“In the past researchers in Australia have looked to government for leadership. But times have changed and in the future it will be up to researchers to take responsibility for themselves.”
Prof Ian Frazer AC, FRS, FAA, FAHMS was the guest speaker at the Scientific Meeting of the Australasian Leukaemia and Lymphoma Group (ALLG) in Brisbane in May. Rather than discussing specific trials or research projects, Prof Frazer’s addressed the broad environment within which clinical and translational research operates in the present time.
Following on from the 2013 Strategic Review of Health and Medical Research (the McKeon Report), a number of leaders from health and medical science came together in 2014 to establish the Australian Academy of Health and Medical Science. Prof Frazer, as the President of the Academy, explained to the ALLG SM how it will serve the three purposes identified in the McKeon Report:
- Mentoring the next generation of clinician researchers
- Providing independent advice to government and others on issues relating to evidence based medical practice and medical researchers
- Providing a forum for discussion on progress on medical research with an emphasis on translation of research into practice
Further information can be found at www.aahms.org
The Australasian Leukaemia and Lymphoma Group (ALLG) holds Scientific Meetings (SM) twice a year and they are working meetings with a focus on robust discussion of the full trial portfolio. In order to maximise attendance, the SMs are always held in accessible state capitals commonly Melbourne and Sydney.
The most recent SM, held in Brisbane over four days in May, saw 230 clinician haematologists, scientists, study coordinators, consumers, sponsors and ALLG staff discuss the ALLG’s existing trial portfolio, consider new proposals and concepts, participate in small focus meetings, undertake training and network.
The main plenary sessions occur on the Thursdays and Fridays and are divided into the eight Disease Groups which cover the range of diagnoses of blood cancers. A regular feature is always the number of new proposals and this May saw 14 new concepts presented and an additional 7 flagged for further development.
One new concept is the DIRECT study in Chronic Myeloid Leukaemia (CML) proposed by Dr David Yeung from Royal Adelaide Hospital. The majority of patients present with a relatively indolent chronic phase disease that, if left untreated, progresses to a condition that resembles acute myeloid leukaemia. Over the last 15 years patients are treated with a class of drugs known as TKI-inhibitors, and long term survival is now excellent. This means that increasing numbers of patients are now on long term medication. The priorities of CML treatment are now similar to the management of other chronic illnesses – prevention of complications and minimising the impact of treatment related toxicity on quality of life. The proposed DIRECT study will focus on individualisation of drug dose via therapeutic drug monitoring for toxicity management with the aim of preserving efficacy whilst minimising toxicity.
At the same time, treatment emphasis in CML is now shifting to the intermediate goal of deep molecular response, ultimately leading to treatment free remission, especially in younger patients. The ALLG CML11 PInNACLe trial adds the drug interferon, one of a class of proteins known as cytokines, molecules used for communication between cells to trigger the protective defenses of the immune system. The aim is to thereby augment the response induced by the TKI. The PI is Prof Tim Hughes from the Royal Adelaide Hospital. Seven sites are now active in this trial with 6 more to come and 16 patients have been registered.
A new trial in aggressive non-Hodgkin lymphoma (NHL) has been enthusiastically received within the group. The Principal Investigator of the NHL29 trial A/Prof Judith Trotman from Concord Hospital recognised the unmet need for evidence-based treatment paradigms for truly elderly patients with DLBCL. Older patients are usually treated with a less intensive version of the standard treatment for NHL known as R-mini-CHOP. The aim of NHL29 is to improve the survival of patients over 75 by adding Ibrutinib, a drug targeting B-cell malignancies. Given the limitations of deliverability of full-dose CHOP, it is anticipated patients will find the option of a less-toxic enzyme inhibitor instead of intensive chemotherapy very attractive. The trial is planned to accrue 80 patients from 20 Australian sites over 2-3 years and is expected to start later this year.
At the other end of the trial process, the NHL18 trial has recently been published. This international trial, coordinated by the Austrian collaborative cancer group AGMT, was conducted in Australia under the auspices of the ALLG with PI A/Prof David Goldstein. The trial investigated the effectiveness of rituximab maintenance treatment in aggressive B-cell lymphoma. While rituximab maintenance did not prolong EFS or OS it did prolonged PFS and showed significantly more activity in male patients in subgroup analysis.
The ALLG’s Scientific Meeting also includes a two-day program for study coordinators, data managers and research nurses conducting ALLG trials. The Tuesday Haematology Education Day provides a unique opportunity for training in haematology and draws upon the expertise of leading specialists. The focus this May was in Multiple Myeloma and was facilitated by the Chair of the Myeloma Disease Group, Dr Peter Mollee from Princess Alexandra Hospital. Presentations covered topics ranging from diagnosis, investigations, staging and prognosis, through treatment options and bone disease. Participants commented afterwards that it was very helpful in explaining the rationale behind ALLG trials and that the day contributed to improved understanding of the disease. As one person wrote afterwards, “It was exciting to know about all the advancements in the future of treatments in Multiple Myeloma”.
A highlight on the Wednesday was a presentation by Prof Maher Gandhi from Princess Alexandra Hospital, who spoke on the very current topic of assay techniques and genetic issues in consent. Prof Gandhi covered issues such as genetic discrimination law and gene patenting. He emphasised that HREC applications should not be seen just as an administrative burden. “Ethics applications should be seen as a process of ethical research conduct, in which the initial application is the first part, but the most important part is performing research in an ethically responsible manner”.
Two study coordinators were presented with Awards which will enable them to attend conferences in 2015. Angela Neville (Holman Clinic, Launceston) received the Janey Stone Perpetual Award and Andy Phay (Queen Elizabeth Hospital) received the Anne Lenton Memorial Award.
The oldest collaborative cancer group in Australia, the ALLG has in the 41 years of its existence initiated 148 studies involving over 6000 patients with blood cancers in Australia and New Zealand. Internationally the group is very highly respected and has participated in trials initiated from France, the UK, Germany, the Netherlands, Italy and many other countries. The next Scientific Meeting will be 10-13 November 2015 in Melbourne.[hr]
By Delaine Smith, CEO of ALLG. Images: ALLG.