Genomic medicine is the future for all cancer treatment, but has the greatest impact on rare, high-mortality cancers which are more difficult to diagnose and treat. The Australian Genomic Cancer Medicine Program (AGCMP) focuses on improving health outcomes for patients with less common, high-mortality cancers, including ovarian, and pancreatic cancer, sarcomas and cancer metastasis.
While rare cancers are individually less common, they collectively account for around a third of cancer incidence and nearly half of cancer deaths in Australia.
Genomic medicine offers an innovative strategy for diagnosing and treating cancer, based on a person’s entire DNA sequence. Variants in the DNA sequence determine the differences between individuals, and between types of cells (e.g. tumour cells and non-tumour cells). We use the latest genome sequencing technologies to look at the genetics of the cancer, rather than treating it based on location (e.g. breast, colon, skin). This allows us to understand inherited cancer risk and find more effective treatments for people with cancer.
Run clinical trials to identify more effective therapies for rare and less common cancers.
Study heritable cancer risk and risk management, to mitigate the development of disease.
The Genomic Cancer Medicine Program (GCMP) was established as part of a $24 million, four-year investment by the NSW State Government in using genetic technologies to improve patient outcomes. We collaborate with clinicians, pharmaceutical companies and funding partners who share our vision.
- St Vincent’s Hospital Sydney
- NSW State Government
- NHMRC Clinical Trials Centre (University of Sydney)
- Vodafone Foundation
- Rare Cancers Australia
Australian Genomic Cancer Medicine Programagcmp@garvan.org.au
More than 162,000 Australians are diagnosed with cancer every year. About 52,000 of these patients will be diagnosed with a rare or less common cancer.
Cancer is usually considered a disease of older people, with mortality rates increasing with age for most cancers. One of the key characteristics of rare cancers, however, is that these cancers place a great burden on children and young families. In every age group, ‘rare’, high-mortality cancers are the most common cause of disease-related death in Australia. Together with less common cancers, they account for over half of all cancer deaths.
Reasons for these high mortality rates include:
- Difficulty in diagnosis (as they are seen less often)
- Standard treatments are often less effective
- Limited access to new therapies.
While there's excellent evidence that participation in standard clinical trials is associated with better outcomes for people with cancer, patients with rare or less common cancers have very limited access to them. Despite there being over 180 types of rare cancers, trials are often not financially feasible to run for the small numbers of patients with these diseases.
The Genomic Cancer Medicine Program uses Garvan’s whole-genome sequencing facilities in the MoST Clinical Trials to identify more effective treatments for cancer patients, and to understand heritable cancer risk in the Genetic Cancer Risk in the Young (RisC) study and risk management as part of the Surveillance in the Multi-Organ Cancer prone syndromes (SMOC+) Study.
Genome sequencing helps clinicians diagnose illness and provide better, more personalised treatment.
Genomic information can predict how a person’s cancer will respond to surgery or drug therapy, guiding the use of existing treatments, or suggesting more targeted treatments. This can spare some patients costly and complex procedures, and can result in better outcomes.
Genomic information also helps us understand the genetic drivers that increase a person’s risk of developing cancer. Identifying that a patient is at risk allows personalised monitoring and more effective early detection.
We have developed targeted approaches to treating rare and less common cancers, using two specific strategies:
- Drugs which inhibit tumour growth
- Immunotherapies which stimulate an immune response that delivers long-lived tumour destruction.
These medicines, which work on differing cancer mechanisms, offer patients a more individualised approach to cancer treatment.
We're also working to understand more about the heritable causes of cancer and risk management, and are developing new diagnostic techniques and treatments to improve the health outcomes of individual patients, and all Australians.
The GCMP runs clinical trials to identify new treatments for patients with rare or less common cancers. If you're interested in participating in trials, please read the information below.
For questions about the program, please email: firstname.lastname@example.org
Our staff will get back to you as soon as possible, however please allow a day or two for us to process your request.
The MoST clinical trials
The Molecular Screening and Therapeutics (MoST) clinical trials personalise experimental treatments based on an individual’s unique cancer genetic profile. Because of this, eligibility for participation is independent of where the cancer arises in the body. In these trials, rather than focusing on a tumour’s location, such as the ovaries or pancreas, patients who have a shared harmful genetic variant, are treated with a drug that may target the variant, even if they have different types of cancer.
Clinical trials are generally used to test a new treatment, with some patients getting the new drug and the others getting an existing drug or a placebo. One-third of GCMP patients will have a biomarker matched to a targeted therapy, while those remaining may be directed on to other trials or therapies, including immunotherapies.
The clinical trial process
Traditionally, clinical trials for new drugs have been conducted in four to five phases, taking around eight to 10 years to complete. The financial costs of conducting cancer clinical trials have risen from less than US$10,000 per patient in 1980, to around US$47,000 in 2011.
Because there are fewer patients with rare cancers, it isn’t possible to follow the usual progression of clinical trials mechanisms for these small groups of patients.
While phase 1, 2 and 3 studies are, – and will remain, – critical to drug development, they are costly and slow. New trial designs, such as MoST, which sit between a phase 1 toxicity trial and a phase 2 efficacy trial and include genetic testing of cancers, offer opportunities for trialling targeted treatments more efficiently. MoST has already shown that genomic cancer profiling can identify treatable options for a significant portion of patients who previously had none.
Joining the MoST clinical trial
Our trials seek to determine if a treatment will work, or work more effectively than another treatment. First, all patients (and their tumours, where possible) are genomically screened to see if they're suitable for the trial and if there are variants that can guide treatments.
After screening, patients are offered either:
- MoST clinical trials, including immunotherapies
- Clinical trials outside MoST that use molecular eligibility criteria
- Other biomarker-guided treatments outside MoST
All participants, including those with no ‘actionable’ biomarkers are informed of the results of the screening through their own doctors.
Joining the immunotherapy trials
The MoST protocol is also conducting clinical studies to test new immunotherapy drugs in patients with high-mortality cancers. The first MoST immunotherapy sub-study tests a combination of so-called ‘immune checkpoint inhibitor’ drugs that take the brakes off the anti-tumour immune response, enabling immune cells to attack cancer cells. A second immunotherapy study, for patients with specific genetic abnormalities in their tumour, combines a targeted treatment with a checkpoint inhibitor.
Although immunotherapies are proving to be effective in many cancer types, they do not work in all patients. We're seeking biomarkers that can predict which patients will benefit from specific treatments targeting the immune system, and to better understand how immunotherapies work to fight cancer. With this knowledge, we aim to develop a more precise approach that tailors immunotherapy treatment to individual patients, based on the characteristics of their immune system and its interactions with tumour cells.
The immunotherapy trials will allow us to understand how these immune biomarkers influence the anti-tumour response, and help develop a precision approach where treatment can be personalised.
All component studies of the Genomic Cancer Medicine Program have been approved by the St Vincent’s Hospital Sydney Human Research Ethics Committee, which operates under the requirements of the National Health and Medical Research Council’s National Statement on Ethical Conduct in Human Research (2007), the Australian Code for the Responsible Conduct of Research (2007), and for research specific to NSW, the NSW Supplement to the National Statement (2008).