2018 funding recipients

Project: Improving the benefits of the renewal of the National Cervical Screening Program for Victorian Aboriginal women

Investigators: Prof Margaret Kelaher (Lead Applicant), A/Prof Julia Brotherton, Ms Louise Lyons, Prof Sandra Eades, Prof Jon Emery, A/Prof Douglas Boyle, Ms Maureen Turner

Collaborating Organisations: University of Melbourne, Victorian Aboriginal Community Controlled Health Organisation, Victorian Cytology Service, Victorian Comprehensive Cancer Centre, BioGrid Australia

Funding: $1,991,700 over four years

Project Description: Australia has shown global leadership in cervical cancer control with its' Human Papillomavirus (HPV) vaccination program and the introduction of a more sensitive screening test for cervical cancer. The renewal of the National Cervical Screening Program (rNCSP) is projected to lower cervical cancer rates and deaths by around 30 per cent. Australia is well positioned to eradicate cervical cancer and this could well happen first in Victoria. However achieving this requires making sure that rNCSP is effective in controlling cervical cancer among Aboriginal women. The project will improve cervical cancer outcomes by harnessing the strengths of the Victorian Aboriginal communities and capacity in research and cervical cancer control and treatment.

Project: A partnership approach to preventing liver cancer: tackling viral hepatitis in primary care

Investigators: A/Prof Benjamin Cowie (Lead Applicant), Prof Gregory Dore, Prof Monica Robotin, Ms Jennifer MacLachlan, Ms Melanie Eagle, Ms Emily Adamson

Collaborating Organisations: Melbourne Health, Peter Doherty Institute for Infection and Immunity, The Kirby Institute (University of New South Wales), University of Notre Dame, Hepatitis Victoria, Cancer Council Victoria, Eastern Melbourne Primary Health Network, Gippsland Primary Health Network, South Eastern Melbourne Primary Health Network, Outcome Health

Funding: $1,599,545 over four years

Project Description: Most cases of liver cancer are preventable, and if people who are living with hepatitis B or hepatitis C have access to good health care to manage their condition, their risk of getting liver cancer later in life is reduced significantly. For this to happen, people who are affected by hepatitis need to be offered testing, and receive follow-up and appropriate treatment by their doctor. This project aims to discover the best tools to support doctors to do this, and will help people living with hepatitis increase their understanding of how to reduce their risk of liver cancer.

Project: Real-time patient-reported outcomes in clinical practice – a novel approach to improving quality of care for patients with upper gastrointestinal cancer

Investigators: Prof John Zalcberg (Lead Applicant), Dr Liane Ioannou, A/Prof Sue Evans, Prof Madeleine King, Dr Daniel Croagh, Dr Charles Pilgrim, Prof Wendy Brown, Prof Kate White, Prof Jennifer Philip, Prof Arul Earnest

Collaborating Organisations: Monash University, University of Sydney, Monash Health, Alfred Health, University of Melbourne, Peter MacCallum Cancer Centre, Victorian Cancer Registry, Southern Melbourne Integrated Cancer Services

Funding: $1,598,233 over four years

Project Description: People with pancreas and oesophagus/stomach cancers generally have very poor quality of life. Often, they don’t tell their medical team about serious physical or emotional problems, so won't always get the help they need. We hope to change this. Patients in the trial group will complete an online symptom questionnaire every 2 weeks. If they report problems, they will immediately:

1. Receive information on how they might help themselves
2. Be asked whether they wish to report the problem to their medical team
3. Receive a phone call from a trained nurse, who will connect them with appropriate services.

Project: Using next generation sequencing to improve the speed and accuracy of diagnosis in pancreatic cancer

Investigators: Dr Daniel Croagh (Lead Applicant), Prof Melissa Southey, Prof Brendan Jenkins, Prof Eva Segelov, Dr Vivek Rathi, Dr Bronte Holt, Mr Charles Pilgrim, Dr Belinda Lee, Prof Manoop Bhutani

Collaborating Organisations: Monash University, Monash Health, St Vincent's Hospital, Alfred Health, Melbourne Health, Epworth Healthcare, Cabrini Health, Hudson Institute for Medical Research, MD Anderson Cancer Centre

Funding: $459,446 over four years

Project Description: Endoscopic ultrasound fine needle biopsy is the predominant diagnostic investigation for pancreatic cancer. However its accuracy is only 85 per cent. A negative biopsy means patients need repeat procedures to achieve a diagnosis which is necessary to begin chemotherapy or enter clinical trials. Falsely negative biopsies, therefore, delay treatment and cause enormous distress. We are using next generation sequencing to significantly improve the sensitivity of this test. We wish to validate this approach and demonstrate its potential in a prospective clinical trial. The information provided will also allow patients to be considered for personalised treatment which will become the standard of care.

Towards precision medicince for the prevention of cancer-associated thromboembolism

This fellowship is focused on significantly improving supportive cancer care and patient outcomes, with the development and widespread implementation of real-time, personalized, risk-directed tool, which will prevent unacceptable cancer associated thromboembolism (CAT) among patients receiving anticancer therapies. In a multi-centre Victorian study, we will validate a newly derived, potent, CAT risk-stratification tool and decision-making algorithm, which will assess targeted preventative therapy for safety, efficacy and cost-effectiveness. Evidence from this research will inform world-wide clinical guidelines, with the potential to significantly reduce CAT incidence and the impact of associated adverse events, with substantial health and economic benefits.

Improving oral medication adherence and reducing medication errors in cancer treatment

Research has shown 50 per cent of patients do not take their medication as prescribed. Medication-related hospital admissions cost Australian taxpayers $1.2 billion annually. Our research team recently developed and tested a nurse-supported mobile health intervention to assist patients to take oral cancer medication and manage side-effects, assessed in ten patients and two administering nurses. This research will assess the intervention for implementation across cancer types and centres. It will include online training and administration tools to maximise program availability, and test the intervention in people with different blood cancers to establish acceptability and usefulness across patient groups, nurses and hospitals.

Ineffective complications of childhood cancer treatment: enhancing surveillance, standardising treatment and reducing risk

Infections and fever are the most common side effects of cancer treatment in children. In Victoria we do not have a standardised system to monitor or report these side effects or identify areas for improvement. We also lack guidelines for common infection complications which can result in unnecessary variation in care and impact the cancer treatment course. This project will ensure that all children in Victoria with cancer and infection or fever receive best practice treatment. It will also ensure that hospitals can monitor their performance and share resources so that the safest care is delivered to all children.

Accelerating translation or research into clinical outcomes: Implementing guidelines for cancer-related fatigue

This research aims to improve treatment of cancer-related fatigue (CRF) by applying evidence-based guidelines. In the absence of national guidelines, a Canadian guideline will be adapted and tested for use in Australia. Health professionals, consumers, guideline developers and policy makers will contribute to design ways to apply the guideline and evaluate outcomes. The CRF guideline will be pilot tested at a comprehensive cancer centre. As feasibility is demonstrated, education materials to help health professionals and consumers use the guideline in different settings will be produced, with the potential to transform the lives of many people diagnosed with cancer in Australia.

Improving health outcomes for people with cancer in rural and regional areas: Embedding evidence based smoking strategies into usual car

Smoking after a diagnosis of cancer is a powerful clinical risk indicator, with known poorer health outcomes and extensive health care costs. In Australia, smoking rates are higher in rural and regional areas. There are established and effective interventions to promote smoking cessation after a diagnosis of cancer yet these are not in practice. Across three regional sites, and with partners Quit Victoria and Western Alliance, we aim to embed evidence based smoking cessation strategies for people with cancer who are current smokers into routine care, resulting in in system wide improvements, an implemented program and model for further dissemination.

Exploiting KEAP1 vulnerabilities to treat aggressive lung cancer

In Victoria, lung cancer is the fourth most commonly diagnosed cancer, and the leading cause of cancer related death. Understanding how defects in our DNA can result in the development of lung tumours has already been used to target, and effectively treat, specific subsets of lung cancer. A high number of patients diagnosed with a particularly aggressive form of lung cancer have defects in a gene called KEAP1. We have identified new therapies that demonstrate anti-cancer activity in KEAP1-mutant cancers. This proposal will establish novel combination therapy strategies and guide the design of clinical trials for KEAP1-mutant lung cancers.

Physical activity and cancer: Improving causal inference to inform public health policy

My aim is to help clarify whether physical inactivity causes a number of cancers. Peak international and national cancer control agencies focus on only three types of cancer (postmenopausal breast, colon and endometrial) in relation to physical inactivity. There currently isn’t enough evidence to clearly link physical inactivity with other cancer sites. My research will address this gap, using research methods that will improve causal inference. If my research confirms that physical inactivity is causally related to the risk of other cancers, there will be a strong rationale for more cancer control resources to be directed to addressing physical inactivity.

Utilising whole genome sequencing and patient derived organoids for predicting tissue of origin and therapeutic vulnerabilities in cancers of unknown primary

Cancer of unknown primary (CUP) represents a disease that has spread to distant sites in the body while providing few clues to its tissue of origin. CUP is a devastating disease with a very poor prognosis. This proposal seeks to improve the diagnosis and treatment of CUP in order to improve survival outcome. New precision medicine approaches for CUP will be tested including complete genome DNA sequencing to help reveal the cancer's identity and potential therapeutic vulnerabilities as well as development of patient-derived cell lines enabling testing of drugs against individual cancers in the laboratory before their use in patients.

Combating adaptive resistance to targeted therapy in triple-negative breast cancer

Triple-negative breast cancer (TNBC) is an aggressive form of breast cancer that desperately needs new treatments. TNBC patients treated with single-drug therapies, however, often develop resistance as TNBC cells rapidly find ways to bypass the drug effect. Doctors are turning to combination therapies - cocktails of drugs - in an effort to kill the cancer. However there is currently no reliable way to predict which combinations, amongst many possible candidates, will work (and work quickly) for an individual patient. This project aims to identify novel combination therapy strategies for TNBC and biomarkers that help match them to the right patients.

Targeting lymphocyte function to treat colon cancer

Cytokines including IL-17 are normally produced by immune cells to protect the lining of the intestine. My research aims to understand the mechanisms controlling production of these cytokines and how targeting them can be used to benefit patients with bowel cancer. This research program is a critical step in identifying new potential for detection of bowel cancer, disease treatment and predicting patient prognosis.

Investigating the origins of neuroendocrine prostate cancer

The most common drugs for treating advanced prostate cancer target the actions of hormones. Unfortunately, in some patients these treatments promote the emergence of aggressive, treatment-resistant tumours, known as neuroendocrine prostate cancer. This study will investigate the progression of neuroendocrine prostate cancer in patient samples and identify early detection strategies for these tumours.

New combination therapies for castration-resistant prostate cancer

Some men with prostate cancer have life-threatening tumours that require ongoing treatment. These patients usually receive one drug after another until their tumours become drug-resistant. In contrast, some other types of cancer are often treated with multiple drugs at once. Therefore, this study will examine whether it is better to treat aggressive prostate cancer using two drugs at a time. We predict that this approach will improve patient treatment by eradicating more prostate cancer cells, providing new treatment strategies for advanced prostate cancer.

Deciphering how the immune system detects metastatic cancer cells

Immunotherapy has transformed cancer treatment by harnessing the body’s own immune system to hunt down and kill cancer cells. However, this type of therapy is still only effective in a limited number of patients. We hope to improve our understanding of how the immune system responds to a cancer by studying the under-appreciated but aptly named 'natural killer' (NK) cell. NK cells are thought to be particularly effective at preventing cancer spread (metastasis) by killing tumour cells circulating in the bloodstream, though the precise molecular mechanisms by which NK cells perform this function are largely unknown. My project aims to decipher how NK cells use a specific receptor called 'NKp46' to recognise tumour cells. By identifying what the NK cell 'sees' on the surface of a cancer cell, we hope to be better able to predict a patient's risk of metastasis and therefore better inform therapy to improve outcomes for cancer patients.

Predicting muscle loss during lung cancer treatment: the PREDICT study

Substantial muscle loss occurs in approximately 50 per cent of people during lengthy and demanding chemoradiation for lung cancer. This is a serious issue associated with reduced survival and function, meaning early identification is critical to prevent these significant consequences. Currently we have no way of knowing who is at risk of muscle loss, limiting the opportunity to provide timely and appropriate treatment. We will study predictors of muscle loss which will allow high risk patients to be identified early and engaged in supports and services that can assist in improving their experience and survival.