The New Frontier in Cancer Research

When the Victorian Comprehensive Cancer Centre (VCCC) opened in July 2016 it heralded a new dawn for cancer treatment, research and collaboration.

Developed by an architectural design team of Design Inc and Silver Thomas Hanley in partnership with McBride Charles Ryan, the building has an imagery that is ‘expressive of optimism and progress. The key public building on a key Melbourne axis will acknowledge and make evident our collective endeavour to gain mastery over cancer. The centre will provide hope, health and wellbeing to all Victorians.' (McBride Charles Ryan.)

The $1 billion purpose-built facility brings together cancer research, education and clinical care. It provides patients with access to the latest cancer treatments and allows clinicians to collaborate directly with researchers. And it is a symbol of hope.

Attending the opening of the VCCC, the former US Vice President, Joe Biden, said: “You are making cancer research a team sport. You have poured your heart—and a lot of your money—but your heart into building this facility. It’s a testament to your tenacity as well as your dedication in the fight against cancer.”

Located opposite the Melbourne Medical School and the street-facing cafĂ© is busy with staff and visitors—many of whom are patients. It is the largest combination of cancer research and treatment in Australia and, in the same way as the leading comprehensive cancer centres in North America and Europe, the VCCC has a world-leading university at its core.

Professor Jennifer Philip

“Palliative care is still a relatively new area of clinical care and there is enormous scope for research into how we control and alleviate symptoms of advanced illness, how we convey important and challenging information to patients, how we improve patient access to research, and how we can build research capability in the field. My aim is to ensure that all care provided to people with advanced disease is informed by evidence and delivered by people who are well-trained, well-supported, compassionate and passionate about what they do.”

Professor Jennifer Philip (MBBS 1988, PGDip Palliative Med 1998, MMed (PallMed) 2001) is the inaugural Chair of Palliative Medicine in the Department of Medicine at the University of Melbourne, St Vincent’s Hospital and Victorian Comprehensive Cancer Centre. She describes the primary focus of palliative care as ‘helping a person to live fully’.

Associate Professor Mehrdad Nikfarjam

“Targeting PAK1 could reduce the fibrosis surrounding pancreatic tumours and allow conventional chemotherapies to have a greater effect on the tumours. Its role as an iFoundationignalling protein in both the tumour and tumour environment is an important finding in unravelling the puzzle that is pancreatic cancer.”

Associate Professor Mehrdad Nikfarjam (PhD 2005), Liver, Pancreas and Biliary Surgeon in the Department of Surgery is also the founder of Pancare Foundation, a pancreatic cancer charity organisation. He has identified in pancreatic cancer a protein called p21-activated kinase 1 (PAK1) within specific cells called pancreatic stellate cells (PSCs).

The University of Melbourne Centre for Cancer Research (UMCCR) is the nexus of the University’s cancer research program based at the VCCC. The inaugural Director of the UMCCR is Professor Sean Grimmond, a founding scientific fellow in The Royal College of Pathologists of Australasia. Professor Grimmond is also the inaugural Bertalli Chair in Cancer Medicine, thanks to the generosity of philanthropists, Neville and Di Bertalli.

Professor Grimmond obtained his PhD in pathology from “I was lured to Melbourne from Glasgow about a year ago to take up the opportunity of the Bertalli Chair of Cancer Medicine and Director of the University’s Centre for Cancer Research. Our work up here on the 10th floor of the VCCC is really the start of building an integrated clinical research centre to rival the best in the world, based here at Melbourne.”

Professor Grimmond was Professor of Genetics at the University of Queensland and founding Director of the Queensland Centre for Medical Genomics. “I had always been interested in working in cancer, specifically by trying to use genomic approaches to understand the machinery behind the disease.” He later established the United Kingdom’s genome-directed clinical trials and was the Chair of Medical Genomics at the University of Glasgow where he co-founded the Scottish Genome Partnership, a national initiative aimed at population-scale genetic sequencing of cancer, rare genetic diseases and healthy cohorts.

“I am very happy to be in Melbourne; it’s a sophisticated city and the sheer concentration of research here makes it the anymore—our work is all about scale and convergence. I have a skill set that just 10 years ago was esoteric and boutique, but I am now in the perfect position to exploit my skills to their fullest, in partnership with the complementary expertise of my colleagues here, and with computational technology to magnify the impact of our research.”

Associate Professor Sarah-Jane Dawson

“The results of our test can be more precise because cancer cells from all disease sites within the body shed their DNA into the bloodstream, providing a much more complete picture of the state of the tumour. While it is not a substitute for a bone marrow a patient experiences through their treatment, and we may be able to provide more effective treatment, based on the information it provides.”

Associate Professor Sarah-Jane Dawson (MBBS 1998) is based at the Peter MacCallum Cancer Centre and the University of Melbourne Centre for Cancer Research. She has developed a simple blood test that can analyse trace amounts of cancer DNA found in patients’ blood. This new test will help replace invasive tissue biopsies which are currently endured by blood cancer patients and which require sedation, pain relief and at least six hours in hospital up to three times a year to track the progress of their treatment.

Professor John Hopper

“My team is creating a new risk scoring system for breast cancer. By combining hundreds of genetic variants with mammographic density lifestyle factors and family history we can better determine what a woman’s risk is, and what screening and prevention can be offered to reduce the impact of breast cancer.”

Professor John Hopper (BA 1989) is Director (Research) of the Centre for Epidemiology and Biostatistics, Director of Twin Research Australia and Redmond Barry Distinguished Professor at the Melbourne School of Population and Global Health. Professor Hopper and his team are working on how to combine SNPs (single nucleotide polymorphisms or single DNA bases that vary between individuals), mammographic density lifestyle factors and family history to determine a woman’s overall risk of breast cancer.

Professor Grimmond believes that genomic-directed oncology—using genetic information to treat disease—is the cornerstone of precision personalised medicine and the future of cancer prevention, diagnosis, and treatment. “I am driven by a belief that in future cancer will be a preventable and treatable disease, managed much the same as we manage chronic diseases like high blood pressure or diabetes.

“Our researchers, clinicians and academics at the UMCCR have the knowledge and skills to radically minimise the burden of cancer. We have at our fingertips an incomparable pocket of complementary knowledge and expertise and I am in no doubt that our cross-disciplinary approach to discovery and our co-location with hospital and research partners will maximise the impact of breakthroughs and be the springboard for extraordinary innovation.

“The future of cancer medicine is to locate the Achilles’ heel of every single cancer using genomic-directed oncology. Only then can we administer the right treatment for each individual at the right time for the right cancer. By capturing a patient's genetic information we can improve outcomes in diagnosis and treatment selection, minimise adverse side effects of treatments, and improve the decision-making processes of clinicians and ultimately the patient’s overall wellbeing.

“Precision oncology is about decoding a patient’s genetic blueprint to understand all of the damage that has occurred to the DNA within their cancer. Once we have that information we can understand the root cause of the mutations within that individual, and we can understand what broken genes are driving the disease and causing those normal cells to become cancerous. Then, based on that understanding of the DNA damage, we will be able to prioritise one drug over another, or at least allow the clinicians and researchers to factor in all of the available information when developing new treatments.

“At the UMCCR we are starting where modern medicine is failing: in rare, recalcitrant and resistant cancers. For patients with these cancers, the current standard of care—the treatment protocol that works for the majority of patients—is ineffective or has been exhausted. If we can harness the power of genomic-directed oncology for the more than 50,000 Australians each year diagnosed with these types of cancers we will be able to accurately pinpoint the most effective treatment for each individual and, where there is no treatment, invent one.”

Dr Grimmond is committed to teamwork. “It can be easy to focus on the first two steps of whatever you are doing—everyone can think about where they want to go next, and then quite often you can think about what happens thereafter. But not many of us think about what happens 10 steps away. But by having different people around all the parts of those processes it becomes possible to get a more complete view.

Professor Grant McArthur

"Modern cancer treatments can turn off individual proteins in the cancer cell with precision. Now, we can screen patients for changes in their DNA sequence to tell which drugs will work. The real challenge is to be able to personalise treatment based on events that are occurring in patient cancer genomes that are only found in a low frequency of patients. That is what we are working toward and where the future of cancer treatment lies."

Professor Grant McArthur (BMedSci 1983, PhD 1994) is the Executive Director of the VCCC and the inaugural Lorenzo Galli Chair in Melanoma and Skin Cancers at the University of Melbourne and Department of Oncology at the Peter MacCallum Cancer Centre. Professor McArthur’s laboratory in Melbourne was among the first centres in the world to conduct clinical trials of a drug designed to deactivate a gene (known as BRAF) which helps regulate cell growth. Patients’ responses to the drug were dramatic and the treatment is now a standard throughout the world.

Professor Alex Boussioutas

"Cancer is a disease that transcends a single discipline. As a clinician and a scientist, I work with a diverse team to address the cancer enigma by understanding the molecular steps leading to cancer in at-risk groups as well as understanding key hallmarks of cancer once it is established"

Professor Alex Boussioutas (MBBS 1992, PhD 2004) is Associate Dean (Research Training), Deputy Director of Gastroenterology Royal Melbourne Hospital, Gastroenterologist to the Peter MacCallum Cancer Centre and Group Leader in the Research Division at the Peter MacCallum Cancer Centre. As a clinical gastroenterologist his interests involve screening, surveillance and prevention of cancers of the gastrointestinal tract as well as developing a molecular understanding of these cancers.

“The expertise we have at the Centre for Cancer Research at the University of Melbourne covers the full gamut: from understanding risk and looking at the epidemiology of disease through to people who work on cancer predisposition and the genetics of being predisposed. I work on the genomic pathology of cancer diagnosis based on mutations. Others are in the field of computational oncology, which looks at genomic information to predict drug sensitivity and patient outcome.

“But if you do these things or develop a new drug that goes into clinical trials, medicine doesn’t just stop at the p-value. New information in cancer diagnosis and treatment has to be factored into all aspects of healthcare, including how it impacts on the activities of the surgeons, the oncologists, the nursing specialists and palliative care.

“We cover all of these aspects here at the UMCCR. The beauty of being part of a university is that we can pull in expertise and collaborate across all schools including Population and Global Health, Mathematics, Engineering, Pathology, Psychology and Psycho-oncology, to improve our understanding of cancer and make significant leaps forward in the care of patients. We also have a new joint appointment between the Faculty of Medicine, Dentistry and Health Sciences and the Melbourne Law School who will be working on the ethics of new technology and its impact on health care.

“Once we are up and running with our full complement of staff we will have 260-280 researchers at UMCCR. At the moment, we have a little less than half this number. We are currently going through a process of recruitment, with four group leaders appointed this year.”

Melbourne alumni who have been appointed to positions within the UMCCR include a number of leaders in their fields: Professor Jennifer Philip, Professor Alex Boussioutas, Professor Grant McArthur, Professor John Hopper, Professor Mark Jenkins, Associate Professor Sarah-Jane Dawson and Associate Professor Mehrdad Nikfarjam.

As Professor Grimmond explains: “The initiative here right now is in the early stages of funding cycles. There are things happening within the VCCC to get strategic efforts going. The genomic pathology and all that computational oncology work is extremely valuable, and once it’s established we want to be able to use it as widely as possible. We’re in an ideal situation within the VCCC alliance where we have the vehicle to enable groups to work in powerful partnerships to do extraordinary things. So, I will be here for a while!”

Professor Mark Jenkins

Australia has the highest rates of bowel cancer in the world. Many bowel cancers can be prevented when still in a pre-malignant polyp form and can safely be removed without surgery. Our new blood tests and risk screening tools will improve our national bowel cancer screening program so that Australians can receive cancer screening appropriate to their personal risk. Knowing where patients are along the spectrum of genetic risk will undoubtedly save lives.

Professor Mark Jenkins (PhD 1994) is Director of the Centre for Epidemiology and Biostatistics at the Melbourne School of Population and Global Health. Professor Jenkins has identified 45 genetic variants that indicate increased risk of bowel cancer, and he has developed a simple blood test to identify them. When analysed alongside family history and lifestyle factors (such as high BMI or smoking) these genetic variants provide a stronger indicator of bowel cancer risk than previously available.