Some women who undergo preventative surgery to avoid reproductive cancers go on to develop incurable abdominal cancer. A clinical trial, involving Peter Mac, is testing a way to possibly prevent this.
Women with a BRCA1 or BRCA2 gene mutation have increased lifetime risk of ovarian and fallopian tube cancers, so many opt to have their reproductive organs removed. At the time of preventive surgery, some women will have a pre-cancerous "serous tubal intraepithelial carcinoma”, or STIC, in their fallopian tube.
Latest research (by Steenbeek et. al.) published in the June print edition of the Journal of Clinical Oncology (JCO) found women with STIC at the time of surgery had an almost 30% chance of developing abdominal cancer within 10 years. Women without STIC had less than a 1% chance of abdominal cancer.
In an accompanying editorial also published in the JCO, Professor Kelly-Anne Phillips said the Steenbeek research confirmed that STIC was a “strong predictor” of which of these women would later develop abdominal cancers.
Prof Phillips is also leading the STICs and STONEs clinical trial, which is testing if a commonly available pain relief and anti-inflammatory medication can prevent STIC. Read more about the trial on the STICs & STONEs website.
“The benefit of using an established drug in this trial is that it is really simple to administer, cheap, and has a well understood and generally minimal side-effect profile,” says Prof Phillips who is Principal Investigator for the trial in Australia, and a Consultant Medical Oncologist and Senior Strategic Research Leader at Peter Mac.
“This is an exciting trial because it might provide a new way to prevent cancer in these women with an inherited BRCA1 or BRCA2 abnormality.”
The trial is open to woman with an inherited BRCA1 or BRCA2 abnormality who are planning to undergo preventative surgery within the next two years. Trial participants take a pill daily – either the drug or a placebo – to determine if the drug is able to reduce incidence of STIC.
The STICs & STONEs trial is led by the Canadian Cancer Trials Group, jointly conducted by University of Sydney NHMRC Clinical Trials Centre (NHMRC CTC) and Australia New Zealand Gynaecological Oncology Group, funded by the NHMRC. The research project has been authorised by Sydney Local Health District Ethics Review Committee (RPAH Zone), and in Victoria and Western Australia under the National Mutual Acceptance Initiative.
Women interested in taking part in the trial can call 1800 111 581, or email [email protected].
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Contact
For more information or to arrange an interview, call the Communications team on 0417 123 048.
About Peter Mac
Peter MacCallum Cancer Centre is a world-leading cancer research, education and treatment centre and Australia’s only public health service solely dedicated to caring for people affected by cancer.
About NHMRC CTC
The NHMRC Clinical Trials Centre (CTC) is a flagship research centre based at the University of Sydney. They run studies designed to improve global health outcomes by bringing together world leading experts in healthcare, clinical trials, and related research methods.
About ANZGOG
The Australia New Zealand Gynaecological Oncology Group (ANZGOG) is the peak, national gynaecological cancer clinical trials organisation for Australia and New Zealand. Their purpose is to improve outcomes and quality of life for women with gynaecological cancer through conducting and promoting cooperative clinical trials and undertaking multidisciplinary research into the causes, prevention and treatments of gynaecological cancer.
See the story of our patient Kate who, when five-months pregnant, needed emergency bowel cancer surgery.
Internationally, this surgery is very rarely performed during pregnancy and it was a first for the surgical team led by Jacob McCormick, a specialist Colorectal Surgeon at Peter Mac and the Royal Melbourne Hospital.
This story, which aired nationally on The Project last night, marks Bowel Cancer Awareness Month and also highlights rising rates of this cancer in younger Australians.
Bowel Cancer Australia is calling for the screening age to be lowered to 45 from the current 50 years.
Watch the story:
Evusheld is an extra COVID-19 medication that provides added protection for vulnerable patients. Peter Mac is recommending this medication for patients with blood cancer, or cancer patients who are immunosuppressed.
A clinic at Peter Mac's Parkville location will be administering doses of Evusheld between 27 June and 29 July, 2022.
Evusheld protects against all variants of COVID-19 that have been identified to date. Research studies have shown that it may help reduce the risk of COVID-19 infection for at least 6 months.
Ask your doctor about whether Evusheld is suitable for you.
You can watch a patient information video about Evusheld below, or click here to download the Evusheld Patient Guide.
Evusheld is made up of two medications designed to work together against COVID-19. These medications can prevent the virus from entering human cells and reduce the chance of becoming seriously ill due to COVID-19 infection.
Evusheld is given in addition to COVID-19 vaccinations and boosters and is not a replacement for them.
An AI-powered, virtual platform is being developed to improve care for patients living with genetic disorders, as part of a Digital Health CRC project led by Peter MacCallum Cancer Centre and Swinburne University of Technology.
The online cloud-based platform will initially focus on familial cancers and cardiac conditions, providing patients with guidance on how to find specialist care, support for clinical and psychological issues and clinical trial updates.
Utilising a unique AI-driven algorithm, the platform also aims to identify and alert genetic counsellors to specific sub-group of patients at key life stages, or who are at risk of not adhering to management recommendations. This triage facility will enable time-sensitive clinical and psychological support to be efficiently targeted to the most clinically vulnerable people.
Associate Professor Alison Trainer, a Clinical Geneticist at Peter Mac, said access to genetic testing had improved over the years leading to more people with a high-risk genetic predisposition for disease being identified.
“Identifying these patients is only the first step in reducing mortality and morbidity, equally important is making sure they can access world-class care for the rest of their lives,” Associate Professor Trainer said.
“We can support this with new tools to help our genetic counsellors respond quickly to individuals’ needs, providing ready access to the right information and support at the right time. That is what is envisioned with this technology.”
Associate Professor Prem Prakash Jayaraman, Director, Factory of the Future and Digital Innovation Lab at Swinburne, commented on the potential of the AI technology to address the gap in genetic counselling.
“AI-based digital health platforms can support early intervention by using genetic mutation data and advanced AI algorithms to automatically identify individuals at risk,” Associate Professor Jayaraman said.
“This platform is envisioned as a life-long companion for individuals at risk, providing them with instant access to information and support services.”
The project commences this year with a planned two-year timeline. The core objectives of the project include:
Co-design and develop the platform to align with healthcare professional and patients’ needs and preferences, ensuring a interactive and user-friendly platform.
Design and develop seamless integration of patient or specialist-entered clinical data collected via the platform into a specialist CGS familial database.
Develop and integrate AI algorithms into the platform based on data captured and held in other linked databases. A stakeholder focus group will be organised to determine the priority of the following features that will be incorporated in the development of AI algorithms.
Trial the platform in the Clinical Genetic Service setting at Parkville Familial Cancer Services Centre at Peter Mac, and develop the role of a genetic counsellor digital care coordinator.
Develop a business case, business model and market analysis to inform a commercialisation pathway for the platform.
Digital Health Chief Innovation Officer, Dr Stefan Harrer, said the project was an exciting next step in utilising the power of AI, combined with end-user needs, to support the health system while building a product that has the potential to contribute to Australia’s digital health economy.
"This project includes AI-driven recommender algorithms to deliver targeted value to consumers by individually matching carers and patients. We see this as an important step to bring precision medicine to genetic counselling,” Dr Harrer said.
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Digital Health CRC
The Digital Health CRC (DHCRC) brings together Australia's health and aged care sectors, industry and academia. Working together, we invest in research and development to support the growth of a strong digital health industry, improve patient outcomes and experience and deliver sustainable digital health solutions. The DHCRC is a $155M organisation funded through the Commonwealth Department of Industry, Science, Energy and Resource’s Cooperative Research Program, and supported by our Participant organisations including universities, healthcare providers and industry.
Peter Mac
Peter MacCallum Cancer Centre is a world-leading cancer research, education and treatment centre and Australia’s only public health service solely dedicated to caring for people affected by cancer.
Swinburne University of Technology
Swinburne University of Technology is a dual-sector institution, defined and inspired by technology and innovation, and renowned for our strong industry and community engagement. With a vision to bring people and technology together to build a better world, our people are driven by a shared purpose: to create tomorrow’s technology and the human capital and talent required for a digital, tech-rich future.
A Peter Mac-led clinical trial has found combination PET/CT scans are better at investigating the causes of prolonged fever in blood cancer patients than conventional CT scans.
The randomised multicentre trial found patients who were given a combination FDG-PET/CT scan instead of a conventional CT scan were able to be given more targeted treatments.
This reduced the use of broad-spectrum antibiotics – and also time spent in hospital.
A combination FDG-PET/CT scan is a combined positron emission tomography (PET) scan which produces images of how organs or tissues inside the body use sugar, a key fuel for the body's organs, with a computed tomography (CT) scan which provides more anatomical information. FDG, or fluorodeoxyglucose, is the sugar compound used as the radioactive tracer in the PET scan.
"A combination PET/CT scan allows us to rule in and rule out important diagnoses better than using conventional CT imaging," says infectious diseases physician Dr Abby Douglas, who was the investigator running the trial.
"That's because it is both more sensitive at picking up the site of the infection causing the fever, and ruling out other important causes of fever."
Prolonged or recurrent fevers are a serious problem for blood cancer patients because the patients often have low levels of neutrophils – a type of white blood cell – that help them fight off infection.
Without enough of these defender cells, a fever left untreated can quickly lead to sepsis and even death.
"The issue in this patient group is that we often do not know what is causing the ongoing fever," says Professor Monica Slavin, who was the Principal Investigator on the trial.
"We worry about various types of infection, but there are other reasons for fever that don't need antibiotics."
Without a clear diagnosis, patients will often be given a protracted course of broad-spectrum antibiotics which heightens their risk of developing antibiotic resistance, and can also do long-term harm to their gut microbiome.
"It's both better for the patient and the healthcare system if we can pinpoint what is causing a fever so we can optimally treat it, and not use unnecessary broad-spectrum antibiotics," says Professor Karin Thursky, a senior investigator on the trial.
The researchers conducting the trial also found the patients who were given a combination PET/CT scan had a shorter stay in hospital.
"Getting out of hospital sooner is really important for patients who spend long and repeated stints here, and will likely improve their quality of life," Dr Douglas says.
It also reduces their risk of healthcare-associated complications and the cost of their care.
While a combination FDG-PET/CT scan costs the healthcare system approximately $1,000 that would likely be offset by the reduced time a patient is in hospital, and will be examined further in future research.
Results from the trial were published in The Lancet Haematology today.
The trial was conducted by Peter Mac clinical researchers from the Infectious Diseases, Haematology and Nuclear Imaging departments, in collaboration with colleagues from the University of Melbourne and the Royal Melbourne Hospital.
Image: PET scan of the rectum showing site of infection as the lower orange spot.
Contact
For more information or to arrange an interview, call the Communications team on 0417 123 048.
About Peter Mac
Peter MacCallum Cancer Centre is a world-leading cancer research, education and treatment centre and Australia’s only public health service solely dedicated to caring for people affected by cancer.