OncoDaily Dialogues #6 – Navneet Singh / Hosted by Roupen Odabashian

In our ongoing series called “OncoDaily Dialogues,” we consistently feature prominent individuals in the field of oncology. We showcase their achievements, obstacles they’ve overcome, and significant moments in their journey.

Today, we have the privilege of hosting Dr. Navneet Singh, Tenured Professor Pulmonology/Thoracic Oncology at Postgraduate Institute of Medical Education and Research, Chandigarh, India, as our distinguished guest.

Dr. Navneet Singh is a thoracic medical oncologist, tenured professor of pulmonology and faculty-in-charge of the Lung Cancer Clinic at Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India. His primary area of clinical expertise & research is thoracic oncology especially targeted therapies and immunotherapy for treatment of non-small cell lung cancer (NSCLC). He is the coordinator & convener for PGIMER’s multidisciplinary thoracic oncology group that received the Lung Cancer Care Team Award (Overall Winner) of the International Association for Study of Lung Cancer (IASLC) at its 2019 World Conference on Lung Cancer (WCLC) in Barcelona, Spain. He was recently conferred the IASLC Clifton Mountain Lectureship Award for staging at 2023 WCLC at Singapore.

Prof. Singh has 200+ publications in peer reviewed medical journals, authored several book chapters and was a nominated member of IASLC’s Publications Committee for two successive terms. He is/has been member of IASLC’s Staging & Prognostic Factors Committee, Education and Membership Committees as well as invited faculty and program committee member for its annual WCLC. Currently, he co-chairs the IASLC Corporate Roundtable Meeting initiative.

A past recipient of the International Development & Education Award (IDEA) of American Society of Clinical Oncology (ASCO), Prof. Singh was Chair (2018-20) of the IDEA steering committee. He has been an invited member of ASCO’s Thoracic Cancer Guideline Advisory Group and Special Awards Selection Committee. In 2023, he became one of the few select oncologists from the Asia-Pacific region to be conferred lifetime Fellow of ASCO (FASCO) distinction and is among the 1st two from this region to have received both the IDEA and FASCO.

He is a past recipient of AACR-NCI’s International Investigator Opportunity Grant, European Society for Medical Oncology’s (ESMO) Palliative Care Fellowship, ISSLC’s Oration on Lung Cancer & ICMR’s Kamal Satbir Award in addition to travel grants for several international meetings.

Dr. Singh has been elected fellow of the Royal College of Physicians (FRCP – London), American College of Physicians (FACP), American College of Chest Physicians & Indian Chest Society.

He has been an invited member/author in ASCO’s expert panels that developed/published clinical practice guidelines on:
A) Molecular Biomarker Testing in advanced/metastatic NSCLC
B) Surveillance after curative intent treatment of lung cancer
C) Systemic therapy for stage IV NSCLC (panel co-chair)
D) Management of stage III NSCLC (panel co-chair)

Our host is Dr. Roupen Odabashian, hematology/oncology fellow at Karmanos Cancer Institute in Detroit, USA. Beyond his clinical practice, Dr. Odabashian possesses an unwavering passion for delving into the intricacies of healthcare policy, regulations and Oncology. He understands the multifaceted nature of cancer as a medical condition and acknowledges the various stakeholders and regulatory bodies that influence the delivery and administration of cancer treatments. In alignment with this commitment, he has joined OncoDaily, where he plays a pivotal role in conducting interviews with Leaders of the Cancer world.

About OncoDaily 

OncoDaily was founded in 2023. It is a US-based oncology media platform, which features the latest news, insights, and patient stories from the world of oncology. Within a short period of time it became one of the leading oncology media platforms globally.

OncoDaily gathers content from various sources, including social media posts from renowned oncologists from all over the world, news from oncology societies and cancer centers, patient and survivor stories, and career-related information for professionals.

The mission of OncoDaily is to empower patients, survivors, and professionals with the knowledge and inspiration they need to fight cancer. The motto of OncoDaily is “Cancer doesn’t take a day off – neither do we”.

Previous series:

OncoDaily Dialogues #1 – Harout Semerjian / Hosted by Roupen Odabashian

OncoDaily Dialogues #2 – Piotr Wysocki / Hosted by Roupen Odabashian

OncoDaily Dialogues #3 – Andrés Wiernik / Hosted by Roupen Odabashian

OncoDaily Dialogues #4 – Therese Mulvey / Hosted by Roupen Odabashian

OncoDaily Dialogues #5 – Sarkis Meterissian / Hosted by Roupen Odabashian

Follow the transcript below

Roupen Odabashian: Welcome to OncoDaily. We are today honored to introduce Dr. Navneet Singh, a distinguished figure in the field of thoracic medical oncology. Dr. Singh holds a professorship in pulmonology and serves as the faculty-in-charge at the lung cancer clinic of the esteemed Postgraduate Institute of Medical Education and Research in Chandigarh, India. His expertise and research are deeply rooted in thoracic oncology, with a particular focus on innovative treatments such as targeted therapies and immunotherapy for combating non-small cell lung cancer.

His contributions to medical science are vast, with over 200 publications in peer-reviewed medical journals, numerous book chapters to his name, and a significant impact on the global medical community through his involvement with the International Association for the Study of Lung Cancer’s Publications Committee for two successive terms. He is a past recipient of prestigious awards and fellowships, including the International Development and Education Award (IDEA) from the American Society of Clinical Oncology (ASCO), the AACR-NCI International Investigator Opportunity Grant, and the Palliative Care Fellowship from the European Society for Medical Oncology (ESMO). He was also recently conferred the IASLC Clifton Mountain Lectureship Award for staging at the 2023 World Conference of Lung Cancer in Singapore. Dr. Singh, I’m so happy to have you here today.

Navneet Singh: Thank you for inviting me. Pleased to be here.

Roupen Odabashian: Thank you so much. So, what inspired you to focus your career on mainly lung cancer research and innovation in this field?

Navneet Singh: When I was in the process of completing my fellowship, which was almost 16-17 years back, there was an unmet need for streamlining the services of the lung cancer clinic, which has historically been run by our department, the Department of Pulmonary Medicine at The Institute where I work, which is the Postgraduate Institute of Medical Education and Research in Chandigarh, which is north of India.

It’s an apex referral center, and so we get patients from several neighboring states. As soon as I finished my fellowship and I joined as a faculty, I got involved with the lung cancer clinic, and one of my first steps was streamlining its working, reinventing the chemotherapy protocol so that they were in line with what is internationally followed and yet took into account the local geographical and demographic factors, and improving the recording data recording process, data extraction process. And then it just was from one step to the another.

Roupen Odabashian: Throughout your career, you didn’t only practice thoracic oncology or lung cancer, you made a change, you made a difference, and like you had almost more than 200, like or 250 publications. How did you achieve that?

Navneet Singh: It’s even I don’t have the exact count right now, but it is above 200, maybe close to 250. Initially, obviously, the publications were small, starting with reading original articles and then writing letters to the editor or correspondence, moved on, and then started case reports. I think that’s the normal trajectory for when you go from training to a full-time faculty appointment. And then obviously brief reports, case series, and ultimately original articles, and ultimately culminating in writing editorials and being the lead author for international guidelines like the ones from the American Society of Clinical Oncology. I mean, that was really the pinnacle of having worked in this field, being co-chair for ASCO’s stage four lung guideline as well as for stage three NSCLC management.

Roupen Odabashian: Have you had any mentors in the pathway, anyone who guided you, or did you have to figure out the pathway on your own?

Navneet Singh: My first award was ASCO’s International Development and Education Award, and that was when I was very early on in my academic career as a faculty appointment. I was paired with somebody who is very well known throughout the world, Dr. Len Einhorn, or Larry Einhorn as he is called, and he is my first mentor and I believe also my strongest mentor. We are still in touch after all of these years, and in fact, even last month when I was at a meeting, we met each other and he remarked that he’s been truly happy and proud of what I have accomplished. So having a good mentor is very very important. He has always been there to support me, has been able to help out anytime I have had issues. But apart from him, there have been several mentors outside my country who have whom I have reached out anytime I have had issues with difficult cases or scenarios where I needed help.

Roupen Odabashian: So you believe in the power of mentorship. It’s easier to figure out the way you have someone guiding you than doing it all on your own.

Navneet Singh: Yes, definitely. It helps and obviously one has to be doing self-learning all the time, reading the latest research which gets published in journals, staying abreast of what is happening. And ultimately when you are well read, you can apply that knowledge in the clinic for the benefit of patients. But time to time, everybody, all clinicians face challenging cases and thereforeit’s always good to be able to reach out to somebody who you believe has had a much greater experience in all of that, and the advice they give has been very very useful both for my understanding as well as for ultimately patient care. And I have both, you may call friends or senior colleagues or mentors, whom I have reached out multiple times and have helped me for whatever advice I wanted.

Roupen Odabashian: And also like beyond publications and the beyond publishing, you talked about the award and I want to touch more on it. Like you’ve been awarded like international awards, like what do you think is the secret, like let’s say I’ve been an oncologist early in my training and I look at you and see all the awards, like how can I achieve this in my career?

Navneet Singh: Well, I think the simplest thing is that you should be dedicated in what you are doing, be focused in the area that really appeals to you, keep on doing it, and awards typically follow. So you don’t have to run after awards, awards will run after you.

Roupen Odabashian: Can we switch gears a bit to talk about the state of oncology in India? Do you think that people have the appropriate access to chemotherapies and immunotherapies in India or there is a shortage in some part of the country?

Navneet Singh: This can be addressed in two different ways. For chemotherapy, there are no issues for the very simple reason that almost all of these drugs are manufactured by multiple Indian companies. And are pretty much easy to afford. In fact, there is also a national level scheme by the government of India which is called the Ayushman Bharat scheme or the Prime Minister’s fund, and this covers almost all of the chemotherapy regimens. So access to chemotherapy is not an issue at all. However, if you talk of targeted therapies, well there are issues. For the most common oncogenic driver alteration, which is EGFR in our setting, and which is to the prevalence of approximately 30%, again the first generation and one of the second generation drugs, basically gefitinib, erlotinib, and afatinib, they are manufactured by multiple Indian companies. From a cost perspective, they are affordable and they’re also covered under the same government scheme which I was talking about.

However, if you talk of the third generation EGFR drug or you talk of the other targeted drugs, they are manufactured usually only by one company which is the innovator, and their pricing is also much much more than what you have for the ones which are made locally within the country. Some of the drugs are also not marketed, so for them having access can be an issue for both from two aspects. One is they are marketed but the price is so much that most patients cannot afford it.

And the second scenario is that they are not yet even marketed within the country. And obviously for some of them, you may have you can try for getting these drugs for patients via the compassionate access programs of the manufacturers. It obviously it’s not as easy a task as for the drugs which are locally made and locally available. Even for the immune checkpoint inhibitors, all of these drugs are made only by the innovator companies and are very very expensive, and therefore only a small fraction of patients who are eligible would actually be able to afford the drugs.

Roupen Odabashian: And when we talk about affordability, how is the Indian healthcare marketplace? Is it like paid, is the healthcare sponsored or paid by the government, or is it insurance companies, or is it a cash marketplace, or is it a mix of three?

Navneet Singh: It’s a very heterogeneous scenario. So as I was saying, that for people who fall in a certain socioeconomic bracket, which is typically the lower socioeconomic bracket, they are covered by the federal or the central government scheme. There is also a certain percentage of patients who have access to health insurance and will get reimbursed from their respective insurance companies. Then there is another small percentage of patients who are working in organizations, whether they are governmental or non-governmental, and get reimbursed from their respective organizations and not directly from insurance.

And then there is a big huge proportion of patients who will typically end up paying from their own savings or as you may call it from cash-paying patients. So it’s a completely heterogeneous scenario and even for the place where they go for seeking treatment, it varies from going to the private or the corporate hospitals to the government-funded healthcare facilities.

Roupen Odabashian: Gotcha, gotcha. And what is the state of lung cancer research in India? Where do you think India stands when it comes to the research in the field and helping in crafting the guidelines?

Navneet Singh: In the recent past, I think the research scenario has improved quite a bit. You now have important papers coming out of the well-known reputed cancer centers, whether that’s the Tata Memorial Center in Mumbai, the All India Institute of Medical Sciences in Delhi, or an institute like ours which is PGIMER. One area which still needs a lot of improvement is the access to clinical trials. India has historically been underrepresented in the global clinical trials, and although the manufacturers or the companies which are doing these trials now have that realization and they are making an attempt to include India as sites for global phase three trials and also include Indian patients, but there are still a long way to go.

And therefore, I think it would really help patients if all of these companies, when they do these phase two and phase three trials, give weightage to India in terms of the population and not just having a name that this country was representative because what has been observed is that, for example, if you have 200 patients being enrolled in a global phase 3 trial, the number of patients which are allocated for enrollment in India would be in single digits or sometimes 10-15, which is not in line with the population and the percentage of the population which the country has.

Roupen Odabashian: So that is one thing which they should improve. And you think it’s the, what I’m hearing is I feel it’s more like the companies in this space, they are the ones who are not including enough percentage or number of Indian patients. Is that the situation?

Navneet Singh: Yes, so the numbers are definitely lower. So either India would not be represented in these trials, or the number of patients allocated per trial would be much lower than what one would expect. This may in part also be due to the time difference it takes for various regulatory approvals from country to country, but I think a lot of those things have changed, improved in the recent past, and maybe if there is enough effort, the situation could improve further.

Roupen Odabashian: And you mentioned the conversation earlier that there’s like, there is heterogeneity in how the Indian healthcare marketplace is paid or like the transactions happen. Like what do you think are the reasons or the challenges of different types of access or lower access in certain populations in India to cancer care?

Navneet Singh: I think it’s very important. People living in big cities, the metro cities as we call them, Delhi, Mumbai, Kolkata, Bangalore, so they have access to the big hospitals where all of these facilities are available. But people who are living in either remote geographical areas, hilly locations, or far away from cities, they often need to travel significant distances in order to access healthcare, especially state-of-the-art treatment facilities. And it’s empowering, I think, district-level hospitals or smaller centers to be able to diagnose cancer early and make early referrals or even do the initial part of the treatment would go a long way.

One of the important things, especially in the context of tuberculosis, which I may put in, is the endemicity of tuberculosis. It is not uncommon for us to see that patients who ultimately get diagnosed with lung cancer have been empirically treated with anti-tubercular therapy simply because they presented with pulmonary symptoms and had some abnormalities on chest radiographs which the treating clinician initially thought was tuberculosis and just started on tuberculosis treatment. And when there was no response, further evaluation was done and ultimately lung cancer got diagnosed. So that is one thing which we believe that educating both the population as well as the primary healthcare providers could make a difference in improving the stage at which lung cancer gets diagnosed and thereby improve outcomes.

Roupen Odabashian: Gotcha. Thank you so much, those were my questions and that was very enlightening to understand tips and tricks about success in academic oncology and how the practice of oncology is shaped in India. Thank you so much, I appreciate it.

Navneet Singh: Thank you so much, and thank you for doing this and inviting me over.