The next frontier in cancer treatment

As Director of Oncology and Cancer Services at St Vincent’s Hospital Melbourne, Associate Professor Sue-Anne McLachlan leads a team of hard working and compassionate oncologists striving for new breakthroughs in cancer treatment.

A/Prof McLachlan is working closely with oncologist Dr Melissa Moore recruiting for a number of international trials looking at the next frontier in cancer treatment, immunotherapy.

‘Immunotherapy is the latest and greatest in cancer therapy,’ A/Prof McLachlan says. ‘Cancers have very clever ways of telling the body’s immune system to go away, ignore me. New drugs used in immunotherapy tell the immune system to overcome cancer’s tricks to evade the immune system.’

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Associate Professor Sue-Anne McLachlan

Immunotherapy is now part of standard care in melanoma treatment, and A/Prof McLachlan and Dr Moore are leading the charge on looking at a wider range of cancer types. The team is working with a clinical trials group in Canada and with cancer researchers across the globe to use immunotherapy in early stage lung cancer for the first time.

‘In initial research, which has come really quickly, immunotherapy has been tried in an advanced cancer setting, where cancer has spread to other parts of the body,’ A/Prof McLachlan says. ‘Now we have mounting evidence that it is helpful in a number of situations.’

Studies are now moving into early stage cancer, in situations where the cancer has been surgically removed. While in many cases the cancer will come back, the team is trying to use immunotherapy to kill off the cancer before it returns.

The advantage about immunotherapy that has them most excited is that the side-effects are generally not as severe as chemotherapy and can be tolerated by patients.

‘Whereas chemotherapy is toxic against cancer cells and has a range of side-effects because of that, immunotherapy allows the body’s immune system to recognise cancer as foreign and attack the cancer cells,’ A/Prof McLachlan says.

‘Tantalisingly, we are seeing patients live for some years with cancers that would otherwise have a survival rate of months.’ The next step is combining immune therapy with a different mechanism of action, such as combining immunotherapy with chemotherapy, or combining it with radiation therapy.

‘We are recruiting patients to a number of studies, including eight patients that had newly diagnosed metastatic or advanced lung cancer and they were randomised to either chemotherapy, immunotherapy, or chemotherapy plus immune therapy. Some of those patients are responding very well.’

St Vincent’s is a major centre of thoracic surgery in Victoria and the lung cancer research group on campus is a very active group, punching above its weight on the world stage. A/Prof McLachlan believes this is due to the relationships the research group has built with collaborators over a number of years. ‘It’s about building trust, building a relationship, and building a reputation.’

Cancer trials are becoming more and more selective and applicable to only very small groups, as more is discovered about cancer, and the research group has become very collaborative, sharing patients for trials and endeavouring to find the  best options for patients.

‘Lung Cancer isn’t just one cancer, it’s many different cancers at a molecular level,’ Dr Moore says. ‘It isn’t possible to have all of the patients you need to fill clinical trial spots at your centre, so there is a need to collaborate, to reach out to other centres doing niche trials.

‘Across the board we are learning more about the individual characteristics of lung cancer at a cellular level, which in turn is helping to guide treatment. We are getting to the point now where we are working out, once they become resistant to a particular kind of treatment, what process is driving that resistance and what treatment can we give to target that resistance. It’s a very exciting time for cancer research.’

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