Precision medicine approach improves treatment for soft tissue sarcomas

A study conducted by researchers from the Agency for Science, Technology and Research (A*STAR), National Cancer Centre Singapore (NCCS) and National University of Singapore (NUS), in collaboration with biotech company, KYAN Technologies, has demonstrated that a precision medicine approach improves treatment selection for patients with soft tissue sarcomas (STS) in a clinical setting. Published in npj Precision Oncology in March 2025, the study's findings support using data-driven and phenotypic screening approaches to treat STS.

STS are rare, heterogeneous tumors that account for less than 1% of all cancers globally. However, they disproportionately represent a significant portion (20%) of pediatric and young adult malignancies, affecting individuals in the prime of their lives. The challenge in treating STS is that conventional chemotherapy often yields unpredictable and poor results. As the biological diversity of these tumours and their rarity have made conducting large-scale clinical trials difficult, researchers postulated that the best way to target STS would be through a precision medicine approach, analyzing each patient's unique tumour characteristics to potentially improve response rates and reduce toxicities.

The research team utilised the Quadratic Phenotypic Optimisation Platform (QPOP) to apply precision medicine approaches to treat STS. QPOP uses data-driven, phenotypic screening to identify effective cancer treatment combinations from a panel of approved drugs and investigational treatments, with a turnaround time of 7 days. The team:

1. Analysed if QPOP was clinically accurate in predicting drug sensitivity by screening the tumour samples of 45 primary STS patients – the largest reported ex vivo drug testing cohort to date. Results showed over 70% of patient responses to standard of care treatments matched with results from ex vivo testing in QPOP, validating the accuracy and reliability of the platform.
2. Identified unconventional personalised drug combinations through QPOP for a subset of STS patients unresponsive to standard treatments. These targeted approaches were used to select treatments for two patients who had compelling clinical responses. This application underscores the potential of functional precision medicine to identify alternative treatment strategies for complex and treatment-resistant STS.

3. Explored the use of QPOP to identify new treatment combinations for STS, thereby discovering that the combination of AZD5153 (a BRD4 inhibitor) and pazopanib (a multi-kinase blocker) is more effective than standard treatment across multiple STS subtypes. This was further validated in the lab in patient-derived cell lines and in vivo models. The combination therapy effectively repressed MYC, a well-known oncogene that is difficult to target, and other related pathways that play critical roles in STS and various other cancers.

The study was led by Assistant Professor Valerie Yang, Visiting Consultant in the Division of Medical Oncology at the National Cancer Centre Singapore (NCCS) and Joint Research Clinician and Group Leader at the A*STAR Institute of Molecular and Cell Biology (A*STAR IMCB), with co-corresponding authors from NUS, Dr. Tan Boon Toh and Dr. Edward Kai-Hua Chow, with bioinformatics expertise contributed by Dr Xing Yi Woo of A*STAR Bioinformatics Institute.

"This work is game-changing for several reasons. We show that ex vivo drug testing of patient-derived cells in these rare cancers can not only accurately predict patient responses to drugs but can also provide important information to derive good disease control in selected cases in patients who have exhausted all treatment options. What is also exciting is the novel drug combination that was identified may supersede existing treatment for soft tissue sarcomas," said Asst Prof Yang.

This study marks a pivotal step toward transforming how we treat rare and aggressive cancers like soft tissue sarcomas. By leveraging QPOP to match patients with optimised drug combinations based on their tumor biology, we move closer to realising the promise of functional precision medicine - offering real hope for better outcomes where conventional therapies have fallen short."

Dr. Tan Boon Toh, Head of the Translational Core Laboratory at the N.1 Institute for Health at NUS and Senior Research Fellow at the Institute for Digital Medicine (WisDM) at the NUS Yong Loo Lin School of Medicine

Further clinical trials are needed to confirm these results and to explore the broader applicability of QPOP in other cancer types. The team are currently planning to run a prospective clinical trial in Singapore.