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International Physician Update
| HOPKINS DOCTORS CIRCLE THE GLOBE |
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Researcher Sets Up Lab in Singapore to Study Rare Cancer
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| The Hseihs in Singapore: Francesca, Katherine and Wen Son. |
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The Epstein-Barr virus is a mysterious pathogen that most people in the world encounter at some point in their lives without even knowing it. In healthy young adults, EBV can cause mononucleosis, or in someone who’s severely immunosuppressed, it can trigger certain lymphomas. Most people simply develop an immunity to the virus without ever getting sick. But for certain groups of Asians, particularly those from south China, the same virus acts in a much more dangerous way—spreading a tumor of the endothelial tissue in the nose and throat called nasopharyngeal carcinoma, or NPC.
The good news is that a lab team at Hopkins has been making great strides in understanding this mystifying virus. For example, the group has deciphered how EBV hides itself in tumor cells and even developed a plan for treating NPC. And Wen Son Hsieh, a post- doctoral fellow in the group, had hoped to continue those studies. But there was a problem. He needed to study the cancer in patients, and patients with NPC just don’t turn up in the United States.
Then, Hsieh got a stunning job offer from oncologist Richard Ambinder, head of the lab team. Ambinder asked him if he’d like to spend three years as a researcher in Hopkins’ recently established branch in Singapore. Called Johns Hopkins Singapore, the ultramodern facility collaborates with Singapore’s National University Hospital, which has its sights set on becoming the leading center for cancer care in its part of the world. By putting Hsieh on site in Singapore, says Ambinder, “suddenly we had an opportunity to get the answers to crucial questions. What was the virus’s role? Why was it causing this cancer and not others?”
On the tiny island, Hsieh found a country burgeoning with energy for the biomedical sciences. “Singapore,” he says, “is building the infrastructure to be a leader in medicine. It’s amazing to be part of the development from the ground up—and because decisions about funding or building tend to be made by a small number of people, things can happen quickly.”
Hsieh now sees as many as five patients a week who have the mysterious cancer he studies. More prevalent in men than in women, the disease hits with flu-like symptoms: blocked hearing, sinus congestion and nose bleeds. It runs in families, but nobody knows why this population of Asians is at risk. In clinical trials, one of his tactics will be to use a vaccine that goes after EBV proteins to impel the immune system to assault first the virus and then the tumor. Hsieh also will use a chemotherapy agent called 5-azacytidine to try to block the destructive cascade the virus trips once it’s inside the cell. Both tactics may work with other cancers.
Singapore patients tend to ask fewer questions about potential new therapies than Americans, Hsieh finds, but are just as likely to say no when it comes to testing them. His Mandarin Chinese has proven a distinct benefit in explaining the pros and cons of participating. “The questions patients ask,” he says, “are very much like at home, and most are well informed. They’ve gotten information off the Internet.”
But as with almost everything else, what Hsieh senses most about practicing medicine in this shiny, tiny country on the other side of the world is an infectious feeling of excitement, “not like any kind of experience you could have in the U.S. or Europe. I can imagine,” he says, “staying right here way beyond three years.”
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