Taichung Veterans General Hospital｜ Advancing in Cellular Therapy and Genetic Testing for Cancer Risk

Ongoing developments of regenerative medicine and medical technologies benefit patients with cancers and rare diseases, often requiring significant resources before novel therapeutics can be introduced to patients.

One institution making ceaseless efforts in research and development is Taichung Veterans General Hospital (VGH Taichung), which has teamed up with top-notch R&D facilities in Taiwan and overseas to bolster its offerings. The hospital plans to unveil a Good Tissue Practice (GTP) laboratory in September, 2023 as a new addition to its arsenal to meet the demand for cell-based therapy and genetic testing for cancer risk.

Having admitted 1,200 cases of cell therapy in 2023, the Cell Therapy and Regenerative Medicine Center (the CTRM center) at VGH Taichung provides therapies using chimeric antigen receptor T cells (CAR-T), cytokine-induced killer cells (CIK), natural killer cells (NK), and dendritic cells (DC). “Our hospital offers the most extensive range of cell therapies, and we are currently conducting clinical trials targeting solid tumours.” said Dr. Kuan-Der Lee, the Director of the CTRM center.

The hospital is dedicated to professional training and development programmes, with over 70 sessions organised between 2022 and 2023, whilst sending neurosurgeons, nephrologists, and oncologists abroad to familiarise themselves with trends on CAR-T, induced pluripotent stem cells (iPS cells), and various gene-modified cell therapies.

In the realm of treating rare and non-cancer diseases, VGH Taichung primarily focuses on early-stage clinical trials, with 40% of projects in phases 1 and 2, and more to come with industry partners. As per Dr. Lee, the hospital has initiated cell-based clinical trials, including the use of autologous adipose-derived stem cells for osteoarthritis or hard-to-heal wounds, allogeneic mesenchymal stem cells for pulmonary fibrosis and cerebral palsy, and a partnership with the University of California, USA, to explore gene-edited MSCs in chronic lower limb ischemia.

The hospital is also expanding into allogeneic stem cell therapies. One patient, whose cervical segments 2-4 were injured for over a year and a half, was able to rehabilitate after being treated with allogeneic mesenchymal stem cells.

VGH Taichung has ventured into both cancer and non-cancer therapies, led by Dr. Huey-En Tzeng, the CEO of the Precision Medicine Center and a haematologist oncologist, and Dr. Yi-Ming Chen, the Director of the Department of Medical Research, Translational Medicine Division.

Although genetic testing holds the potential to help patients and doctors identify optimal treatment options, there are often cases where no specific medications are tailored to certain types of cancers with gene mutations. This is when drugs for off-label use may be considered, but more analysis by qualified professionals has to present beforehand, as Dr. Tzeng explained. “We need pharmacists to provide their expertise as part of review process, along with analysts in this regard.”

Hence VGH Taichung has established the Molecular Tumor Board (MTB), a multidisciplinary team of healthcare professionals who specialise in oncology, molecular medicine, and bioinformatics. The MTB convenes every two weeks, to review various sources, including but not limited to diagnoses, imaging, medical records, genetic testing results, and clinical trial data. They then formulate personalised treatment plans for complex cancer cases.

In terms of non-cancer genetic testing, VGH Taichung has emphasized on conditions like systemic lupus erythematosus, hearing loss, and colonic polyps, using multi-gene risk scores for early disease screening and treatment.

Dr. Chen indicated that specific genes associated with hearing loss have been identified, and carriers of these genes may also have led to balance issues in the nervous system. This discovery, confirmed through 300 patients at the hospital, suggesting that even carriers without hearing impairment should take precautions to prevent falls and fractures. Hearing loss may be related to the use of specific antibiotics, in such cases VGH’s prescription system will prompt the risk of complications.

Another area where VGH Taichung excels is hereditary disease screening and early detection. Dr. Chen noted that people with genetic factors do not necessarily tend to disease onset but do increase the likelihood compared to those without such factors. “VGH Taichung boasts the largest genetic database in Taiwan, which serves as the foundation for studying disease incidence variations among different populations.”

Mutated DNA repair genes are often spotted in hereditary tumours. Hereditary non-polyposis colorectal cancer syndrome (HNPCC), for example, involves mutations in genes like MSH2 and MSH6. Apart from developing colon cancer, individuals with HNPCC may also be at risk of endometrial cancer. According to Dr. Chen, the Director of the Department of Medical Research, Translational Medicine Division, “We conducted colonoscopies on 100 carriers, of whom 30% had colon cancer, and 10% had endometrial cancer. We want to understand at what age carriers in Taiwan and family history they have are prone to disease. This will help us establish predictive models, and the findings that we hope to integrate into treatment guidelines.”

He further explained, “Each carrier will receive a score that takes into account environmental factors and family history, and that will determine whether a screening test should be arranged.”

In terms of industry collaboration and development, VGH Taichung offers its expertise and facilities for diagnostics and therapeutics development. On top of that, the genetic database platform with data from 70,000 patients can be served as a reliable source for studying biomarkers related to underlying health conditions and various disease types and subtypes, including chronic diseases.

VGH Taichung is eager to engage in discussions with potential partners regarding its advancements in regenerative medicine and precision medicine.