Most cancer treatment guidelines are built on research from the U.S. and Europe, but according to Dr. Szu-Yuan Wu, these guidelines may not be ideal for Asian populations. During a break between his responsibilities as a physician, researcher, and educator, Dr. Wu spoke with Spotlight about his work.
The hardships faced by patients with esophageal cancer are a strong motivation behind Dr. Wu’s research. Treatments often mean a difficult regimen of chemotherapy, radiation, and radical surgery to remove cancerous tumors, along with much of patients’ facial structures. “[My patients] can’t eat, they can’t speak, they lose much of their face… How can I prevent local recurrence?”
Until now, most research used combined populations of patients with both subtypes of esophageal cancer: squamous cell carcinoma and adenocarcinoma. But Dr. Wu felt that genetic differences between research populations might not lead to ideal treatments in Asia, where more than 90% of Chinese and Taiwanese patients suffer from squamous cell carcinoma. “I always found differences between Western and Asian populations. Squamous cell carcinoma is common in Asia, but not in the West,”
He addressed the difference in three studies published in Cancer and Radiation Oncology last year. Taiwanese patients with squamous cell carcinoma did indeed benefit from treatments that differed from existing Western guidelines. For patients with stage 1 or 2 disease, either chemoradiotherapy or surgery alone were effective, while patients with stage 3 and 4 disease benefited from a higher dose of radiation; one that could even be an alternative when surgery is not an option.
Dr. Wu thinks genetic differences likely influence other cancers as well. In Taiwanese with head and neck cancer, genetic interactions with betel nut chewing, smoking, and drinking may cause localized tumor recurrence not seen in Western patients. Taiwanese women with left side breast cancer have heart failure rates double that of women in the West, and drinkers with ALDH2 deficiency (a mutation found in a third to a half of Asians) have markedly higher levels of both squamous cell carcinoma and liver cancer.
This has important implications for cancer treatment guidelines in Taiwan, and across Asia. “If we always copy the NCCN (National Comprehensive Cancer Network) or the European guidelines, treatment for Asian patients I think it’s not reasonable…We should set up our own guidelines, because the disease and genetics are different. We cannot always follow Western guidelines.”
Dr. Wu wants to build Taiwan’s capacity for research through his position as an educator and research leader at Taipei Medical University. Speaking as a guide to the next generation of cancer researchers he said, “We have the responsibility to improve treatment outcomes for Taiwanese patients… If you want to be a physician-scientist, you can go to our lab where we can give you a good template for cancer epidemiology research. If you are interested in clinical trials, you can join us.”