Friday, May 20 is International Clinical Trials Day, a day that highlights the importance of clinical trials research and commemorates the day Scottish physician James Lind began his study to find a treatment for scurvy in 1747.
By dividing 12 sailors into separate groups and testing the effect of providing different treatments to each group, Lind was able to provide evidence of the link between citrus fruit and preventing scurvy. This was the first recorded controlled clinical trial.
Today, thousands of incredible researchers and professors across the world are working together in a global effort to pave the way for a better future through clinical trials. This day is about celebrating their work, shining a light on the results, and appealing to those considering medical research as a career. The Australian and New Zealand Urogenital and Prostate Cancer Trials Group – ANZUP – is just one of many groups conducting clinical trials, focusing on research into below the belt cancers (kidney, bladder, testicular, penile, and prostate).
Last year alone, 27,224 Aussies and 4,502 Kiwis were diagnosed with a below the belt cancer, an average of 77 people every day. ANZUP currently has over 7000 patients enrolled across 27 clinical trials being conducted over 650 sites in an effort to significantly reduce this statistic and are running the Below the Belt 77KM in May #YourWay Challenge to help raise awareness and much needed funds in support of this research.
Professor Dickon Hayne touches on the importance of International Clinical Trials Day, the work of ANZUP in improving the outcomes for people affected by below the belt cancers, and an insight into the future of medical practices.
- Can you please tell us about some of the latest research projects that you have been involved in?
Perhaps one of the main ones that I am still very much involved in is the BCG Mitomycin (BCG+MM) trial, which is now the largest Australian initiated bladder cancer trial that been undertaken. We’ve got over 415 patients on study, 15 centres around Australia, and now also open in the UK.
This trial takes a look at standard treatment for non muscle invasive bladder cancer and BCG treatment, comparing that with a combination treatment of BCG and a chemotherapetic agent called Mitomycin.
I’m also leading SUBDUE-1, a study looking at a new route of administering the checkpoint inhibiting drug Durvalumab for bladder cancer. It’s a drug used in metastatic bladder cancer and we are trying to bring these drugs earlier into the treatment paradigm. In the study increasing doses are injected directly into the bladder wall. In the future this may become a new treatment for early bladder cancer.
I’m also involved in the ZIPUP study, which is a new PET scan staging trial for bladder cancer. We are using an antibody that sticks to bladder cancer attached to a radioactive substance that shows up on a PET scan. It is important to try to see how far a cancer is spread in order to decide what the best treatment is for patients.
2. What do survival rates look like at the moment?
I’m going to answer about bladder cancer specifically. The most recent up to date data that we have indicates that we are going backwards and that survival rates in bladder cancer in Australia are actually getting worse. The whole impetus behind bladder cancer research is to try and reverse that alarming trend.We do have a number of new agents and therapies that are available for bladder cancer that are only just emerging and haven’t made it into clinical practice yet. This is where clinical trials come into effect.
3. What is International Clinical Trials Day and what does it represent?
It’s the ability to collaborate across international borders, allowing you to complete essential trials that you couldn’t really perform in one single country alone either because the cancer is so rare or for various other mechanisms – you need a lot of patients to answer a clinical question. Sometimes it’s impossible to do that within a realistic timeframe unless you collaborate widely, whether that be locally, nationally or internationally. Effective collaboration is the key to clinical research.
Some trials for example the highly successful ENZAMET (Enzalutamide in First Line Androgen Deprivation Therapy for Metastatic Prostate Cancer) trial that was run through ANZUP recruited very rapidly through an international effort.
4. What have been some of the major breakthroughs that come out of clinical trials for below the belt cancers?
It depends on how far back we look – we didn’t even have hormonal therapy for prostate cancer until Huggins and Hodges won a Nobel Prize for it in 1966. That may seem like a long time ago but it was a gamechanger.
Platinum based chemotherapy for testicular cancer was another one that really revolutionised treatment – metastatic testicular cancer was almost always fatal but with the arrival of platinum based chemotherapy it’s now very unusual to die from.
Those are two massive leaps in two of the below the belt cancers.
In recent years there have been a lot of advancements with immunotherapy, which is one of the new and exciting areas in oncology.. The immunotherapeutic drugs and other new agents that are used are often targeted, appropriate for patients that have specific mutations in their DNA and require certain drugs suitable for their individual case.
Another recent trial, the proPSMA PET trial, implemented a new staging scan for prostate cancer showing that it was accurate and superior to conventional staging. It’s important to note that in terms of survival rates, prostate cancer is the second most common in terms of male cancer deaths, so it’s important to be able to stage these patients properly.
The other thing that is changing the face of cancer therapy is theranostics, where you can image a patient with a pet scan and if the cancer is visible, you can add on a killer radioactive molecule that will hunt down, stick to the cancer, and kill it.
We have been talking about targeted therapy and personalised medicine for years but now it is becoming a reality. The trials we are focusing on now and will inform the basis of future treatments..
5. How does Australia stack up against the rest of the world when it comes to trials and research into below the belt cancers?
Australia punches above it’s weight in terms of clinical trials. With ANZUP as a coordinating centre for urogenital cancers and trials into below the belt cancers, we are starting to make some proper inroads to cancer care that are practice changing .
About Professor Dickon Hayne:
Professor Dickon Hayne is a clinical academic who leads urological research education in urology, at the University of Western Australia. He works as consultant urological surgeon and is the Head of Urology for the South Metropolitan Health Service, WA. He is Chair of the Bladder, Urothelial and Penile (BUP) Cancer Sub-committee of the Australian & New Zealand Urogenital & Prostate Cancer Trials Group (ANZUP), an SAC member, leads the BCGMM trial and is widely engaged in other sub-committees, trials and activities of ANZUP. His major clinical and research interests are urological cancer, in particular bladder cancer.
About ANZUP:
The Australian and New Zealand Urogenital and Prostate Cancer Trials Group was formed in 2008, bringing together a world-leading multidisciplinary team of doctors, nurses, allied health care professionals, scientists, researchers, and community representatives, all working in areas related to urogenital cancer.
ANZUP has members in every state and territory in Australia and New Zealand, with an increasing international membership.
ANZUP receives infrastructure funding from the Australian Government through Cancer Australia. Fundraising also remains an important part of ANZUP’s activities allowing us to support each and every new clinical trial.
Urogenital cancers, also called below the belt cancers, are those coming from the testicles, prostate, kidney, penis or bladder. ANZUP aims to improve outcomes for people affected by these cancers by exploring and defining priority areas in below the belt cancer research. We investigate which data deserves attention, which treatments hold promise for the future, which drugs should be tested in clinical trials and most importantly, we need to understand the main areas of concern of our patients.
By performing clinical trials we are able to generate new evidence for better treatments, or ways of providing other support.
About Below the Belt 77KM in May #YourWay:
https://www.belowthebelt.org.au/
The Below the Belt 77K in May #YourWay Challenge is about doing it #YourWay from the comfort of your
home, in your office or in your local area to help raise awareness and much needed funds for below the belt cancers.
You can choose to cycle, walk, or run any way. Do it as a team, with your family, with a friend or by yourself. Do it every day, or some days in May.
77k in May #YourWay Challenge is open to all in Australia and New Zealand.
Do 77KM in May #YourWay and help us raise $150,000 for ANZUP’s below the belt cancer research.
