Research Personality: Dr. Daren Teoh Choon Yu

Dr. Daren Teoh Choon Yu Consultant Clinical Oncologist, Head of Radiotherapy and Oncology Sabah Women and Children’s Hospital (Hospital Likas), Kota Kinabalu
Dr. Daren Teoh, popularly known as Dr. Daren, obtained a Bachelor of Medicine, Bachelor of Surgery and a Bachelor of Medical Science (1st class honours) from the University of Nottingham, United Kingdom in 1999. He went on to pursue MRCP (UK) and FRCR (UK) before completing his specialist training in clinical oncology at various notable institutions including the University Hospital Birmingham, University Hospital Coventry and Warwickshire, New Cross Hospital, North Staffordshire Hospital and Royal Shrewsbury Hospital.
Dr. Daren’s expertise are in non-surgical local and systemic management of all solid organ cancers, 2D, 3D, conformal and image-fusion external beam radiotherapy techniques, as well as in gynecological and prostate brachytherapy techniques. As principal investigator with more than 10 ongoing trials currently, he has successfully published his findings in top tier international journals. Currently, Dr. Daren is a Consultant Clinical Oncologist, Head of Radiotherapy and Oncology Department and Deputy Head of the Clinical Research Centre at the Sabah Women and Children’s Hospital. He is also Honorary Lecturer at the School of Medicine, University Malaysia, Sabah.
CRM recently interviewed Dr. Daren for insights on his professional journey in clinical research:
Can you describe how you got involved in clinical trials and when did it all begin?
I’ve been conducting clinical trials since my early training days as a sub-investigator under the guidance of Professor Robert Grieve at University Hospital Coventry and Warwickshire. Prof. Grieve strongly believed that we should have a clinical trial for each problem that we did not have an answer to. He was instrumental, inspiring and showed me the ropes in conducting clinical trials; eventually I caught the bug. This happened between 2003 and 2009.
Is there a difference in the conduct or environment of the clinical trial industry during your early training years compared to now?
Yes, there’s a huge disparity in terms of infrastructure. The West had more advanced infrastructure compared to Malaysia and we were nowhere close to those countries 20 years ago. However, Malaysia has been developing the infrastructure needed to conduct clinical trials and CRM has been a step forward in building that infrastructure and research culture. Research cannot be conducted without good infrastructure and resources, and the initiative by the Malaysian Government to form a dedicated organisation within the Ministry of Health to support this ecosystem should be applauded.
How big is your clinical research team?
In 2010, my team comprised of one sub-investigator and one study coordinator. We were a small team then, but right now my team is growing with an additional Principal Investigator, three Study Coordinators, one Study Nurse and three Sub-Investigators.
Can you briefly describe your normal working day?
I get tied up with work from sunrise to sunset. Rarely do I get the luxury of indulging in a wholesome meal for lunch, most often only managing to settle with biscuits and tea to get me through the day. Unlike my daily clinical practice, clinical trials are not as rigid and can sometimes be flexible. However, when an adverse event happens, extra work needs to be done and completed before I call it a day. To sum it all, conducting clinical trials and my own clinical practice requires good time management.

Chemotherapy treatment centre at Sabah Women and Children’s Hospital
How many hours a day do you spent conducting clinical trials and how often do you deal with adverse events?
It really depends on the type of trial. What’s important is to be contactable at all times. In this department, we have dedicated one day a week whereby each Principal Investigator concentrates on monitoring and looking after the patients who are in clinical trials. Very rarely does a serious adverse event happen. I believe that with good management, the incidence of adverse events can be minimized.
What would be the phases of trials that you mainly conduct?
Phase II and phase III trials. We are not ready for phase I trials in this department. I believe this is how every department should start, by concentrating first on Phase II and III trials to build experience.
Can you highlight a few of the trials which you have conducted and which you particularly remember?
One will be the SAVE-ONCO phase III clinical trial. It is a multinational, randomised, double-blind, placebo-controlled study to evaluate the efficacy and safety of AVE5026 in the prevention of venous thromboembolism (VTE) in cancer patients at high risk for VTE and who are undergoing chemotherapy. The other will be the SAFE-HER study which is a phase III prospective, non-randomized, multinational, open label study to assess the safety of assisted and self-administered subcutaneous trastuzumab as therapy in patients with operable Her 2 positive early breast cancer.
We are mostly bound to fail in new endeavours but the willingness to bounce back and learn from mistakes are essential – Dr. Daren
In your opinion, what is the most important criteria to be a successful investigator?
The most important criteria to be a successful principal investigator is the ability to pick oneself up each time after a fall. In other words, perseverance is the key ingredient. When I returned to Malaysia in 2010, I did not manage to recruit any patient for the first clinical trial which I undertook. I was not selective enough and unaware of the cultural differences of the people here. Having flopped my first clinical trial in my motherland was not a good start but in subsequent trials I went on to recruit more patients. I am proud to claim that my team and I have recruited the most number of patients in this region for some trials and had the first patient in for others. We are mostly bound to fail in new endeavours but the willingness to bounce back and learn from mistakes are essential.
What would be your biggest challenge in conducting clinical trials?
Skilled human resource. As the clinical trial industry is still very new in this country, the challenge lies in developing and improving the level of clinical research skills among clinicians and supporting staff. And to develop this we need the support from the government, CRM and non-governmental organizations.
And the top three most rewarding part of it?
Firstly, to be able to treat patients with drugs that would either be too expensive for the patient to afford or drugs that are not yet available in the country. By doing so, patients may gain extra years of life. In certain cases, even if a patient has the money they can’t get access to these drugs as it is yet to be registered. Secondly, it saves the government and hospital money. For example, when a new clinical trial drug (provided by the sponsor) is used to substitute an already available but expensive drug in the market, taxpayers money can be saved. Thirdly, the level of knowledge and skills of the investigators and supporting staff will be greatly improved because they are carrying out tasks that are beyond the regular day to day routine. It is rather exciting to know that we are trying to do ground-breaking discoveries that investigators in the West are doing.
So, how does clinical trials change your practice and management of patient care?
In a way, it had got me thinking about what I could have done if I had the medical technology or a new drug/target that could make a difference to a patient’s life such as keeping the cancer from returning or giving them additional years of life.
There are many benefits a patient can get from participating in a clinical trial. Can you briefly give examples in your personal experience on how your patients have benefited from it?
I can vividly remember the case of a female patient who required a very expensive antibody drug to treat her cancer and in order to afford this drug, she would have to sell her house. When I told her that this antibody drug is available in a clinical trial and even so in a better form where it can be given in an outpatient basis over a shorter period of time with equivalent benefits to the current drug, she was thrilled. She underwent the whole treatment programme for a year. She was grateful for the fact that she did not had to sell her house or get a loan to pay for the drug, but received a better drug formulation. Her cancer went into remission and she decided to donate her travel reimbursements from the clinical trial to another person from a more distant rural area and also went around encouraging people to participate in clinical trials.
I can also tell you of another patient whose cancer cells had spread all over his body and there was no available treatment at that time. With a clinical trial that was run in partnership with an international pharmaceutical company, he had the access to a new oncology drug which was not yet approved in Malaysia and he received if for free. The drug managed to control his disease by 1.5 to 2 years.

Oncology clinic at Sabah Women and Children’s Hospital
Were there any patients whose condition did not improve and why should patients not be afraid to participate in clinical trials?
There are. In any clinical trial, the investigators will always weigh the potential benefits and side effects of a new drug/treatment before administering it and will disclose even the slightest side effect that could possibly happen. Compared to patients in standard care, those that are in a clinical trial are monitored more closely and thus should there be a serious adverse event, it will be detected immediately and treatment is quickly administered to ameliorate its side effects. In clinical trials, patients are very well informed. Even elderly patients with lower education levels are able to take a calculated risk before consenting to participate in a clinical trial.
Do you think that it is easier to obtain consent from patients in the developing countries than in developed ones?
I would like to think otherwise. In developing countries like Malaysia especially in Sabah, people are less exposed to the idea of clinical trials and thus it is more difficult to convince them to participate in one. Just like the fear of chemotherapy among Asians which are higher compared to our western counterparts because of the lack of exposure to this treatment, so it is with clinical trials. Therefore, I think that we have a bigger challenge in convincing and recruiting patients. At the same time, it is important to ensure that good clinical practice is adhered to in all trials.
What would be your advice to potential doctors who are interested in taking up clinical trials?
As Nike says, just do it! If you fail, pick yourself up and do it again.
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