A vision to cure – Research in New Zealand

6 September 2018 -
Dr Peter Browett

For our patients, the most visible aspect of LBC’s work is the support and information it provides them and their families. As a clinician, I am often aware of LBC’s Support Services Coordinators in our day-stay unit and our ward at Auckland Hospital. Patients exercise in the LBC-funded Support and Wellbeing Room or come to see me with an LBC booklet in their hand. Having spoken at LBC-run support groups and the patient forum, I know how well attended and important they are for patients and their families.

As LBC’s patient support services have grown, so has its support for research into better treatments and cures for blood cancer. LBC started out as a small organisation funding travel grants for New Zealand health professionals working in the blood cancer field. Now, it is a major funder of research on blood cancers and other blood disorders, with competitive research grants nationwide, and the recent establishment of the specialised Leukaemia & Blood Cancer Research Unit within the University of Auckland.

Blood cancer research in New Zealand is being carried out in a number of areas, including:

  • Establishing basic models of leukaemia in mice and zebrafish that allow us to interrogate what causes leukaemia and test novel treatments.
  • Genomic landscape studies – the ability to dissect the molecular basis of blood cancers to further understand their biology, as well as improving strategies for diagnosis, treatment, and monitoring response to therapy.
  • Clinical trials for different blood cancers, including participation in international, multicentre studies, for example, the UK NCRI AML19 trial for adult patients with acute myeloid leukaemia (AML) and local studies such as the recently opened KISS study for patients with chronic myeloid leukeamia (CML). Participation in clinical trials not only improves patient care, but is vital in testing new treatments.
  • Improving health outcomes and quality of care, regardless of health status, is an area of research which is beginning to be explored.

In the last decade, genomic (DNA) analysis in particular, has improved as a result of advances in technology.

Sequencing the first human genome took the world’s scientists 13 years and 3 billion dollars to achieve. Today in the Leukaemia & Blood Cancer Research Unit, we have a DNA sequencing machine the size of a desk printer that can sequence genes in a matter of days. Instead of looking at only single genes, now we can look at 70 or 100 genes in a leukaemia. It has opened up the whole area of personalised medicine.

At a basic science level, it’s telling us what caused a patient’s leukaemia. At the clinical level, whereas we may have treated all these people in a similar way, their different mutations may have different prognoses. Equipped with this detailed information, we may decide on transplant or chemo based on their specific mutation.

Future diagnoses may put together all the molecular or genetic data and the clinical information of the patient, i.e. type of cancer, age of patient and other illnesses present, so that a complete picture can be used to develop an individual’s treatment strategy.

Research has also provided advances in the treatment of cancers and the development of targeted therapies. Haematology has led the way in blood cancers and the overall treatment of cancer.

LBC has helped put blood cancer firmly on the map in the field of cancer research in New Zealand.

Why is research here important?

Much blood cancer research is carried out overseas, but the development of research in New Zealand is important for the following reasons:

  • To answer questions related to the New Zealand population.
  • To make a uniquely New Zealand contribution locally and internationally. For example, the CML clinical trial being carried out here is the only one of its kind in the world. The findings will add to our knowledge of managing CML patients here and worldwide.
  • To develop the technology and expertise here in New Zealand, we have to invest in it and our people. The 18 students and scientists working in the Leukaemia & Blood Cancer Research Unit are part of a growing workforce of people who are interested in blood cancers and conditions. Instead of leaving for overseas or going into different fields, these researchers are more likely to stay in New Zealand and potentially develop their own blood cancer research group in another New Zealand city.

A number of these advances have been game changing. Before 2000, the life expectancy for most patients with CML was four to five years. When Glivec was first trialled in 2000, we thought it might improve outcomes by one to two years. Eighteen years later, I still see the first patient who entered the Glivec trial in clinic and attending LBC support group meetings. The drug, and its next generation versions, have transformed the way we treat CML such that a 50 year old diagnosed with CML now has a similar life expectancy as a person of the same age without CML.

Research and clinical trials are providing new and better treatments on a yearly basis. In myeloma, several new treatments that use targeted drug or antibody strategies have been evaluated in clinical trials, and three targeted drugs for AML were approved by the US Federal Drug Administration last year.

A treatment holding much promise is immunotherapy, which is the ability to harness the body’s own immune system to assist in treating a blood cancer. Bone marrow transplants involving donor bone marrow are a form of immunotherapy using the donor’s immune system cells to recognise residual leukaemia or lymphoma cells and mop them up.

The immunotherapy field is growing in two key areas:

Checkpoint inhibitors
Our immune system typically recognises abnormal cells and destroys them before they can develop into full-blown cancer. Patients with a suppressed immune system, however, have a higher chance of cancer than the general population. Cancers often produce molecules that block the body’s immune response, so the checkpoint inhibitor drugs work to unblock that response and allow the immune system to react.

Modifying immune cells
Immune system cells can be collected from the blood of patients and manipulated by inserting a gene that generates a protein to help these cells recognise cancer cells. These modified killer or CAR-T cells, are returned to the body to kill the cancer.

Immunotherapy for blood cancer is only just beginning. It’s currently being used in acute lymphoblastic leukaemia and lymphoma, but research groups are starting to look at myeloma and AML, and colleagues at the Malaghan Institute in Wellington are working at bringing this technology to New Zealand. LBC has helped put blood cancer firmly on the map in the field of cancer research in New Zealand. As a result, our research is being recognised nationally and internationally. More importantly, the ability of LBC to fund more and better research is making a difference to our own patients and families.

Dr Peter Browett is a Professor of Pathology and Head of the Department of Molecular Medicine and Pathology at the University of Auckland School of Medicine, Consultant Haematologist at Auckland City Hospital, and Consultant Haematologist at Diagnostic Medlab. Peter has had a long association with LBC, acting as Medical Director and Trustee for many years.