High-grade serous ovarian cancer is the most common type of ovarian cancer. Sadly for most people the prognosis is bleak but researchers at Peter Mac and the University of Sydney and their collaborators published data in Nature Genetics that show we can learn a lot from long-term survivors.
“Traditionally we research why treatment fails but we felt a lot could be learned by studying ‘exceptional ovarian cancer survivors’ to try and uncover why and how they have survived against all odds,” said Dr Dale Garsed, Senior Research Officer at Peter Mac.
“We uncovered that there were a number of different things occurring that helped these women survive more than ten years, which is far longer than expected.
“In particular survivors had multiple immune cell signatures, indicating their immune system has mounted a strong response against the cancer cells.”
“Survivors were also more likely to have two or more alterations in genes associated with DNA repair. This seemed to make them more responsive to treatments like chemotherapy.”
“One of the other findings was that long-term survivors had increased cell replication. This is normally associated to a cancer that is aggressive but it is believed that the faster replication made the cell more sensitive to chemotherapy,” Dr Garsed said
The research draws on twenty years of data on over 3,500 ovarian cancer patients from Australia and the US. “Identifying this group of exceptional survivors was only possible due to meticulous, long-term clinical data collection on large numbers of patients who have generously agreed to join our studies” said Professor Anna DeFazio, Group Leader at WIMR and the Daffodil Centre, at the University of Sydney and Cancer Council NSW.
“Our research started with a very deep analysis to try and pin point why these women were surviving. Now we can broaden out this research and apply our findings to a larger group of patients,” said Professor David Bowtell, Group Leader at Peter Mac.
“We hope to apply the insights we learn to the treatment of all women with ovarian cancer to change the course of their disease.
“Before we were walking in the dark, but the research findings have helped shine a spotlight on the path so we now know where to look for more answers.
“Fewer than 15 percent of ovarian cancer patients survive more than ten years with over 50 percent dying in the first five years,” Professor David Bowtell said.
The research was supported by a US Department of Defense Ovarian Cancer Research Program initiative and analysed 60 women with advanced-stage, high-grade serous ovarian cancer who survived for more than ten years.
Whole genome sequencing, clinical histories, and a range of other markers were examined for the 60 women who were exceptional survivors and compared to 66 women who survived less than ten years from diagnosis.
A Peter Mac clinical trial will expand internationally to include patients in Israel and the Middle East, in a sign of Peter Mac’s growing relationship with Sheba Medical Centre in Tel Aviv.
The Peter Mac-led POPSTAR II clinical trial is due to open in early 2023 at multiple Australian sites and will compare two cutting-edge treatments for men with advanced prostate cancer – lutetium PSMA (LuPSMA) therapy and Stereotactic ablative radiotherapy (SABR).
During a visit to Australia this week, Sheba Medical Centre’s Director General Professor Yitshak Kreiss signed a Letter of Intent that would see Sheba Medical Centre become an international recruitment site for the POPSTAR II trial.
Peter Mac Chief Executive Professor Shelley Dolan - who visited Israel in early November - said it was the latest example of a growing international relationship between two leading centres of excellence.
“The international expansion of this clinical trial will boost access for men to innovative prostate cancer treatments that are being advanced in Australia,” Professor Dolan said.
“Peter Mac and Sheba Medical Centre signed a Memorandum of Understanding (MOU) earlier this year to work together in areas of shared interest, and it is fantastic to see this coming to fruition for the benefit of people with cancer internationally.”
Professor Kreiss added: "We see our collaborative agreement with Peter Mac as an important step in strengthening our relationship with the Victorian Government within the realm of innovation and clinical research.”
“Peter Mac is an elite institution that is a leader in research and novel treatments, which endeavours to change the future of medicine, mirroring our vision for Sheba via our ARC innovation centre."
The MOU signed in May will help Peter Mac and Sheba Medical Centre to collectively advance innovation and commercialisation opportunities, research and scientific collaborations, opportunities for bilateral education and training, and fellowship programs and staff exchange.
Sheba Medical Centre - which is the largest hospital in the Middle East - has been listed as one of the world’s smartest hospitals for the past two years by Newsweek magazine, while Peter Mac was listed at number 19 in the recently released Best Specialized Hospitals category.
POPSTAR II is run by Peter Mac's Prostate Cancer Theranostics and Imaging Centre of Excellence (ProsTIC), led by Professor Michael Hofman, with principal investigators Associate Professors Shankar Siva and Aravind Ravi Kumar. Details: https://clinicaltrials.gov/ct2/show/NCT05560659
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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.
Kelly Scherger, a mum of three from Mildura in regional Victoria, was diagnosed with triple negative breast cancer at 39.
She fought for months to get more testing before finding out her result and says “we need to stop treating breast cancer like an older person's disease".
This is her story in her own words.
In October of 2020, I felt a small lump in the shower.
I would normally use a shower loofah but I'd thrown it out and hadn't bought a new one and was using my hands. Thank God I threw out that old loofah.
I went and saw the doctor and was sent for some scans and tests over the next few months which came back as atypical (which can be a precursor to breast cancer).
I initially said I wanted to go to Melbourne and get more testing done but my doctor said, ‘that's overkill, you're 39. It's very unlikely you’ll have breast cancer”.
It took me going, 'I want more testing. I want something done.'
I was on our annual holiday in January 2021 and I had a call from a surgeon in Mildura who said, 'we’ve found breast cancer and you need to come home now'.
I heard cancer and thought I was going to die. And then I stupidly Googled ‘what's the worst type of breast cancer to have' and found it was the one that I had, triple negative.
I was in Peter Mac the next week and going through a treatment plan. I did four rounds of chemo and then another 16 rounds of a different type of chemo – from February to June.
It was a big struggle financially as I wasn’t able to work for six months.
I had all of the chemo done in Mildura. I was initially sceptical of having treatment in Mildura after it taking so long to get diagnosed. But the Peter Mac team organised all the chemo to be sent up to the hospital and worked with the team there. The chemo team at the Mildura Base Hospital were incredible and supported me so much during treatment.
The hardest thing was when my hair started coming out and I had to make the decision to just shave it off – that was really hard on my eldest son because that was when I started to look sick.
In July 2021, I had a lumpectomy (lump removal) and a full auxiliary dissection (removal of lymph nodes) and then at the end of August I did four weeks of radiation at Peter Mac.
I flew down every Monday morning and back on Friday. We have a place in Mildura called Sunraysia Cancer Resources who booked and paid for all my flights, which was a huge help. And the Peter Mac Accommodation lady helped me to find a place to stay.
It was hard and lonely for the first few weeks until my family could come and join me – my husband and three boys have been a huge support every step of the way and I couldn’t have done it without them.
After all that I did another three months of oral chemo.
I’m doing good now. I have lymphoedema (fluid retention due to lymph node removal) and I've had a fair few side effects from chemo – but other than that I just need to have yearly mammograms at Peter Mac.
Mel and Lisa, the breast care nurses at Peter Mac, gave me so much support when I was in Melbourne and I have to thank Louise, the McGrath Breast Care Nurse in Mildura, who helped with so many things - even buying a bra to suit my breasts after surgery.
Cancer shouldn't be a taboo topic – it’s something we should be talking about. I’ve been extremely open about my cancer journey and I’m more than happy to speak with anyone who asks.
My message is to women is to be aware of your own body. If you feel something isn't right, get it checked. And if you feel it's still not right after getting it checked, get it checked again.
At the same time the pandemic placed a huge burden on hospital infection prevention teams, it triggered a rapid overhaul of the way they delivered training.
Bringing people into a room for face-to-face training did not meet COVID safety protocols, and so these usually hands-on sessions needed to be rapidly redesigned.
A paper just published in the American Journal of Infection Control describes how, in the early phase of the pandemic, the training of hand hygiene auditors at Peter Mac shifted to online only.
The time needed to complete the major training session was also cut in half (from 8 hours in-person to 4 hours online) and made more flexible, able to be completed over two weeks.
Associate Professor Leon Worth, lead author on the paper, said the changes were all positive and served as a model for delivering online training that meets strict healthcare standards.
“At an incredibly busy time, our infection prevention team needed to change and re-write how training was delivered to staff who would play key roles in the pandemic response,” says Associate Professor Worth, who is Medical Director of Infection Prevention at Peter Mac.
“Shifting this training online, and reducing the time needed to complete it, led to both a doubling in the number of hand hygiene auditors able to be trained and it improved results in their final assessments.”
Thirteen new auditors were trained Peter Mac in 2018 and in 2019, again before the pandemic, a further 12 were trained. In 2021, with the pandemic in full swing, 24 new auditors were trained.
The newly minted auditors had fewer errors in their final assessments than those trained before the pandemic.
The paper is titled “Hands off hand hygiene training”: Implementation of a COVID safe auditor training program”, and you can read the paper in full online.
Co-authors were Peter Mac Infection Prevention Manager Elizabeth Gillespie and, Infection Prevention Nurse Consultant Cheryl Faul.
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For more information contact the Peter Mac 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.
Glynis Vickery is a proud Gunditjmara and Yorta Yorta woman who lives in Kinglake with her partner and two children.
Diagnosed with cancer twice, Glynis is currently on active treatment at Peter Mac and had just finished her radiation therapy when she sat down to talk with us.
She’s looking forward to a trip back to Gunditjmara country to go fishing for crays.
This is Glynis’ story in her own words.
I’ve been diagnosed twice.
The first time was in 2012 - I was having a shower and I felt a lump.
It was so weird because I was dropping my two-year-old off at day care and my 10-year-old at school and had been thinking to myself, ‘what it something happens to me’ - and then I find a lump the same day.
I don’t know if it was an omen that I needed to find it. But it made me realise you need to think about your health and have it in the back of your mind all the time.
I went to the doctor and she sent me off for a scan and then a biopsy, and the result came back for cancer. I then had surgery on the left breast, radiation therapy and then I was put on Tamoxifen for five years, which is a hormone therapy used to treat breast cancer.
The first time I was diagnosed, it wasn’t difficult. I just kind of walked through it really numb and not really understanding. It was just something that was happening to my body.
But for my family - I have two children and a partner - they all found it really difficult to watch me go through the treatment and were worried about what the outcome would be.
My kids were two and 10 at the time. My partner was really worried what it would mean for their future not having a mum – so he was quite angry about what was happening to me.
But I got through all the treatment and got back to normal life with my kids.
Fast forward 10 years and I was at the gym with my son exercising and I got a sore arm.
I asked the doctor to look at it and she found a lump – and again I was sent for an ultrasound and a biopsy. The cancer had returned. I’ve just had chemotherapy and a lump removed from my lymph node and I’m currently doing radiation therapy again.
This second time, I now know what needs to happen and I just need to get through it – but it’s been pretty tough.
Peter Mac has been really good. After about the fourth session of chemo I was asking them to “please take me off” because I didn’t want to go through it anymore.
I was in and out of hospital to start with, with really high fevers. Whenever I’d ring up and say ‘I don’t feel like it today’, they would change my times and give me rest periods. They listened to my needs and changed plans to suit me, so that made things easier.
Peter Mac’s Aboriginal Liaison Workers, Jay and Andrea, have come and visited me regularly too, which has been great – they have been a great support.
And the breast cancer nurses have been there every step of the way. If I needed something, they would go and source that information for me.
But I just couldn’t have done the cancer treatment if I didn’t have my husband and kids around me. They have been my rock through all this, keeping me going. When I’ve had some down days, my partner says, ‘look at your children, that’s what you’re doing it for’.
But my community has also been a really great support for me, like an extended family. I have a lot of friends who have all reached out. I had a community member who lived across the road who has been cooking my meals and bringing them over and making sure my family are all supported.
I was just talking today that I’m looking forward to going back to country, to Gunditjmara land, where we can go crayfishing and visit our heritage site.
I want to say to all Aboriginal women out there, get tested and pay attention to your body. As soon as I see that pink breast cancer clinic bus is going to an Aboriginal Community Controlled Organisation, I’m all over Facebook and saying get yourself down there and get tested. Catching it early will make the treatment so much easier.