Two clinical trials aimed at improving survival of people with melanoma and endometrial cancer, led by Peter Mac's A/Prof Shahneen Sandhu and Prof Linda Mileshkin, will receive support from the federal government’s Medical Research Future Fund.

Peter Mac’s A/Prof Shahneen Sandhu will lead the Australian component of an international clinical trial in people with early-stage melanoma, co-funded by Cancer Research UK. The trial will determine whether a simple blood test can predict the likelihood of a cancer returning and identify patients who could benefit from potentially life-saving immunotherapy treatment.

Melanoma is the fourth most common cancer in Australia and the second most common cancer in young adults. When caught early and while still localised to the skin, most melanomas can be cured by surgical resection. However, a small proportion of people will have their cancer return later on down the track.

Identifying people most at risk of their cancer returning would open the door for a more personalised therapeutic approach, while avoiding unnecessary treatment of low risk individuals.

“We believe the best approach is to personalise treatment based on accurately identifying the minority of patients at significant risk of developing recurrence and who may benefit from early therapy,” explains A/Prof Sandhu.

The DETECTION trial will bring together top melanoma clinician-researchers from Peter Mac, including Prof Sarah-Jane Dawson, Prof Grant McArthur, Prof Michael Henderson and Dr Stephen Wong as well as world-leading melanoma experts from the Melanoma Institute of Australia, University of NSW and Macquarie University, and the University of Manchester in the UK.

The team will test whether tumour DNA in blood can be a marker of tumour recurrence.

Circulating tumour DNA (ctDNA) is genetic material found in the bloodstream, which has come from the cancer. ctDNA can therefore act as a powerful ‘liquid biopsy’ to indicate small amounts of residual disease or early cancer relapse long before it is detectable by traditional imaging techniques.

“The ctDNA blood tests will help us stratify patients into those who are unlikely to relapse, and those with detectable ctDNA and who are therefore at high risk of their cancer returning.

“We will then use this information to get on the front foot and start treating high risk individuals with immunotherapies that activate the body’s own immune system to seek out and destroy the cancer.

“We anticipate that this early treatment will lead to improved outcomes for people with stage II melanoma,” says A/Prof Sandhu.

Also being supported by MRFF funding, the ADELE trial, led by Peter Mac’s Prof Linda Mileshkin, is a randomised phase 2 clinical trial examining the safety and efficacy of immunotherapy in combination with chemoradiation and chemotherapy in women with high risk endometrial cancer (EC).

EC is the most common gynaecological cancer in Australia, with nearly 3000 new cases diagnosed each year. EC rates in Australia have more than doubled over the last decade.

While a majority of women with non-metastatic EC can be cured by hysterectomy, women with more advanced disease and/or high-risk sub-types are less likely to be cured with surgery alone, and undertake a combination of post-operative chemotherapy and radiotherapy.

This combination of therapies has led to some improvements in survival, however the prognosis for women with high risk EC remains extremely poor.

“Despite advances we have made in improving treatment regimens for high risk EC, approximately one third of women with metastatic EC will still experience disease relapse within 5 years, with a median survival after relapse of just 12 months,” says Prof Mileshkin.

“Better treatment approaches are therefore critically needed.”

The ADELE trial will be led by Prof Mileshkin, on behalf of the Australia and New Zealand Gynaecological Oncology Group (ANZGOG), in collaboration Dr Yeh Chen Lee from the NHMRC Clinical Trial Centre, and drawing on expertise from Peter Mac’s Dr Pearly Khaw, Dr Liz Christie, Dr Rachel Delahunty and Dr George Au-Yeung.

The team will test whether adding immunotherapy to the current standard of care treatment of chemotherapy and radiation therapy can improve outcomes for women with high risk EC.

“Our group and others have demonstrated that patients with some forms of recurrent/advanced EC have a durable response rate to immunotherapy.

“Radiation and chemotherapy induce cell damage that may have immune-stimulating properties and thus are likely to synergise to increase the effectiveness of immunotherapy.

“We expect this combination treatment approach will reduce the risk of disease relapse in women with these aggressive sub-types of EC,” says Prof Mileshkin.

Peter Mac’s Associate Director Clinical Research, A/Prof Jayesh Desai, says that these important studies would not be possible without the exceptional leadership of A/Prof Sandhu and Prof Mileshkin, as well as the outstanding quality of the research teams.

“Shahneen and Linda are exemplars of Peter Mac’s patient-centred approach to cancer research. At Peter Mac we are excited to have researchers at the forefront of clinical research, which has the potential to make a huge difference to the lives of people affected by cancers such as melanoma and endometrial cancer – both in Australia and around the world,” he said.