Why Asian patients need medicines designed for them
For decades, much of the pipeline of medical innovation has flowed from West to East. Now a string of companies are attempting to upend that trend with new drugs and products tailored to Asian bodies and lifestyles.
There’s the Singapore-based drugmaker tackling an obscure cancer that’s rare in the West but common in Asia, where it’s been linked to a popular fish dish. Med-tech startups are preparing to sell tests to detect tumours more accurately in Asian women with denser breast tissue, including one wearable device that slips into a bra. Even Big Pharma firms like AstraZeneca Plc and Roche Holding AG now have drugs targeting a lung cancer-causing mutation most often found in women from East Asia.
This simple yet radical departure comes as Asia’s booming economies and rising incomes enable higher spending on health care. That’s providing incentive for more pharmaceutical companies to set up shop in the region, whether it’s Western firms creating R&D centres to develop drugs for local populations, or new Asian drugmakers springing up. Consultancy Frost & Sullivan predicts that total revenue for the Asian health-care industry will jump 11% this year to $517 billion.
Many of the researchers focusing on Asia have a simple starting point: Diseases and their cures can sometimes work differently in different populations, and a one-size-fits-all regimen tailored to the West isn’t sufficient. The approach is cropping up most often in cancer care in Asia, home to tumours that are rare in the West.
“The patients are here, the tumour samples are here, and also the basic know-how,” said Brigette Ma, a professor at the Chinese University of Hong Kong who specialises in new drug development. “By acknowledging diversity, not just in cultural and economic needs — by acknowledging diversity in terms of cancer care — we are getting the drugs to where they are needed.”
The shift is part of a broader trend sweeping through the global health-care industry called precision medicine, which seeks to tailor treatment to a person’s specific genetic make-up and circumstances, including the ones commonly shared among people of the same ethnic group or culture.
In Asia, Japan has long been an important market for the health-care industry, and a site of new discoveries. But the rapid growth of the rest of the region is heightening its importance as a whole, and diversifying the industry’s focus in it.
Singapore-based biotech company Aslan Pharmaceuticals is now conducting late-stage human tests for a drug targeting bile duct and gastric cancers. The prevalence throughout Asia of a stomach-infecting bacteria which can lead to cancer-causing inflammation is one factor that makes gastric cancer more common in the region. But research suggests it usually takes even more culturally specific traits, like the aggravating diet of salty and fermented foods common in Northern China, Korea and Japan, to turn that inflammation cancerous.
Northeastern Thailand, meanwhile, is the global centre for an obscure disease called bile duct cancer. Rare in the West, researchers have traced its prevalence in certain parts of Southeast Asia to a fermented fish dish called koi pla beloved by the area’s Lao people. The cooking process for the dish often fails to kill an inflammation-causing parasite called the liver fluke, and the infection can eventually lead to bile-duct cancer.
‘There are very few effective treatment options for these patients,’ said Carl Firth, Aslan’s chief executive officer. ‘The focus was very much on cancers that were common in the West.’
Aslan has received orphan drug status for its lead molecule in the US as a potential treatment for biliary tract and gastric cancers, and is seeking approval to sell it both there and in China. When it comes to patients in less affluent parts of Asia, like bile duct cancer patients in Thailand, Firth said his company could look for ways to help them access the drug after completing its clinical trials.
Meanwhile, by controlling for both ethnicity and gender, researchers over the last decade have established that a particular cell mutation, which causes lung cancer even in non-smokers is much more common in Asian women than anyone else. This discovery has since opened the door for two multinational pharma companies, AstraZeneca and Roche, to develop and bring to market therapies that specifically target these parts of the cell, and so have proved to be particularly effective in Asian patients.
And when it comes to breast cancer, just diagnosing it in the first place can be harder because research shows Asian women are more likely to have denser breasts than Caucasians. That can obscure the tumour on a mammogram, leading doctors to miss it entirely or sometimes mistakenly identify one that isn’t there. A host of start-ups have sprung up to tackle the problem.
In Singapore, a company called MiRXES plans to launch a test that will examine patients’ blood for microscopic particles that are byproducts of tumour growth, while another firm based in the city state, Nova Satra Dx, has developed a test that checks chemical changes in how cells read their own DNA for signals they’ve turned cancerous. Meanwhile, Reno, Nevada-based health tech startup Cyrcadia Health has set up a unit in Hong Kong to launch a bra that picks up metabolic changes which may signal development of a tumour.
All these differences have led to postulation of an ‘Asian phenotype’, a distinctive way Asian people’s genes are expressed because of biology and environment. Where traditionally the health-care industry would seek approval for new products in the West before bringing them to Asia, now more firms are planning to go the other way for some diseases.
“These patients really need the drugs in Asia,” said Vishal Doshi, whose drug development startup AUM Biosciences is focusing on therapies for Asia-prevalent cancer. “This is what I term an East to West philosophy, from a West to East philosophy.”