It’s a word that many people are all too familiar with, and are often in fear of. Cancer turns lives upside down and causes immeasurable anxiety and distress – not only to the person diagnosed, but to their family and close friends. It involves treatments that are prolonged, invasive and uncomfortable and sadly, in far too many cases, cancer robs families of cherished time with a loved one. It steals what could have been and what should have been.
Most recently, Princess Catherine has bravely shared that she herself has been diagnosed with cancer. The microscopic cancer was discovered during the Princess’ planned abdominal surgery which took place earlier this year. In response to this, Catherine revealed in the clip posted by Kensington Palace that she was undergoing “preventative chemotherapy” which is also sometimes referred to as adjuvant therapy. But what exactly does cancer prevention look like?
The Australian Institute of Health and Welfare reports that just over 165,000 people in Australia received a cancer diagnosis in 2023 and in the same year, just over 51,000 people died from cancer. That’s the equivalent of around 3100 people being told they have cancer every week and 980 people a week losing their life to the disease.
In 1982, the five-year survival rate of cancer was 47 per cent. Now the chance of surviving cancer for at least five years is 70 per cent and work is being done worldwide to boost that figure.
Researchers are focused on cancer prevention and are in laboratories improving treatments and finding new, effective options that may one day bring a cure. They are also unravelling the complexities of cancer to help survivors remain disease-free.
Better chemotherapy for breast cancer
For a third of patients with triple negative breast cancer – which is aggressive and fast-growing –chemotherapy isn’t effective and women go on to develop advanced cancers elsewhere.
“We’re trying to understand how we can stop patients from becoming resistant to chemotherapy because chemotherapy is still currently the best treatment,” explains Associate Professor Christine Chaffer, who leads the Cancer Cell Plasticity Lab at the Garvan Institute of Medical Research.
“Cancer cells are tricky and they can change from being sensitive to chemotherapy to being insensitive. But, using a new drug, we’ve discovered a way to stop that happening so this type of breast cancer can’t become resistant to chemotherapy.”
Research has been done on human breast cancer tumours grown in experimental models, but within the next year Associate Professor Chaffer hopes clinical trials will begin in patients. She has been working on the research for 12 years.
“The idea will be to give women this drug before and during chemotherapy so we lock the cancer cells in a state where they are sensitive to chemotherapy and can’t change,” she says. “This could eventually be used across all cancers where this cell change happens. It’s an exciting time to be in cancer research and there are a lot of reasons to be hopeful.”
Targeting tumours
T-cells are an important part of our immune system. They hunt and destroy abnormal cells, including cancer cells, but sometimes cancer cells still evade our body’s defence system.
A new therapy called CAR T-cell therapy takes the T-cells of patients, re-engineers them in a laboratory and injects them back into patients so they can more precisely seek out and attack cancer cells.
“We re-engineer the patient’s own immune system to get rid of the cancer,” says Professor Shelley Dolan, Chief Executive of the Peter MacCallum Cancer Centre.
CAR T-cell therapy has already been used to treat blood cancers like leukaemia and lymphoma, and now it is being trialled to see if it can be as effective in the prevention of cancers like multiple myeloma, lung, breast and bowel cancer.
“We have seen fantastic results for blood cancers – patients who are very sick see their cancer go away and stay away – and early clinical trials show this therapy may also be effective with solid tumours,” says Professor Dolan.
Demystifying unknown primary cancer
Each year, Australian specialists see 2,500 new cases of cancer where the primary source is unknown. People present with cancer in their lungs, kidneys, liver or brain, but where the cancer originated is a mystery – it’s known as Cancer of Unknown Primary (CUP).
“It is an exciting time to be able to translate science like this into meaningful medicines.”
“If imaging shows someone has tumours in their body, it’s important to know where the cancer started from so you know how best to treat it,” says Professor Dolan.
Researchers at Peter Mac are building a ‘bio and information bank’ to demystify CUP. They’re gathering clinical, molecular and patient information to better understand how and why these cancers occur and how best to identify, treat and manage them.
“We are gathering tumours and looking at them under the microscope to see where they came from, why they grow and how to treat them, and we are designing the best support
for those patients,” says Professor Dolan.
The research will develop bespoke therapies that more effectively attack the primary cancer in individual patients. “It is an exciting time to be able to translate science like this into meaningful medicines and therapies,” says Professor Dolan.
Mapping childhood brain cancer
About 20 per cent of childhood brain tumours are medulloblastoma – a cancer that most commonly affects children between the ages of three and eight. Treatment usually involves surgery followed by radiotherapy and chemotherapy.
“Treatment has a reasonably good success rate but the side effects are pretty devastating and if you get an aggressive type, the survival rate is not great,” says Associate Professor Melissa Davis, a computational biologist from WEHI in Melbourne.
She and her colleagues have developed a genetic road map of this brain cancer and are repurposing existing drugs to stop tumours growing.
“As with a road system, if you route all traffic through one intersection and then block it, nothing can get from A to B. We’re looking for the key intersection points in medulloblastoma so we can stop the cancer cells connecting to each other at those points. Then we target those intersections with cancer drugs and stop the cells from growing,” says Professor Davis.
In pre-clinical trials, one drug cured 25 per cent of tumours. The other 75 per cent of brain tumours shrank but returned when treatment was stopped, so long-term treatment might be used to keep tumours at bay. Researchers continue to search for new drugs that will improve survival and cancer prevention.
“Families are desperate for treatments and a lot of our research is funded by families who have lost children and who don’t want other families to experience that loss,” says Professor Davis.
Taking on ovarian cancer
Each day in Australia, five women are told they have ovarian cancer and three will die from a disease that often has no symptoms until it is well advanced. The overall five-year survival rate is 48 per cent, compared to 92 per cent for breast cancer. The most common type is high-grade serous ovarian cancer and Dr Ashleigh Poh, a postdoctoral researcher at the Olivia Newton-John Cancer Research Institute, is focusing on cancer prevention by developing new drugs to beat this aggressive disorder.
“Most patients respond poorly, or not at all, to existing drugs and many therapies have severe side effects. We’re looking at a drug target called HCK – a protein found in a type of immune cell called a macrophage,” says Dr Poh, who has received funding from the Ovarian Cancer Research Foundation to continue her work.
“Normally, macrophages play an important role in protecting us from disease, as well as clearing dead or damaged cells, but sometimes they are hijacked by cancer cells to help tumours grow.”
Dr Poh’s research shows that targeting HCK slows the growth and spread of many cancer types, including ovarian cancer. While it may be a decade or so before patients benefit, Dr Poh hopes the research will eventually go from laboratory bench to bedside.
“Cancer doesn’t only affect the person with the disease, it impacts everyone around them, but this is one treatment that we hope will improve survival and quality of life,” she says.
New technology and treatment for breast cancer
“Of the 150,000 people diagnosed with cancer each year, more than one in 10 of those will be diagnosed with breast cancer,” says Associate Professor Cleola Anderiesz, Chief Executive Officer of the National Breast Cancer Foundation (NBCF).
“We know that an Australian woman diagnosed with stage I breast cancer has a 100 per cent chance of surviving five years. So, we need to find better ways of screening patients to detect the breast cancer earlier.”
To that end, Professor Nehmat Houssami, from the University of Sydney, recently appointed NBCF’s first 10-year Chair in Breast Cancer Prevention, has been working on new screening technologies which combine both 3D and 2D mammographic technology.
“The objective of this project is to increase the accuracy of detection, reduce the number of false positives and to detect breast cancers as early as possible,” explains Associate Professor Anderiesz.
“This is not in current clinical practice, but if Professor Houssami is successful it can help inform how we screen women for breast cancer into the future.”
We might see it implemented in the next five to 10 years. Another NBCF-funded project is being run by Monash University’s Professor Erica Sloan.
“Professor Sloan has found that you can potentially use a beta blocker, a medication used to treat high blood pressure, as an anti-metastatic drug for triple negative breast cancer,” says Associate Professor Anderiesz.
“It’s just another little piece in the puzzle of our mission of ending deaths from breast cancer.”
