn’t afford it. Never once did I dream I would be able to do it. I looked at planes enviously and thought how amazing it would be to be flying above the clouds. Then, in 1998 when I was 36, I just decided it was about time I learnt to fly. I took myself down to the aero club, did about three lessons a week and four months later got my pilot’s license. I was just hooked from the first moment.

Describe the experience for the uninitiated.

You race down the runway, you see everything flashing by your periphery. As you pull back it is just this soaring sensation … you see everything below you and it’s like you just leave all the worries of the world behind you. Then, when you soar above the clouds, you see this carpet beneath you. It might be grey and raining below, but when you soar up through this hole, it can be sunny and below you is just this carpet of cotton wool cloud. Although it is very technical, it’s so absorbing but so relaxing and exhilarating all at the same time. Bizarrely, when I land I feel as if I have had a massage. I get in the car and I usually start yawning.

Scariest moment?

I have had an electrical failure at night, when there is no moon, no stars and no light.

I was flying over (WA’s) Cervantes, doing a leisurely orbit over the Pinnacles. Suddenly I realised that the strobeascopes on the wings, instead of blinking every couple of seconds, were blinking about every 10 seconds, and I thought, ‘uh oh’. I literally switched absolutely everything off in the aircraft and hoped there would be some residual battery. As darkness fell, there was no moon and no stars. I had to navigate with a compass and a little red torch that you carry at night time. As we got close to the city, I put the radio on and put out a call.

They said how many POB – short for how many people on board. It really means how many body bags are required.

They told me to contact them again over the coastline, and they said we will put the lights on at Jendicott (airport). It was difficult to land because you can’t put the flaps down, you have to come in quickly and you are landing without lights and putting gears down by hand.

Obviously it all worked, thankfully. Through all of this my passenger was pretty calm. He was the head of a bomb disposal squad in Hong Kong and used to sitting on top of unexploded bombs. He was more bemused that I did not realise sooner that the electrics had failed.

Do oncology and aviation have any parallels?

They are both fascinating, absorbing and you learn something new every day. You learn something new every time you fly. Like every patient is different, every flight is different. Both require 100% attention and both are very rewarding. You get used to thinking on your feet when problems crop up. As in oncology, you have a standard way of dealing with problems.

What do your patients think?

When you have somebody who is sick in Geraldton, it is nice to be able to say, ‘you really need to get down to Perth and do you want me to give you a lift down there tonight?’

You do get a good chance to talk with them and I think it’s inevitable that you form a bond. In oncology, you meet so many different people from so many walks of life. It is a privilege to know people in that way.



Professor John Zalcberg reacts to the QINLOCK® (ripretinib) PBS listing

ST is delighted to announce that our therapy QINLOCK® (ripretinib) was reimbursed for eligible Australian GIST patients from December 1 2021. International GIST expert Professor John Zalcberg reacts to the listing. Click for more.

 



Pharma in Focus: 21 December, 2021

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PHARMA IN FOCUS

By Christine Spiteri 21 December 2021

Job Boom Hits Growing Pharma

Specialised Therapeutics is experiencing a mini-jobs boom, with the company’s growing portfolio and expansion across South East Asia requiring a boost to its workforce.

The company currently has a staff of about 40 but is actively looking to fill five new positions with more roles opening up in the next 24 months.

“We’re going through quite an expansion at the moment – our portfolio is continuing to grow and we have several more partnerships we’re close to announcing for branded specialised therapies,” CEO Carlo Montagner said.

“What we’ve projected over the next two to three years is probably an increase of another 50 to 60 per cent of staff.”

Jobs currently up for grabs include Head of Quality Assurance; Scientific Medical Advisor – Oncology/Haematology and Pharmacovigilance Manager South East Asia.

Although the company is headquartered in Melbourne, its Singapore office is about to move to bigger premises as the company expands its footprint in Asia.

In addition to licenses to supply approved products to Australia, New Zealand, Singapore and Malaysia, Specialised Therapeutics also has regulatory applications under evaluation in Thailand, Vietnam and the Philippines.

“Our goal is always to partner with two new companies a year or two new products per year – that’s our minimum threshold, so we have very active business development discussions continuously,” Montagner said.

“We have new products for the portfolio but we are also starting to ramp up our south-east Asia operations.”

Tough jobs market

Montagner said seeking regulatory approval and offering access programs in multiple countries had created logistical challenges and demand for more staff.

“These are all below the commercial line functions – so not a lot of visibility to the general public – but these are key functions to operate efficiently as a pharmaceutical company,” he said.

The jobs market is hot, according to Montagner who said medical roles, particularly, can be a challenge to fill. But he said Specialised Therapeutics, a company he started with his business partner and wife in 2008 has the edge on traditional Big Pharma when it comes to landing top talent.

“What we offer is variety,” he said. “The benefit of our company is that we choose who we partner with and the products that we take on board.

“So, with pharmaceutical companies that have a pipeline of drugs, you really just accept whatever comes down that pipe and you’re beholden to the quality of that pipeline and the therapeutic areas that the company wants to strategically invest in.

“We have an amazing pipeline of drugs, companies would kill for the pipeline that we have already.

“And we know what we’re doing. We have the expertise, the infrastructure, the resources and the planning in place to ensure we optimise the commercialisation of these products.

“We partner with multiple companies – European based, US-based and we’re hopefully close to doing our first China deal.

“We have this breadth of partnerships over multiple geographies, multiple product therapeutic areas, we’re dealing with lots of different people. We’re launching in multiple countries with new products.

“It’s a really exciting time to be in our company.”



Renee’s GIST Experience

Melbourne mother of two Renee Van Beelan was diagnosed with GIST (Gastrointestinal Stromal Tumours) almost five years ago. Her baby daughter was just eight weeks old and the devastated new mother did not know what the future held. New therapies provide hope for the future. Click on the video above to hear Renee speak about her life changing diagnosis.

 



Comment: Rare Cancers Australia CEO Richard Vines

Rare Cancers Australia CEO Richard Vines says Australian GIST patients were determined to help achieve a PBS listing for a new therapy to treat the disease and their persistence has paid off with QINLOCK® (ripretinib) now reimbursed. Click for more.

 



Medical Oncologist Professor John Zalcberg explains gastrointestinal stromal tumours – GIST

What is GIST? We are passionate about making a difference for patients living with rare cancers. Here, Professor John Zalcberg provides an overview of Gastrointestinal Stromal Tumours. Click for more.