Research In Women's Cancer

The Cancer Council Australia and its state members are committed to defeating cancer and see research as playing a vital role. We are confident that funding quality research and researchers today will ensure we continue to make progress in preventing, diagnosing and treating women’s cancers.

In 2006, the state members of The Cancer Council Australia committed over 30 research grants into women’s cancers. Some of these research projects are profiled below:

• Chemotherapy regimes for ovarian cancer
  
  
• Early exercise program for women following breast cancer surgery: a randomised controlled study
  
  
• Biomarkers of Cell Signalling Pathways in Ovarian Cancer
  
  
• Total Laparoscopic Hysterectomy (TLH) vs Total Abdominal Hysterectomy (TAH) for the Treatment of Endometrial Cancer
  
  
• Regulation of BARD1 localisation and apoptotic function in breast cancer
  
  
• Evaluation of a Fertility-Related Decision Aid for Young Women with Early Breast Cancer
  
  
• Clinical Trials
  
  
• Personal Insight – Rosemary

Chemotherapy regimes for ovarian cancer

Professor Michael Friedlander
Department of Medical Oncology, Prince of Wales Hospital

Platinum is the most important drug for treating ovarian cancer. Since platinum has been employed survival has increased. Yet after 20 years of using platinum and its analogues (drugs that differ in minor ways from the parent drug) the optimal dose and schedule is still unknown.

These days the majority of patients receive carboplatin, a more convenient and less toxic analogue of platinum, in combination with another drug (paclitaxel). However, because of side effects etc, many patients choose to be treated with carboplatin alone and therefore it is very important that the maximum benefit is obtained to optimise their survival.

Previous studies have suggested that escalating the drug dose may increase survival. This study is designed to assess whether this is indeed the case, using a formal randomised trial.

Patients with ovarian, fallopian tube or primary peritoneal cancer who are considered to be unsuitable or unwilling to receive combination therapy will be potentially eligible for the trial. Patients will be randomised to receive either the standard ‘flat' dosing or an ‘escalating' dose of carboplatin.

We are anticipating seeing an improvement in progression-free survival (i.e. the time free from disease recurrence) of 20% through dose escalation. If this is achieved then this new method of dosing is likely to be adopted into clinical practice. The results could have ramifications for dosing for other cancers where carboplatin is used, such as lung cancer.

This is an international trial involving the UK and number of European countries. Worldwide 1300 patients will be recruited to the trial.

Trialling an early exercise program for women following breast cancer

Dr Sharon Kilbreath
School of Physiotherapy
Faculty of Health Sciences, University of Sydney

 After treatment for early breast cancer, women report having chronic shoulder and arm problems including swelling (lymphoedema), stiffness, weakness, pain and numbness.

We will investigate whether early intensive exercises lead to improved functioning of the shoulders and arms and, as a consequence, to improved quality of life.

The exercise intervention has the potential to provide immediate relief of symptoms arising from local treatments for breast cancer, as well as long-term benefits through cutting the number of women developing lymphoedema.

This trial follows two pilot studies involving 52 women, which showed that the exercise intervention reduced the incidence of lymphoedema. We designed the trial based on the input from the women in the pilot studies.

For the trial we will be targeting women who have had a sentinel node biopsy or an axillary clearance, and who are therefore likely to develop upper limb problems.

If the trial is successful, the exercise program can be incorporated into clinical practice without delay and may also become a home-based program. The program requires minimal equipment, such as free weights and resistance bands, which are readily available in physiotherapy departments and sports stores.

Biomarkers of Cell Signalling Pathways in Ovarian Cancer

Dr Deborah Marsh
Kolling Institute of Medical Research
University of Sydney, Royal North Shore Hospital

Five-year survival for women with ovarian cancer is currently only 39%, making increasing survival time critically important. By improving our understanding of ovarian cancer, we will have a greater chance of finding the optimal treatment for this disease.

In this project we aim to identify the biological markers of specific pathways that are active in individual women's ovarian tumours to enable improved targeting with new molecular drugs.

We plan to use cell line models of ovarian cancer to compare the expression of specific genes in this malignancy with the activation of certain pathways. With the knowledge we gain from studying these cell line models, we will analyse blood and ovarian tissue from women with ovarian cancer that we have collected in our gynaecological tumour bank.

We will be able to test our findings from using the model systems immediately in human samples, so we can define their relevance to women with ovarian cancer.

Developing molecular drugs is a new and growing field. Drugs that suppress pathways, such as the PI3-K pathway that is active in many ovarian cancers, are now entering clinical trials. This pathway is one of the subjects of our investigations, and so this research will have immediate application in the ‘real world'.

A randomised trial comparing keyhole surgery with open surgery for endometrial cancer

Dr Russell Hogg
Gynaecological Oncology, Westmead Hospital

Around 2000 Australian women are diagnosed with endometrial cancer every year; it is the most common gynaecological cancer and the incidence is rising.

Endometrial cancer is treated surgically. The current standard treatment involves opening up the abdomen (laparotomy) to remove the uterus, fallopian tubes, ovaries and pelvic lymph nodes. However, data shows that ‘keyhole surgery' or laparoscopy results in fewer surgical complications, less pain, shorter hospital stays and much quicker recovery from the operation than open surgery.

We will be conducting a randomised trial comparing open surgery for endometrial cancer with keyhole or laparascopic surgery, the proposed better treatment.

The trial is designed to prove that laparascopic surgery is as effective as open surgery in terms of survival, and superior in terms of producing fewer complications and better quality of life.

The results will allow patients, under the guidance of their clinicians, to make an informed decision about their preferred treatment.

The research findings will not only impact patients with endometrial cancer, but also patients with benign conditions requiring a hysterectomy.

Examining the role of the BARD1 gene in breast cancer

Dr Beric Henderson
Westmead Institute for Cancer Research, Westmead Millennium Institute

Breast and ovarian cancer patients are known to have a mutated form of BARD1, a gene that is thought to either mediate or accelerate the killing effect of certain drugs on cancer cells.

In this study we will test a range of commonly used chemotherapeutic drugs for their effect on the BARD1 pathway in cultured human breast cancer cells.

Our study group has already contributed significantly to our understanding of how BARD1 works and this latest study builds on this knowledge. Increasing our understanding of the molecular basis of human breast cancer will help us progress in the management of this disease. And it is hoped our work may reveal new ways to kill cancer cells more effectively in the long term.

Evaluation of a fertility-related decision aid for young women with early breast cancer

Dr Bettina Meiser
Psychosocial Research, Medical Oncology
Prince of Wales Hospital

When young women who have not yet started or completed their families are diagnosed with breast cancer they need fertility-related information. We are developing and trialling a decision aid covering the pros and cons of fertility treatment. Previous research has shown that women want this information upon diagnosis. Some fertility treatments need to be undertaken prior to cancer treatment, so the timing is very important.

This decision aid will provide a better understanding of the fertility options available, the impact of these options in relation to breast cancer, and the long-term impact of fertility treatments. Women will be able to weigh up the costs and benefits of each treatment to help with their decision-making process.

We hope that the decision aid will lead to a better understanding of fertility-related issues, educated involvement in decision-making, more confidence in the decision being made and possibly lower levels of distress.

A team of experts is developing the decision aid using clinical guidelines. The aid will go to a group of oncologists and fertility specialists for comment, as well as 20 women who have been previously diagnosed with breast cancer. After appropriate changes are made, 120 women will assess the decision aid via a questionnaire-based study at 16 cancer clinics Australia-wide. Once proven to be effective, it will be made available to women with early breast cancer considering their fertility choices.

Clinical trials

Cancer clinical trials are research studies that test new and better ways to prevent, diagnose and treat cancer.

People being treated as part of a clinical trial do better than people treated outside of a clinical trial. They get the best available treatment or treatment that may be better, and receive extra personalised care and attention from their research nurses and treating doctors.

Clinical trials have enabled numerous advances in cancer care. Death rates from breast cancer have dropped by 30% over the past 20 years. This is probably due to a combination of better treatment – with tamoxifen and chemotherapy – and screening with mammography, which has picked up many cancers early. The benefits of using tamoxifen in early breast cancer have been established by 55 randomised clinical trials involving 37,000 women, and the benefits of chemotherapy have been established by 47 clinical trials involving 18,000 women.

The Cancer Council enables clinical trials to occur in many treatment centres and hospitals by funding Clinical Trials Nurses who recruit patients to participate in selected trials.

Personal Insight - Rosemary

Rosemary, aged 59, was diagnosed with breast cancer in 2000. After having surgery aimed at curing her cancer, she was advised to have additional (adjuvant) treatment. She was offered this additional treatment as part of a randomised clinical trial aimed at improving cure rates. Rosemary agreed, and is one of about 600 women from Australia, and more than 2,700 worldwide, taking part in this trial.

“I was really happy to be involved in the trial. Many women had been on trials before me and I had the advantage of those previous trials,” Rosemary said. “My first reaction was: ‘If I can do something to help other women along the line, I would like to do that.’

“I realise I had a lot of personal benefit from being in the trial because I was very well taken care of. I had a lot of personalised care and I felt that I was receiving better care because I was on the trial.

“With the randomness, there was equal opportunity I would have the new drug that they were testing or the current treatment. It didn’t worry me what treatment I was on. Even if I didn’t have the new drug, I realised that I was better off.

“I would definitely be involved in a clinical trial again. I have worked in market research so I know if we are going to go forward, we have to do the research. I’m 59, I’ve had a good life, and I want to give something back.”

© 2008 Cancer Council