The Newsletter of ANZUP Cancer Trials Group Limited
SPRING 2018
Message from the 2018 ASM Convenor: Henry Woo
This year we decided to shake things up a little, and I think we did just that! We wanted to redefine and deliver a high quality educational program that was innovative and inclusive of the patient, carer and all members of the multidisciplinary team. Staying true to the theme ‘Putting People First’ we focused on the management of GU cancers from a holistic, people-centric perspective. We introduced some new sessions, modified others, whilst some were pure experimentation – all with the intention of celebrating our coming of age over the past 10 years for #ANZUP18. Once again we hosted the ANZUP PCFA Nurses Workshop chaired by Kath Schubach. The aim of the workshop was to provide information, advice and guidance on how to develop a concept outline from an initial idea or clinical question. The feedback was very positive with attendees enjoying the level of interaction and practical guidance.
#ANZUP18
#ANZUP18 ASM ISSUE Putting People First
Prior to the evening symposium, we held the inaugural ANZUPx session. Renowned national and international speakers took to the mic to deliver engaging, dynamic and thought-provoking talks. The first – ‘We have all come to tell our stories’ – set the scene for everything that followed as Fran Boyle shared her knowledge and experience, but also a personal account of her own health challenges. This was bookended by the final ANZUPx session, including a powerful message from Laurence Albiges on the importance of mentoring female clinicians, and more personal anecdotes shared in the ‘Red Chair’ session ably hosted by the one and only BT (Ben Tran) on the final afternoon.
Over the three days, the quality and impact of our international faculty cannot be overstated, with Laurence Albiges, Viktor Grünwald, Tamim Niazi, Monty Pal, Angie Smith, Chris Sweeney and Bertrand Tombal playing significant parts in the scientific, social and progressive aspects of the meeting. Other highlights included a Q&A evening symposium hosted by multi-award winning producer and broadcaster Norman Swan who challenged our distinguished multidisciplinary panel as to whether we really do put people first. CONTINUED OVER
2018 ANZUP ASM Convenor’s Report We saw a trial of a script concordance workshop for the Prostate Cancer MDT Masterclass, which was superbly executed by Carmel Pezaro and Joseph Ischia. Script concordance is an interactive teaching method that poses a typical clinical scenario, asks the learner to declare their opinion, reveals the expert panel’s different opinions, and then changes elements of the clinical scenario to find which variables influence the opinion/recommendation of both the participating learner and the panel. The famous ASM debate became not one but four creatively contested crossfire challenges, with Angie Smith and Andrew Weickhardt’s ‘Wonder Woman vs Batman’ approach to the cystectomy argument a standout. The global trial landscape was headlined by our international guests and sequenced with ANZUP trial updates presented by Principal Investigators. The annual free Community Engagement Forum featured presentations and panel discussions covering quality of life, treatment choices, survivorship, impacts on intimacy and the cost of cancer care. This session gave the public the opportunity to engage with an experienced team of healthcare professionals and patient advocates while learning about ANZUP and our clinical trials research program.
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We also saw the return of the Cycling Challenge where delegates swapped suits for lycra to secure a place in the highly competitive “ASM ride off” at the conference dinner. Congratulations to the eventual winners – The Yuros. Following the ride off, it was time to blow out the candles on ANZUP’s 10th birthday cake, celebrating the many individuals who have made ANZUP what it is today. For the first time at an ANZUP ASM, questions from the floor were facilitated by the interactive platform, Pigeonhole Live. Across the four MDT Masterclass live polls and six Q&A sessions, 352 unique users (or 93% of delegates) had at least one interaction with the platform, with 127 questions asked and 405 votes cast on popular questions.
2018 ANZUP ASM Convenor’s Report This year we again raised the social media bar with record Twitter engagement of more than 3.86 million #ANZUP18 impressions and 2,403 tweets – with Monty Pal, Angie Smith and Haryana Dhillon setting a new record as key influencers. Attendance also increased to more than 390 delegates – all testament to the high quality, collegial, educational, entertaining ASM for which ANZUP has become renowned. On behalf of the ANZUP ASM convening committee, it was a great privilege to convene the 7th standalone Annual Scientific Meeting (ASM). Thank you to every speaker, sponsor, chair, delegate, participant, committee member and organiser for your contribution. We look forward to seeing you in Brisbane for #ANZUP19. HENRY WOO 2018 Convenor
HELLO, WELCOME TO ‘UPDATE’ Contents: 2018 Convenor’s Report . . . . . . Cover Message from the Chair . . . . . . . . . . . 4 ANZUP ASM: As it Happened . . . . . . 7 Cycling Challenge . . . . . . . . . . . . . . . . 8 Community Engagement Forum . . . . . . . . . . . . . . . . . . . . . . . . . . 9 ASM Awards . . . . . . . . . . . . . . . . . . . . 10 ASM By Numbers . . . . . . . . . . . . . . . 14 2018 ASM Highlights . . . . . . . . . . . . . 16 Thanks to our 2018 ASM Sponsors . . . . . . . . . . . . . . . . . . . . . . . 19 2018 Concept Development Workshops . . . . . . . . . . . . . . . . . . . . . 20 ANZUP Concepts: A Guide . . . . . . . 22 Clinical Trial Updates . . . . . . . . . . . . . 22 Below The Belt Pedalthon . . . . . . . . 23 Updates from SAC and Subcommittees . . . . . . . . . . . . . . . . . 24 Clinical Trial Awareness Video . . . . . 30 Chemotherapy Induced Hearing Loss . . . . . . . . . . . . . . . . . . . 31 Other News . . . . . . . . . . . . . . . . . . . . 32 2018 ANZUP GU Preceptorship . . . . 33 Upcoming Events . . . . . . . . . . . . . . . 34 Corporate Supporters . . . . . . . . . . . . 35 ANZUP UPdate Spring 2018 | 3
MESSAGE FROM THE CHAIR Welcome to this edition of UPdate, the newsletter of the Australian & New Zealand Urogenital and Prostate Cancer Trials Group Ltd (ANZUP)! I remember my 10th birthday vividly. I had my closest friends around; we had a great day of fun including the entertainment of going to a movie, complete with treats; and my young all-things-spaceloving mind was blown away by going to the museum to see an actual rock from the moon. It was sealed in a glass bubble full of nitrogen, and was a thousand shades of grey and brown with tantalising glints reflecting in the lights. I stood there wrapped in the wonder of it all, and to this day I will never understand the mind of the lady next to me who said, “Huh, it’s just a rock.” Then we went home, worn out and happy, and afterwards as always I had the job of writing thank you cards to everyone who gave me presents on such a notable occasion. This year we are celebrating ANZUP’s 10th birthday, and as I write we are not long out from our Annual Scientific Meeting in Sydney in July. The sheer
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happiness and wonder of my own 10th birthday (so many, many years ago…) have come back afresh. The ASM was another chance to renew connections with old friends and make connections with new ones. The program was engrossing and entertaining, and full of treats. I was amazed by the science and by the humanity of what we do and who we are. We went home buzzing, needing a rest but at the same time energised. And now here I am, writing a thank you card to you all. The only difference is that I did not meet a single rock-brained person, and for that I am very grateful. The ASM is a very important part of ANZUP’s activities. We continually need to learn more about our fields but also to hear about what others are doing. That in turn triggers new ideas and connections, and before we know it we have novel research proposals and trial ideas coming through, or new collaborations, or challenges to our everyday status quo. We were able to hear and learn from local and international experts at the ASM and then talk and connect with them in informal settings, often leading to new links.
The program was engrossing and entertaining, and full of treats. I was amazed by the science and by the humanity of what we do and who we are.
MESSAGE FROM THE CHAIR Several of our well-travelled and conferenceexperienced international guests have told us that this was the best meeting they have attended all year, which is high praise but not surprising to those of us who were there and agree! The ASM provides opportunities for us to present our work and in particular we are able to support early career or junior researchers to highlight their activity in a positive and constructive setting. These are the people who will lead our organisation in the future and who will care for us and those we love, so it is important that we get this right. We are able to provide research grants and other awards to celebrate the high quality of the work so many of us are doing. And most importantly we enjoy and celebrate the community we have built for a common purpose: to improve the outcomes for everyone affected by genitourinary cancers, by doing clinical trials that matter and that will change practice. Thanks to Henry Woo and his amazing convening committee for doing such a great job, and thanks in advance to David Pryor who has taken on the role of convenor for our 2019 ASM in Brisbane. Many of you have provided feedback on the ASM. This is very important and valuable for us. We need to know what works and what does not. We are happy to take comments and suggestions throughout the year as well, so feel free to provide them even if the survey is closed. ANZUP’s activities continue throughout the whole year, and our 10th anniversary year is no exception. The 2018 Sydney Pedalthon will take place on 18 September, and we are already deep in planning for the next Melbourne Pedalthon in 2019. We are planning our next Preceptorship for later in the year, as well as our Best of GU symposium, and already thinking about the 2019 meetings and activities.
One of the great things we have been able to achieve through our fundraising is the Below the Belt Research Fund. We have already awarded $806,000 over the last 3 years to help support researchers linked to ANZUP. This year we have been able to support 8 projects totalling $275,000, and you will read the details of these awards inside these pages. The field of applications was very high quality and it is increasingly difficult to work out which of the many applications we were unable to fund. We hope to continue to grow this resource in order to support more research in the future. The ANZUP Board has agreed that none of the costs of this Below the Belt fundraising will come out of the donations and sponsorship we receive for it, meaning that all of it is reinvested where it will do the most good. This is a powerful message underscoring our commitment to this initiative. We are of course a clinical trials group, and our trials form the centre of our activities. In our short existence we have run 23 (16 ANZUP led and 7 co-badged) trials and enrolled thousands of patients across Australia, New Zealand and internationally.
Several of our well-travelled and conference-experienced international guests have told us that this was the best meeting they have attended all year...
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MESSAGE FROM THE CHAIR ANZUP is recognised internationally as an important contributor to the global initiative to drive genitourinary cancer clinical research, and the outcomes of our trials are awaited with great interest. Again, you will find information about the trials elsewhere in the newsletter, and you can also be kept up to date by our regular emails. To mention only a few, since our last newsletter we have completed recruitment to the ENZARAD trial; the TheraP 177Lu-PSMA prostate cancer trial is recruiting well with nearly all sites open; the UNISoN trial recruitment is far exceeding expectations; BCG/ mitomycin bladder trial is also recruiting well; and we have several new trials in various stages of planning. Our Pain Free TRUS B trial recruitment has accelerated considerably, due in no small part to our activation of more sites in New Zealand. Our four Concept Development Workshops once again brought together people from multiple disciplines to survey the landscape and come up with many exciting suggestions for future trials. Thanks again to all of you involved in this great progress. Don’t forget you can contribute to all of this at any time by participating in various committees or other processes within ANZUP, and you are most welcome. Our Board continues to meet regularly and provides excellent oversight of the running of ANZUP. Four of the elected directors (Guy Toner, Shomik Sengupta, Henry Woo, and myself) were re-elected at the Annual General Meeting held on 9 July 2018. Thank you to my fellow directors for re-standing, our continuing directors for ongoing brilliant work, and to all of you for supporting us. Thanks as always to our great ANZUP team: our CEO Marg McJannett, Lucy Byers, Michelle Bowers, Gillian Bailey, Simran Chawla, Nima Amatya, and Christine Garforth. We are very sad that Michelle will be leaving us.
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...we have completed recruitment to the ENZARAD trial; the TheraP 177Lu-PSMA prostate cancer is recruiting well with nearly all sites open; the UNISoN trial recruitment is far exceeding expectations; BCG/mitomycin bladder trial is also recruiting well; and we have several new trials in various stages of planning.
Thanks Michelle for everything you have done for us, and all the very best for what comes next for you. ANZUP is leaving childhood behind. Adolescence will probably bring growing pains as it often does, but for us that is a great problem to have. I have a feeling that teenage angst is not going to be an issue. Thanks for bringing us to this tenth year, poised for many more. What a joy and privilege to be part of it. Let us never forget why we are doing it, and remember: it’s even possible to bring bits of the moon within reach. Please enjoy this edition of UPdate. IAN DAVIS Chair
ANZUP ASM: AS IT HAPPENED ANZUPx – Making ideas matter
“Best debates I’ve ever seen. Batman for 2019”
For the first time at an ANZUP ASM, a new style of presentation was introduced with ANZUPx. ANZUPx featured a line-up of renowned national and international speakers, handpicked by Convenor Henry Woo for their expertise, personality and compelling ideas. Seven presenters took to the stage over two sessions (Sunday and Tuesday) to deliver a series of engaging, dynamic and thought-provoking talks.
The afternoon session of the final day of the 2018 ASM opened with four crossfire debates pitting some of the finest minds in uro-oncology against each other under the watchful gavel of ‘judge’ Lisa Horvath. Respected colleagues Monty Pal and Laurence Albiges engaged in some pre-debate friendly fire on Twitter before taking to the stage to argue the CARMENA case – to cut or to TKI? International stars Chris Sweeney and Bertrand Tombal fought hard for intermittent vs continuous ADT for M1 HSPC and Sanchia Aranda and Cathy Mason had equally strong arguments for and against the importance of the social in psycho-social. However, it was Angie Smith and Andrew Weickhardt who stole the show with a thoroughly entertaining, superhero-themed debate about whether having no bladder is worse than having bladder cancer.
Sticking to only two rules – the subject must relate to the ASM theme ‘Putting People First’ and be no longer than 18 minutes – each speaker embraced the challenge to bring a topic of their choosing to life. Tackling the tough opening spot, Fran Boyle captivated the audience as she led them on a journey from the patient’s perspective to a personal revelation of her own health experiences. It was a standard that was maintained by every ANZUPx talk that followed. Ben Tran channelled Justin Timberlake to make data anything but boring, Laurence Albiges talked about a revolution led by the power of mentoring and Chris Sweeney tapped into his Adelaide roots to highlight when more is less and less is more in prostate cancer treatment. Monty Pal bridged the gap between the lab and the clinic, Bertrand Tombal peered into the future of academic urology and Venu Chalasani led the room on a journey of enlightenment though clinical trials. Feedback about the ANZUPx sessions was very positive with all seven talks highly rated.
With Shomik Sengupta and many others in the audience live tweeting throughout the action, the debates proved to be an #ANZUP18 highlight.
“Loved the AN ZUPx idea! Very inspiring ta lks” g opening” “An outstandin
“I’d give Bertrand a higher mark if possible. All excellent!!”
“Love this style of talk – much more engaging” ANZUP UPdate Spring 2018 | 7
CYCLING CHALLENGE For the second year running, the excitement of the Below the Belt Pedalthon returned to the ASM with the stationary bike cycling challenge. The challenge saw 25 delegates, including two international guests, roll up their sleeves (or even go so far as to swap their suits for Lycra) and form the teams: • Clonal Ablation • Accelerated BEP • Astellas All Stars • The Yuros • MSD Peddlers • Ben and the Cycle Chicks • Team Puffed Out The teams cycled during morning tea, lunch or afternoon tea on Monday in the trade exhibition area with their pedal power tracked using the Body Bike Indoor Cycling app. The challenge, as well as helping burn off the conference food, provided an opportunity to promote the 5th Sydney Pedalthon on Tuesday 18 September
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at Eastern Creek and the 2nd Melbourne Pedalthon in March 2019. All funds raised from the Pedalthon events go straight to the Below the Belt Research Fund to help progress concepts to clinical trials (see page 9-11 for more details about the research fund recipients and page 21 for information about the THE YUROS Pedalthon). After a highly competitive ride off at the conference dinner in 2017, the 2018 Cycling Challenge was again decided on the dancefloor with two heats and the high energy final adjudicated by CAP member Matt Leonard. The champagne was put on ice while The Yuros and the Astellas All Stars went head to head cheered on by the audience. After much tension and heart rate acceleration, The Yuros took the 2018 championship title! Thank you to everyone who participated, either on a bike or cheering from the sidelines. The Below the Belt Research Fund can only continue to fund concept development and pilot studies if we raise awareness and support the Pedalthon events.
COMMUNITY ENGAGEMENT FORUM ANZUP held the sixth annual Community Engagement Forum as part of the 2018 ASM in Sydney on Sunday 8 July.
changes after cancer and Kath Schubach addressed the effect of cancer on sexuality and intimacy.
This free event provided an opportunity for the audience to engage with an experienced team of healthcare professionals and patient advocates and featured presentations and panel discussions covering a variety of topics.
An engaging panel discussion with audience participation was facilitated by Leonie Young and wrapped up another informative and interactive question and answer session.
As summarised by one attendee, there was “a broad spectrum of subjects – it was brilliant.” The forum began with Ian Davis providing a brief overview of ANZUP and an explanation of how ideas move from concept stage to clinical trials. The next topic was presented by Suzanne Chambers and stressed the importance of quality of life when undergoing cancer treatment. A highlight was Gavin Marx and his patient, Rob Palmer, who provided the audience with a most informative account of their shared decision making process in relation to participation on an ANZUP clinical trial. Richard de Abreu Lourenco discussed the impact of the cost of cancer care, Haryana Dhillon provided guidance about making emotional, social and lifestyle
The forum was promoted in print media (including The Saturday Paper) and online, as well as via PCFA, Cancer Council NSW, Chris O’Brien Lifehouse and NSW-based ANZUP members’ clinics.
“Relevant, focu sed and well presented ” jargon, “ No technical onal and very conversati engaging”
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ASM AWARDS Congratulations to all 2018 winners ANZUP/AstraZeneca Travel Fellowships ANZUP ASTRAZENECA TRAVEL FELLOWSHIP RECIPIENTS WITH IAN DAVIS AND TAMARA KILBY
Alexandar Blazevski
Emily Wong
Jiasian Teh
Rajiv Shinde
Tatenda Nzenza
Angelyn Anton
Frank Lin
Mal Arasaratnam
Roxanne Toivanen
Yeji Ham
Arveen Kalapara
Heidi Fettke
Michael Williams
Sachinka Ranasinghe
Edmond Kwan
Hilary Fernando
Orlando Rincones
Simeon Ngweso
ANZUP Mundipharma Fellowship ANZUP CHAIR IAN DAVIS WITH RECIPIENTS OF TRIAL COORDINATOR SCHOLARSHIPS
Trial Coordinator Scholarships Ashley Baring Cynthia Hawks James McQuillan Laura Galletta Lorna Eggers Louise Francisco Mal Arasaratnam
The ANZUP Mundipharma Uro-Oncology Clinical Research Fellowship (CRF) valued at $60,000 supports an early/mid-career clinician or researcher of any healthcare discipline. This year’s Mundipharma Fellowship was awarded to Kate Mahon. Kate Mahon is a staff specialist medical oncologist at Chris O’Brien Lifehouse and ANZUP MUNDIPHARMA FELLOW KATE MAHON (CENTRE) WITH MAULIK SHROFF a post-doctoral prostate cancer research FROM MUNDIPHARMA AND ANZUP CEO MARGARET MCJANNETT fellow at the Garvan Institute for Medical Research. Dr Mahon’s research has focused on implementing effective biomarkers into clinical practice. The Fellowship will facilitate the next phase of biomarker development by testing the clinical applicability of a novel biomarker, providing a foundation for future pragmatic adaptive biomarker led studies.
Astellas Young Investigator of the Year Award The Astellas Young Investigator of the Year Award recognises an outstanding early career researcher in prostate cancer clinical trials research with up to $10,000 to support his/her attendance at an international GU meeting and ANZUP ASM. The 2018 award was presented to Edmond Kwan. Dr Kwan is a medical oncologist and translational researcher at Monash Health in Melbourne. He is currently completing his PhD at Monash University, identifying mechanisms of drug resistance and response in advanced prostate cancer through the analysis of circulating DNA and RNA in the blood. He is also actively involved in the care of prostate cancer patients and recruitment to innovative clinical trials investigating novel therapies. 10 | ANZUP UPdate Spring 2018
2018 ASTELLAS YOUNG INVESTIGATOR OF THE YEAR EDMOND KWAN WITH ASTELLAS PHARMA AUSTRALIA MANAGING DIRECTOR JUNKO KOMATSU
ASM AWARDS 2018 ANZUP/BMS Best of the Best Awards The Best of the Best Awards are given based on the content, degree of innovation, significance, and quality of oral or poster presentations given at the ASM, as judged by an independent panel.
2018 winners: Best of the Best Oral – David Pryor Best of the Best Poster – Shankar Siva Best of the Best Trainee / Fellow – Arveen Kalapara Best of the Best Nursing / Allied Health – Orlando Rincones
BEST OF THE BEST NURSING / ALLIED HEALTH WINNER, ORLANDO RINCONES, BELOW THE BELT RESEARCH FUND GRANT RECIPIENT
AWARDS Below the Belt Research Fund Thank you to all 2018 Below the Belt Research Fund applicants. ANZUP received a large number of high quality applications, and after careful consideration, the review panel selected and announced the following successful applicants at the ASM. Ben Smith – Development and piloting of a Question Prompt List (QPL) to aid informed treatment decision making in men diagnosed with localised prostate cancer
decision-making with clinicians. Simple and inexpensive decision support tools, such as Question Prompt Lists may overcome barriers to implementation in routine care. This study aims to develop a Question Prompt List (printed and online) for men with localised prostate cancer deciding between treatment options and to assess the acceptability of the Question Prompt List to patients and feasibility of implementation in routine care.
Common treatment options for localised prostate cancer include active surveillance, radical prostatectomy, and radiotherapy. These treatments may have a similar impact on quantity of life but differing effects on quality of life. Men diagnosed with localised prostate cancer often experience conflict and regret after making a treatment decision due to the lack of a clearly optimal treatment option. Many decision aids have been developed to try to improve decisional outcomes whilst engaging in shared
BEN SMITH
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AWARDS Camille Short – Why do men leave active surveillance? A mixed methods investigation examining factors contributing to adherence on active surveillance
thus delaying selection of treatment-resistant tumour cell populations. Adaptive therapy therefore involves stopping a treatment that is working, and allowing patients’ cancers to regrow, before restarting the same treatment once again.
Men with low risk, localised prostate cancer may commence active surveillance which involves closely The EnzAdapt study will explore and monitoring biological markers of the determine the acceptability, feasibility disease until progression is detected, and safety of adaptive dosed whereupon the patient is offered enzalutamide in men with castrateactive treatments. Active surveillance resistant prostate cancer. This will be is a recommended option for patients defined by patients’ experience of with a PSA ≤ 10 ng/mL, clinical stage adverse events by CTCAE 4.03, and T1-T2a, and a Gleason score ≤ 6 CAMILLE SHORT RECEIVING HER AWARD by failure to induce a 3rd re-response (3+3). Research has established that FROM ANZUP’S DEPUTY CHAIR, GUY TONER to enzalutamide in 3 or more of the active surveillance poses no greater first 10 patients on study. Finally, the threat to mortality than those treated research will examine the clinical benefit of adaptive immediately, and may help to preserve quality of life dosed enzalutamide as defined by (a) PSA response, for longer by avoiding treatment-related side-effects. and re-response after enzalutamide re-introduction; (b) However, there is some concern that active surveillance radiological response per PCWG3 criteria and (c) time to may place a psychological burden on men, and that this on-treatment enzalutamide failure. If safe, feasible and is currently not being addressed. acceptable, this pilot will lead to formally powered late Of particular concern is the rate of men transitioning stage efficacy trials. from active surveillance to active treatment for nonEdmond Kwan and Heidi Fettke – clinical reasons. This research will Application of a multi-gene prostate seek to investigate Australian circulating tumour DNA (ctDNA) men’s reasons for transitioning panel in men with metastatic from active surveillance to active hormone-sensitive prostate cancer treatment, focusing on when (mHSPC) disease progression is not the primary motive. The findings will be EDMOND KWAN AND HEIDI FETTKE There is an ongoing need for research RECIEVING THEIR AWARD FROM ANZUP’S useful for informing best practice DEPUTY CHAIR, GUY TONER into new biomarkers, capable of better active surveillance guidelines predicting patients that will benefit and supportive care interventions the most from specific therapies. An area gathering designed to increase adherence, patient well-being, and tremendous momentum in prostate cancer biomarker overall health. research is the analysis of circulating tumour DNA (ctDNA). By combining ctDNA with next-generation Craig Gedye – EnzAdapt: feasibility, acceptability and sequencing technologies, great strides have been made safety of adaptive dosing of enzalutamide in men with in our understanding of the genomic landscape of metastatic castrate-resistant prostate cancer advanced prostate cancer. Cancers are made up of genetically diverse populations This pilot study aims to custom-design and optimise of cancer cells, that can adapt to their environment and a multi-gene prostate ctDNA assay and apply it to threats to their survival, like drug treatments. The idea a cohort of men with metastatic hormone-sensitive of “adaptive therapy” is inspired by confronting this prostate cancer (mHSPC) commencing androgen reality, and proposes that rather than reflexively using deprivation therapy (ADT). This study seeks to a treatment continuously until progression, treatment characterise the genomic landscape of mHSPC, utilising is interrupted in a patient-individualised schedule to an in-house novel assay capable of detecting low allow tumour populations that are exploiting different frequency genomic alterations in ctDNA. evolutionary survival strategies to return to equilibrium, 12 | ANZUP UPdate Spring 2018
AWARDS In doing so, we hope to provide ANZUP with preliminary data that not only guides translational research strategy, but may also form a critical component of future ANZUPled grant submissions to competitive funding bodies.
proof of concept of in vivo expression of GLP1 receptor by mCRPC. Such data would support both the rationale for and feasibility of, a trial of GLP1 receptor agonist as a treatment for prostate cancer.
Haryana Dhillon – Assessing the feasibility, acceptability and impact on practice of electronic patient reported outcome assessment of symptoms in people with Genitourinary cancer: a mixed methods study
Shomik Sengupta – Feasibility of water irrigation post TURBT for NMIBC
Recurrence after transurethral resection of bladder tumour (TURBT) is a significant clinical problem requiring close follow-up and retreatment. The re-implantation of tumour cells is postulated to be one mechanism of Patient reported outcomes assessment (PRO), particularly recurrence. A single instillation of chemotherapy agents symptoms and side-effects of treatment, integrated (commonly Mitomycin) has been into cancer care have been shown shown to be effective in reducing to improve quality of life and survival recurrence after TURBT. Nonetheless, in people living with a range of practical barriers including availability cancers. What is unclear is the best of drug and nursing expertise mean way to integrate data collection into that this remains under-utilised. cancer care to ensure symptoms There is some evidence that bladder are responded to and effectively irrigation, particularly using water, addressed outside a clinical trial. SHOMIK SENGUPTA RECEIVING HIS AWARD FROM ANZUP’S DEPUTY CHAIR, GUY TONER which can have an osmotic cytotoxic Our study will assess the feasibily of effect, may be as effective as postcollecting Patient Reported Outcome TURBT chemotherapy. This study will determine the Common Toxicity Criteria Adverse Events (PRO-CTCAE) safety and feasibility of undertaking water irrigation using a web-based app; if using the app is acceptable to during and after TURBT, with the aim of progressing patients; if it is acceptable to clinical staff; the number of to a larger randomised trial. patients providing their data at clinic visits; patterns of Suzanne Chambers – QualTheraP: A nested, multitoxicity recorded and how this modifies treatment and perspective longitudinal qualitative study of also the impact on care. participants in the TheraP trial Mark Stein – A pilot trial of Exendin PET scanning in The TheraP trial is an Australian multi-site randomised metastatic castrate resistant prostate cancer phase 2 trial of Lu-PSMA617 theranostic versus A large randomised trial in diabetes found incidentally cabazitaxel in progressive metastatic castration resistant that fewer men who received the glucagon-like peptide prostate cancer. The aim of the trial is to determine one (GLP1) receptor agonist, Liraglutide, developed the activity and safety of Lu-PSMA compared to prostate cancer compared with those who received chemotherapy with cabazitaxel, which is presently the placebo. This raises the possibility that GLP1 receptor standard treatment for this population. agonists may have efficacy in prostate cancer. Based on the literature and our previous work, it As it has been found that in vitro efficacy of GLP1 emerged that there was a need to better understand receptor agonist on prostate cancer may be independent men and their partners/informal carers experiences of of androgen receptor function, Liraglutide could advanced prostate cancer over time. To date, no study potentially have clinical efficacy in castrate resistant has qualitatively explored the experiences of men with prostate cancer (CRPC). advanced prostate cancer and their partners throughout their involvement in a medical trial. Accordingly, we In this pilot trial, men with metastatic CRPC (mCRPC) will propose a multi-perspective qualitative longitudinal undergo an Exendin PET scan. Such scans detect lesions study nested within the TheraP trial. expressing the GLP1 receptor. If the trial demonstrates that Exendin PET scans detect mCRPC, it would provide ANZUP UPdate Spring 2018 | 13
ASM by numbers
390 DELEGATES
68
NATIONAL SPEAKERS + CHAIRS
23 SESSIONS
59
SUBMITTED ABSTRACTS
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7
INTERNATIONAL SPEAKERS
60 7
ANZUP X TALKS
13+ PROFESSIONS REPRESENTED
PEOPLE ATTENDED COMMUNITY ENGAGEMENT FORUM
4
CROSSFIRE DEBATES
ASM by numbers
16
16
7
ANZUP/ASTRAZENECA TRAVEL FELLOWSHIPS
TRIAL COORDINATOR SCHOLARSHIPS
TALKING UROLOGY PODCASTS
25
15
CYCLING CHALLENGERS
SPONSORS
#ANZUP18 Twitter 3.86M IMPRESSIONS (UP FROM 2.65M IN 2017)
TOP INFLUENCER (BY MENTIONS) =
MONTY PAL WITH 340 TWEETS
60 NEW FOLLOWERS 2,403 TWEETS (UP FROM 2,136 IN 2017)
GAINED DURING ASM
(TOTAL INCREASE FROM 1,750 TO 1,820)
Pigeonhole Live 352
127
51
2,500
UNIQUE PARTICIPANTS
Q&A QUESTIONS ASKED
POLL QUESTIONS
POLL VOTES CAST
(15 BLADDER, 17 PROSTATE, 11 RENAL, 8 GERM CELL)
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2018 ASM Highlights For ASM resources, including presentations and photo albums, visit https://www.anzup.org.au/content.aspx?page=asm-home
“Excellent program, speakers and focus”
“The availability of the app was great - what a way to receive and manage questions. A great innovation!”
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2018 ASM Highlights “…well executed innovative sessions (ANZUPx and debates) that kept a high level of engagement throughout the meeting”
“2018 set a new standard for sure. The international speakers were so engaging and there were many outstanding national speakers as well.”
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2018 ASM Highlights
“Great conference this year. Upbeat, lively, and a great theme.”
“Cutting edge talks. Excellent organisation” 18 | ANZUP UPdate Spring 2018
Thanks to our 2018 ASM Sponsors PLATINUM:
GOLD:
SILVER:
MDT MASTERCLASS:
TRAVEL FELLOWSHIPS:
EVENING SYMPOSIUM SPONSORS:
BEST OF THE BEST SPONSOR:
SUPPORTIVE CARE BREAKFAST SPONSOR:
INTERNATIONAL SPEAKER SPONSORS
NURSES’ SESSION SPONSORS
EXHIBITORS:
ANZUP UPdate Spring 2018 | 19
2018 CONCEPT DEVELOPMENT OTHER NEWS WORKSHOPS ANZUP’s Concept Development Workshops (CDWs) continue to serve as a great vehicle for bringing people together, scanning the horizon for new opportunities, and brainstorming proposals with a view to developing fully-fledged ANZUP trials. This year ANZUP once again supported CDWs across the four disease subcommittees. Although concepts can be brought to the various subcommittees at any time of the year, the workshops are an increasingly important part of ANZUP’s core business and most new concepts are discussed at one in the first instance. The invaluable feedback enables research to be further developed into high quality, innovative proposals.
IAN DAVIS AND MARTIN STOCKLER AT THE BLADDER CDW
Renal 11 April 2018
Germ Cell 30 April 2018
The Renal Concept Development Workshop was held in Sydney with a wonderful multidisciplinary panel including CAP members who contributed to the day’s discussion.
The Germ Cell Concept Development Workshop was also held in Sydney with 19 members attending across multiple disciplines including medical oncologists, psychologists, statisticians and clinical trial operations staff.
Seven proposals were presented at the workshop with one already progressing to discussions with a potential funding partner. If successful it is planned to submit to Ethics later this year.
Discussions focused on potential concepts to be explored, key topics including hypogonadism in testis cancer and updates on potential and current collaborations. There was also a demonstration of the iTestis National GCT Database.
SAUSAGE ROLLS AND SWOT ANALYSIS AT THE RENAL CDW
Bladder 20 April 2018 The Bladder Concept Development Workshop was held in Sydney with a superb line-up of multidisciplinary clinical experts in attendance including surgical and medical oncologists, nurses, statisticians, health economists, psychologists and clinical trial operations. Nine proposals were presented at the workshop, including a penile cancer concept. The day concluded with a brainstorming session with everyone contributing to the discussion, highlighting the truly collaborative nature of the ANZUP CDWs. 20 | ANZUP UPdate Spring 2018
GERM CELL CDW
2018 CONCEPT DEVELOPMENT WORKSHOPS Prostate 15 May 2018 The Prostate Concept Development Workshop was held in Melbourne with 37 multidisciplinary members in attendance. Twelve proposals were presented on the day with a plan to continue discussions around several of those concepts at the Prostate Cancer Subcommittee. It is hoped at least one of these concepts will progress to a full protocol in the near future. The CDW also provided an opportunity for the Prostate Cancer Foundation of Australia (PCFA) to talk about their research strategy consultation process.
PROSTATE CDW
I strongly encourage all trainees to consider attending the next CDW in your area of interest By Edmond Kwan As a junior ANZUP member, I often felt perplexed with how one gets more actively involved in such a large and complex organisation. The idea of contributing was daunting, and seemingly out of reach. Recently, I realised this could not be further from the truth. This year, encouraged by senior colleagues, I attended the ANZUP Concept Development Workshops (CDW) for the Renal Cancer and Prostate Cancer subcommittees. What an experience! Never have I encountered such a fantastic gathering of great minds across so many diverse disciplines, all driven by the singular mission of improving the lives of patients affected by urogenital cancers through clinical trials. Whether someone was presenting a fully-developed randomised Phase III trial protocol, or a small concept dreamt up whilst sipping a glass of pinot on a lazy Sunday
afternoon, it didn’t matter. The room never failed to give their undivided attention, unwavering passion, and their cumulative years of wisdom and knowledge to light the way forward. The highlight for me was the rapid-fire, intellectual banter between health professionals who are true masters of their craft, with unrivalled experience and expertise that left me stunned at every exchange. I also marvelled at our consumer representatives, who, time after time, provided unique insights at critical junctures, reshaping a great concept into a phenomenal concept. What a gift! I strongly encourage all ANZUP members to come along to the next CDW in their area of interest. Whether you are there as a spectator or a presenter, you will not regret it. At the centre of every CDW is a strong culture of mentorship. Find a mentor to champion your concept and guide you through the process. Watch as your ideas are taken from infancy, into something that gains tremendous traction and becomes tangible in the space of 20 minutes. If you do not have your own concept, no worries. Whilst the community is tight-knit, extra hands are always needed, and forever welcome. There will always be ways you can contribute. Look forward to seeing you at the next CDW!
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ANZUP Concepts: A Guide All members are invited to submit ideas for clinical trial concepts at any time. This can occur through the annual Concept Development Workshops (CDW) or any time throughout the year, where ideas would generally be discussed at various Subcommittee meetings. The aim is to encourage members to consider submitting their ideas/ concepts for broader feedback from a multidisciplinary panel including senior investigators, statisticians, consumers, trainees and operational staff. The resulting discussion is often wide-ranging and aims to define clear “next steps.” These might include forming a working party to support the member submitting the concept to create a protocol, or refining of the concept with the help of newly identified collaborators, or sometimes moving the idea in a different direction. Once approved the concept is presented to the Scientific Advisory Committee (SAC) for further review /consideration and endorsement.
ANZUP encourages and supports those concepts that are: • Investigator Initiated; • Multidisciplinary; • M ulticentre ie ideally across multiple ANZUP sites • I nclusive where possible of Quality of Life, Translational Research, or Health Economic components • C apable of leading to changes in practice • P romote a culture of research amongst all clinicians involved in the care of patients with urogenital cancers • A ble to help build systems to simplify and streamline clinical trial research of the highest quality
Initial concepts need to consider: • D oes the concept address a scientifically and clinically valid and important question?
• Is the accrual target reasonable and achievable?
• H as the question taken into account the most current research and “horizon scanning” for opportunities?
• Have opportunities for translational, Health economic, quality of life or supportive care studies been considered?
• I s the design likely to answer the primary question?
Later in development concepts need to consider:
• I s the question relevant to current international initiatives, and will the question remain relevant at the time that the outcome is expected to be known?
• Has there been appropriate statistical input into the protocol? • Is a funding source available? Note: ANZUP discourages
contact with potential industry supporters early in the concept process, as this should only occur once the concept design is mature and all budget aspects can be considered.
Other things ANZUP considers: • Does the study involve a junior researcher? • Gender balance • Opportunities for innovation e.g. Teletrials • New Zealand engagement • International engagement
CLINICAL TRIAL UPDATES BCG MMC Study sites: 13 sites Recruitment: 170 patients randomised ENZAMET Accrual of 1125 patients from 83 sites Recruitment closed 25 March 2017 1,125 participants from 83 global sites Trial in follow-up phase
PCR MIB Study sites: 4 sites open to recruitment in Australia. RNS Hospital received Governance approval on 10/9/18. Liverpool Hospital aiming to open in Q4. Recruitment: 6 patients randomised. The last 2 patients coming from Sir Charles Gairdner Hospital
ENZARAD Accrual of 802 patients from 69 sites. Recruitment closed 30 June 2018 Trial in follow-up phase
P3BEP Study Sites: 25 sites in Australia and 5 sites in New Zealand Recruitment: 54 patients
KeyPad Study sites: 12 sites open to recruitment in Australia Recruitment: 10 patients randomised
TheraP Study sites: 11 sites in Australia (10 open to recruitment, 1 in start-up) Recruitment: 57 patients randomised
Pain free TRUS B Study sites: 6 sites open and recruiting Tauranga Urology Research, New Zealand activated on 30/5/18. Recruitment: 276 patients randomised
TIGER Study site: Princess Alexandra Hospital activated on 10 Aug 2018
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UNISoN Milestone: 50% recruitment milestone achieved on 14 Aug 2018
Recruitment: 48 patients randomised in Part 1 & 10 patients randomised in Part 2
ANZUP Co-badged Studies ProPSMA Study sites: 10 Recruitment: 251 patients randomised e-TC (v2) Recruitment: 41 patients in total FASTRACK II (TROG 15.03) Study sites: 7 Recruitment: 28 patients randomised https://www.anzup.org.au/content. aspx?page=nmibc-sievaluation NMIBC-SI Evaluation: Recruitment aim: 450 participants Patients enrolled Field test 1: 220 (closed - completed) Patients enrolled Field test 2: 6 (open - recruiting)
OTHER NEWS
Join us at the Below the Belt Pedalthon! ANZUP will once again host the Below the Belt Pedalthon at Sydney Motorsport Park on Tuesday 18 September – and we’d love to see you there! The Below the Belt Pedalthon raises much needed funds to support our members to progress new trial ideas to the point of full scale studies through ANZUP’s Below the Belt Research Fund. Now celebrating its 5th year, the Sydney Pedalthon has raised more than $1 million since 2014, with a further $80,000 added to the total at the inaugural Melbourne Pedalthon in March. Every cent has been invested into the Below the Belt Research Fund and to date, seed funding has been awarded to 18 ANZUP members to help gather the evidence needed to develop full scale clinical research studies. The Pedalthon also plays a key role in raising awareness of ANZUP and the importance of clinical trials research in improving patient outcomes.
You can race against your friends and colleagues, meet some of ANZUP’s most dedicated supporters and rub shoulders with Pedalthon Ambassador, Commonwealth Games gold medallist Kaarle McCulloch. If you can’t make it on the day, you can still play an important part by promoting the event through your networks, supporting a team or donating to the research fund. Posters and content for emails/websites are available by emailing pedalthon@anzup.org.au.
FREE REGISTRATION Sydney Pedalthon registration is FREE for ANZUP members. For more information, visit www.belowthebelt.org.au or to register a team or a place on a team email pedalthon@anzup.org.au. The more teams we have, the more money we raise, the more people will understand the vital work you do and, ultimately, the more concepts we can help turn into reality.
Join us and ride for your research fund in teams of up to six or just come along and cheer on those taking part. It’s a fantastic day out at the iconic Sydney Motorsport track.
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UPDATES FROM SAC & SUBCOMMITTEES Scientific Advisory Committee (SAC) Scientific Advisory Committee Strategic Workshop The ANZUP Scientific Advisory Committee (SAC), along with members of the Board and Consumer Advisory Panel (CAP) met on 7 July 2018, for a facilitated strategic planning workshop. This was a great opportunity for us to catch up face to face and to think about ANZUP’s scientific and clinical directions, review our approaches to generating ideas and developing trial proposals, look at how trial information is communicated, critically assess our own processes, and brainstorm how to take the greatest advantage of what the SAC can provide for ANZUP. The day also included a review of the ANZUP Strategic Plan 2018–20 with particular emphasis on the aspects most relevant to SAC operations and functions.
Driving our research agenda: key priorities The workshop stimulated robust discussion about how to identify key research priorities, and the advisory input needed to maintain a forward-looking clinical trials agenda. Agreed priorities included: 1. A stronger focus for the SAC/CAP on identifying needs to be addressed through ANZUP’s research; 2. C learer articulation of ANZUP’s scope and role to help prioritise activities and effort;
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3. A more targeted approach to calling for and reviewing concepts aligned with agreed priorities; 4. A stronger emphasis on supporting early career researchers to build ANZUP’s future research capacity; and 5. C reation of a stronger profile and awareness among patients and researchers of the role and value of ANZUP research in driving improvements in outcomes from urogenital and prostate cancer.
Achieving our strategic goals Discussions identified several areas for consideration as ANZUP builds its clinical and scientific research strategy. These can be mapped against three main areas of need: • h aving a clear vision of priorities informed by broader contextual and environmental considerations • b uilding a well-considered strategy for how key goals will be achieved • e nsuring that implementation of the strategy is supported by appropriate and sustainable resources.
Reviewing the trial pipeline Further detailed planning was undertaken through a critical review of the trial pipeline. This review helped to identify the key questions, considerations and resource required to ensure that ANZUP continues to identify, pursue and implement clinically relevant, patient-centric trials that have the potential to improve outcomes for people with urogenital and prostate cancer.
Scientific Advisory Committee (SAC) Next steps Outcomes from the SAC Strategy Workshop will be used to inform our approach to idea and concept generation and prioritisation. Next steps to take our scientific and research strategy forward include: • revision of SAC Terms of Reference • recommendations from the SAC on how to ensure our SAC and subcommittee agendas allow for a stronger focus on horizon scanning and idea generation
• revision of concept development templates to incorporate questions such as clinical and patient need, expected contribution to practice change and value to the system. This was a highly productive day and I am very grateful to everyone who contributed their time and considerable energies to make it such a success. IAN DAVIS Chair, ANZUP Scientific Advisory Committee
• establishment of a SAC / CAP ideas forum early in 2019 prior to concept development workshops
Bladder Cancer The Bladder Cancer Subcommittee Concept Development Workshop, held in Sydney in April, was an outstanding success with an array of exciting new ideas across the bladder and urothelial cancer spectrum. For the first time research concepts related to penile cancer were presented. Whilst rare, cancer of the penis can be a devastating urogenital cancer and our subcommittee is pleased to include this challenging and complex condition within its research remit. In the muscle invasive bladder cancer setting, PCR MIB has successfully recruited further patients. Bladder preservation strategies in the management of muscle invasive bladder cancer are here to stay and this unique trial explores the potential to combine IOs with state of the art tri-modal therapy. I would encourage anyone seeing patients appropriate to this study to consider referral to a recruiting centre. The ACCEPT project, the first phase of which involves the creation of the ANZUP
multi-centre cystectomy database is now collecting data at multiple sites with approvals for many more at various stages of completion. With an ultimate goal of being able to perform multicentre trials involving cystectomy I would encourage all urologists who perform cystectomy to contribute to this database and help shape future trial initiatives. In the NMIBC space BCGMM continues to recruit steadily and a further NHMRC application was submitted this year and rebuttals recently completed to provide the necessary funding to complete this important study. Fingers crossed for the end of the year. The co-badged trial NMIBC-SI (Non-muscle invasive bladder cancer symptom index) has completed Field test 1 and the process of refining the questionnaire into Field test 2 is already underway. Many thanks to all of you who put so much time and effort into all of these projects. DICKON HAYNE Chair, Bladder Cancer Subcommittee
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Germ Cell
Renal Cell
Recent news
Recent news
1. P 3BEP continues to accrual steadily and with international sites now coming on board, we should see a significant incline in recruitment.
1. The KeyPAD trial is open and recruiting. Most trial sites are now open and screening.
2. TIGER is a multi-national pivotal study in refractory germ cell tumour patients comparing TIP (standard of care) versus TICE (high dose chemo and stem cell transplant). The first site has now opened in Queensland at the Princess Alexandra Hospital with more sites soon to open. 3. i Testis is Australia’s first national germ cell tumour database. After being put through rigorous testing, iTestis is soon to enrol its first patients. Please contact Ben Tran, if you are interested in contributing your patient data into iTestis.
Coming up 1. W e’ll be hosting an ANZUP workshop with endocrinologists, medical oncologists and urologists in Melbourne later this year, with the aim of developing an innovative and potentially practice changing protocol to improve long term outcomes in testicular cancer survivors suffering from hypogonadism. 2. R ecent studies have demonstrated the potential for microRNA testing to change clinical practice in testicular germ cell tumours. We hope to have the miRNA 371 assay up and running in Australia, which will facilitate ANZUP clinical trials testing their utility in a real world population. 3. A NZUP will host a preceptorship in germ cell, bladder and kidney cancers later in 2018. BEN TRAN Chair, Germ Cell Subcommittee
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Further data is showing that denosumab inhibiting RANKL might improve outcomes for patients taking checkpoint immunotherapy in other cancers, so we are very excited to see how this helps pembrolizumab in renal cell carcinoma. A reminder to please identify all your patients currently on sunitinib or pazopanib for referral to KeyPAD sites at the time their cancer progresses. 2. T he UNISoN study is still recruiting rapidly, with all sites open and patients moving into and through the study well. There have been no major problems identified with protocol, and tumour blocks are being saved for later translational studies. 3. A nother successful Renal Concept Development Workshop took place in April, with seven proposals presented. Discussions are underway on how best to progress the concepts. Thanks to all who presented and attended, it was a great, engaging day.
Coming Up 1. T he RAMPART study will hopefully open soon for adjuvant treatment. 2. O ngoing discussions are taking place about new trial ideas and the successors for the UNSIoN and KEYPAD trials. A follow-on study for UNISoN is in planning to help patients who have been failed by checkpoint immunotherapy – watch this space! 3. O ngoing discussions continue about how to best integrate clinical trials into standard of care to enable more sites to be involved with ANZUP trials. CRAIG GEDYE Chair, RCC Subcommittee
Prostate Cancer
Translational Research Recent news
Recent news 1. ENZARAD has now reached it accrual target of 800 participants. With the challenges associated with opening the study across 69 centres globally, completing accrual seemed a far-off goal four years ago. We are deeply grateful to all the investigators who have put in so much effort to make sure this question could be asked and properly answered. Similarly, the enormous biospecimen resource that has been collated for the study has been a huge amount of work for the translational team, for which we are incredibly appreciative. This bioresource will be enormously valuable for performing more detailed analyses over time. This wonderful collaboration that formed between investigators from ANZUP, Dana-Farber, ICORG, and EORTC accrued in excess of 25 high risk localised prostate cancer patients per month to this trial in recent months. We have learned an enormous amount about making a trial work in this collaborative environment and we hope to capitalise on this going forward with other studies. 2. T he TheraP study comparing Lutetium-PSMA to cabazitaxel chemotherapy is progressing very well with 57 of the planned 200 participants now enrolled. 3. T he randomised trial of the addition of inhalational analgesia to transrectal prostate biopsy continues to accrue well passing the halfway mark. 4. A record number of concepts were presented at the Prostate Concept Development Workshop in May with almost 40 ANZUP members in attendance. Thank you to all participants. 5. W elcome to Lisa Horvath as our new Prostate Subcommittee Deputy Chair!
Coming up 1. A NZUP continues to build the health economic substudy of the ICECaP collaboration. 2. W ith the ENZA studies now completed accrual and in followup, we are calling for concepts to start working into grant applications for biological sub-studies, so please send your ideas in. 3. N ew NHMRC clinical trials grant scheme / MRFF opportunities. SCOTT WILLIAMS Chair, Prostate Cancer Subcommittee
1. The Translational Research Symposium was once again a highlight of this year’s ANZUP ASM. Thank you to our keynote international speaker, Monty Pal. A big thank you also to our stellar group of local speakers: Anthony Joshua, Kate Mahon, Lisa Butler, Edmond Kwan, Colleen Nelson, Luke Selth, Roxanne Toivanen and Michael Hofman. 2. I n collaboration with Chris Sweeney and his team at Harvard/Dana-Farber, translational grant proposals centred on ENZAMET and ENZARAD have been submitted for the PCF Challenge and NIH R01 funding rounds. We hope to bring good news later this year... please keep fingers and toes crossed for us! 3. T he Translational Research Subcommittee was represented at all of this year’s Concept Development Workshops. Some very exciting concepts were presented, many with a strong translational focus. I look forward to some of these becoming ANZUP studies!
Coming up 1. S pecimen collection will continue for recruiting ANZUP-led trials, including but not limited to: ENZARAD, P3BEP, BCGMM, PCR-MIB, TheraP, KEYPAD and UNISoN. 2. F urther grant submissions are planned based on translational research stemming from ENZAMET and ENZARAD biospecimens. Please approach myself or Lisa Horvath if you have any potential ideas for these biospecimens. 3. I t’s never too early to plan for next year’s Translational Research Symposium at the ANZUP ASM. I have a high-profile international speaker in mind and will also be short-listing our national speakers as part of my role on the 2019 Convening Committee. Stay tuned! ARUN AZAD Chair, Translational Research Subcommittee ANZUP UPdate Spring 2018 | 27
Quality of Life and Supportive Care Recent News
4. e-TC
1. T hanks to our inaugural Chair
The e-health intervention for testicular cancer survivors has now reached its recruitment target and is now closed to recruitment. Congratulations to Ben Smith, Louise Heniger and the team for continuing with work to improve the survivorship experience of men and their families.
I would like to pay tribute to Prof. Suzanne Chambers for her many years of dedicated service as the Chair of ANZUP’s Quality of Life and Supportive Care Subcommittee. Suzanne recently stepped down from this role but remains a committed and active member of the ANZUP community. As supportive care and allied health clinicians and researchers, we are very grateful to Suzanne her efforts to increase ANZUP’s activity around supportive care, Quality of Life, and patient experience. As a community we wish Suzanne well as she continues to make a major impact in prostate cancer through her leadership of the Prostate Cancer Survivorship Centre for Research Excellence and some of us will be seeing more of her as she relocated to a new role at the University of Technology Sydney. 2. S upportive Care projects and Below the Belt funding Members of our supportive care community were highly successful in obtaining funding for projects through the Below the Belt Research Fund. Projects range from a qualitative study aimed at understanding patient experience of a new treatment, to the factors impacting adherence to active surveillance in prostate cancer, and whether a question prompt list can improve treatment decision-making for localised prostate cancer. 3. Updates on BTB funded projects During the ANZUP 10th anniversary Scientific Meeting we heard from members who previously received funding through this scheme. Camille Short was able tell us about the web-based physical activity guide she has developed for men with prostate cancer. The guide incorporates information about individual men seeking support and providing a tailored exercise prescription and behaviour change to address their needs.
5. Patient experience of clinical trials Natasha Robert, recipient of the Janssen Allied Health Professional Fellowship in 2017, has been working on her qualitative study aimed at understanding the experience of ANZUP clinical trial participants. It is fascinating we spend so much time and energy recruiting people into trials but rarely have clinical trialists systematically explore the experience. From this work we hope to improve the experience of recruitment and participation into trials for those who are on the receiving end.
Coming Up 1. QoL & Supportive Care Committee With so much activity within our area we will be aiming to establish regular ideas generation and support teleconferences to increase capacity of those working in this area to contribute to the development of ANZUP trials and projects, particularly focusing on embedding supportive care questions into the larger treatment trials ANZUP runs. 2. T ime for a Supportive Care Concept Development Workshop? With all the activity and interest in quality of life and supportive care trials, it is time we held a Concept Development Workshop focused on our projects and ideas. There are a wonderful group of experienced and enthusiastic people contributing ideas through tumour specific committees, we’d like to harness this energy to develop a clear program of supportive care work for ANZUP to commit to. Stay tuned for a save the date in early 2019. HARYANA DHILLON Chair, Quality of Life and Supportive Care Subcommittee
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Consumer Advisory Panel (CAP) I’d like to begin by congratulating ANZUP on its 10th anniversary and to thank the membership for its support of the CAP. Like ANZUP, the CAP has grown in expertise and provides timely and responsive advice utilising the unique perspective of its members. We are also delighted to announce that Leonie Young, who has been a CAP mentor since 2012 and last year was formally appointed to the panel, was recently awarded an Honorary Doctorate from the University of Brisbane. The Honorary Doctorate is in recognition of her distinguished service to the community, particularly as an advocate for women diagnosed with breast cancer. Congratulations!
Recent news 1. A long with providing consumer related input into current and newly established trials, members of the CAP attended the disease specific Concept Development Workshops held in April and May. These workshops are very important to the CAP as they raise our awareness of new directions in disease treatment as well as providing context to the priorities of the organisation. 2. A t this year’s ASM, the CAP, with much appreciated assistance from people throughout ANZUP, launched a short clinical trials awareness and engagement video. Apart from launching the screen career of CAP member Les Land, the video was very well received by the membership. It was screened in 1,900 GP waiting rooms across the country in July and August.
3. T he CAP played a strong participatory role in several of the sessions at the 2018 ASM. CAP member Colin O’Brien was also invited to present at the ASM in the session ‘At what cost? Do the latest therapies put people first?’ and his personal experience on the “cost of dignity” as part of his treatment experience with a prostate cancer diagnosis sent a powerful message about how important it is to put people first. 4. T he ASM also provides the vehicle for the CAP’s annual education session. We thank Andrew Martin, Richard De Abreu Lourenco, Ian Davis and Simran Chawla for taking time out to present to us. This was followed by the Community Engagement Forum in the afternoon (see page 7). Thank you to the panellists and the many people from ANZUP who contributed to its success.
Coming up We will continue to support the membership with requests to review research concepts, patient information and consent forms. We also look forward to receiving the formal feedback from Tonic Health Media following the release of the clinical trials video which will help inform the CAP and ANZUP as to the next steps in this campaign. 1. S eek funding for further development of the clinical trials engagement and awareness video 2. A ssist with trials coming down the pipeline 3. A ssist with input into Camille Short’s Exercise Guide for Men with Metastatic Prostate Cancer. BELINDA JAGO Chair, Consumer Advisory Panel ANZUP UPdate Spring 2018 | 29
CLINICAL TRIALS AWARENESS VIDEO
Is there a trial for me? As part of its Strategic Plan, ANZUP is committed to increasing engagement with consumers, carers and the broader community to promote the importance of clinical trial research in genitourinary cancers. To do this successfully, ANZUP needs to tackle the many myths and misconceptions among the general public surrounding clinical trials. Even for patients, there can be a lack of understanding of how trials work. What patients take away from their doctor can be different from what clinicians think they have understood. ANZUP has partnered with Breast Cancer Trials (BCT) to produce a new video to help educate the public and tackle the misconceptions about clinical trials. The video features Professor Fran Boyle AM and members of the ANZUP and BCT Consumer Advisory Panels, Cheryl Grant and Les Land.
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Thanks to the generous support of Tonic Health Media, the 60-second campaign video was shown on Tonic TV in 1,900 GP waiting rooms around Australia during July and August 2018 with the aim of prompting patients to ask “is there a clinical trial for me?�. By partnering with BCT and leveraging the Tonic TV network, ANZUP will increase reach and value for money by putting the message in front of thousands of people in a healthcare setting. Tonic research indicates average dwell time in waiting rooms of 30 minutes with 71% of patients reporting they had watched Tonic TV and 22% asking their GP about content they had seen on screen. To support the video, information about the campaign has been emailed to GPs and a face-to-face in-practice patient survey will help evaluate its success. Find out more on the ANZUP website https://www.anzup.org.au/content. aspx?page=faq and watch it on the ANZUP Vimeo Channel https://vimeo.com/280467983
CHEMOTHERAPY INDUCED HEARING LOSS Reducing the impact of chemotherapy induced hearing loss with new hearing aid technology Cisplatin-based chemotherapy is a known risk factor for hearing loss. Although most literature suggests hearing loss with cisplatin occurs at higher frequencies and with higher doses of the drug, traditional teaching has been that patients with pre-existing hearing loss should not receive cisplatin, meaning these patients often have inferior cancer outcomes. However, if these patients are adequately counselled, it is thought many would prefer to have better cancer outcomes if there was some ability to correct hearing loss, or retune hearing aids to address further falls in hearing. Another question is whether modern hearing aids can reduce tinnitus. In order to find out more, ANZUP member A/Prof Andrew Weickhardt spoke to Alison Hennessy from Alison Hennessy Audiology.
without feedback and without needing to close/occlude the ear canal (our earlier way of dealing with feedback). This has improved comfort and cosmetics drastically for people with high frequency hearing loss. Hearing aids do not restore normal hearing. This is typically noticed more in noisy/ challenging situations. We know that hearing loss (sensorineural loss) causes not just a loss of sensitivity, but also a reduced ability to ignore the background noise and focus on the signal of interest. There are a number of factors including age and cognitive function, in addition to the degree of sensorineural hearing loss. I do a screening test of the ability to hear speech in noise with appropriate amplification in order to counsel the person appropriately regarding expectations, and in order to decide the level of noise reduction technology likely to be required. Modern hearing aids aim to identify/reduce the background noise. For some people this is very effective, for others, no amount of high tech processing overcomes their reduced ability to cope in challenging situations (e.g. multi-talker conversations).
Current thinking about tinnitus is that much of the issue of Hearing aids are capable of amplifying more high dealing with tinnitus is due to underlying fears regarding frequency sounds than previously. ‘Frequency’ refers to the tinnitus (e.g. “it will get worse” and “it will make me the pitch of the sound (treble or bass). Higher frequency deaf”). It is thought that these may be subconscious speech sounds tend to be the consonants. These provide thoughts. Therefore, management of clarity. Lower pitched speech tinnitus typically involves reassurance sounds tend to be vowels. in the first instance. The aim of tinnitus Thirty years ago, the upper THE COST OF HEARING AIDS management is habituation (i.e. it is still limit of amplification was Hearing Services Program there, but it is not noticed, or noticed Under the Hearing Services Program, the 3-4kHz. Now it is fairly typical Federal Government funds hearing services only infrequently). Sound therapy can to see hearing aids amplifying (tests, etc) and hearing aids if required. The be part of the management and most up to 6-8 kHz and sometimes hearing aids are low-end technology, but do modern hearing aids have ‘tinnitus’ feature some noise reduction and feedback to 10kHz. Generally speaking, cancelling capabilities. More expensive hearing programs – where a sound generated if someone has hearing loss aids may be partially funded by the scheme. in the hearing aid is used to reduce only at 6kHz and above, they Hearing aids awareness of the person’s tinnitus. In would not be considered If paying privately, it is approximately $3,000 my experience, the best sound therapy hearing aid candidates as the – $8,000 for a pair of hearing aids. This will for people with significant tinnitus generally include fitting and review/re-tuning impact of such a hearing loss appointments for a certain period of time. issues and hearing loss is the use of is not regarded as functionally Health insurance extras cover typically provides hearing aids (tinnitus programs usually a reimbursement of $300 – $1,500. The NDIS significant. has strict criteria regarding the degree of not required). hearing loss, but will also fund hearing aids and Earlier hearing aids often services. The expected ‘life’ of hearing aids is Many people are reluctant to consider produced feedback when five years. hearing aids as they have only seen providing significant high Hearing tests big hearing aids. My comment is that frequency amplification. Some clinics are able to bulkbill everyone while many people are wearing hearing aids Nowadays, feedback some can bulkbill only as part of Team Care that you do not see – you only see the Arrangement (referred by GP) or if referred by cancelling technology is an ENT or neurologist. Therefore, patient costs obvious ones.” quite advanced, allowing can vary from nothing up to $150 or more. Re-tuning/review appointments after the initial high frequency amplification period attract a similar consultation fee. ANZUP UPdate Spring 2018 | 31
OTHER NEWS Hello and goodbye New Germ Cell and Prostate deputies Following the appointment of former Deputy Ben Tran as Germ Cell Chair earlier this year, expressions of interest were sought for his replacement. ANZUP was pleased to announce the new Deputy Fritha Hanning in July. Fritha is a medical oncologist at Auckland Hospital and the chair and initiator of the Genitourinary Special Interest Group for New Zealand. She is a key contributor to ongoing scientific research in genitourinary cancer, with involvement in current trials, and is a New Zealand representative on the ANZUP Scientific Advisory Committee. We were also delighted to announce the appointment of Lisa Horvath as the new Prostate Deputy Chair in July. Lisa is the Director of the Department of Medical Oncology at Chris O’Brien Lifehouse. Lisa’s research interest is predominantly in the field of prostate cancer and she is involved with a large number of clinical trials in prostate and colorectal cancers. She has been a member of ANZUP since December 2010.
A new Chair for Quality of Life & Supportive Care Following her recent appointment as Dean of Health at the University of Technology Sydney, Suzanne Chambers AO stepped down as Chair of the Quality of Life and Supportive Care Subcommittee. Suzanne has been Chair of ANZUP’s QoL and Supportive Care Subcommittee since its inception and has contributed significantly to the development and growth of ANZUP. We extend our sincere gratitude to Suzanne and are delighted she will continue to be involved in ANZUP as a member of the Scientific Advisory Committee. 32 | ANZUP UPdate Spring 2018
After a call for expressions of interest, former Deputy Haryana Dhillon was appointed Chair of the QoL and Supportive Care Subcommittee in August. Haryana joined ANZUP in 2011 and has been an active participant and contributor across all our research activities. She was appointed to ANZUP’s Scientific Advisory Committee in 2015.
Farewell Michelle We were sad to say goodbye to Internal Communications and Project Manager Michelle Bowers in August. Over the past year Michelle has helped us build our trial and member communications, enhance our website and grow our social media following. We wish Michelle all the best in her new ventures.
Welcome Fiona We’re delighted to welcome Fiona Bickerstaff to ANZUP as our new Internal Communications and Project Manager. Fiona comes to us following a recent deployment to Iraq as a Military Public Affairs Officer with the Australian Army Reserve. Prior to this, Fiona was a consulting project manager with the Spirit of Anzac Centenary Experience, an Australian War Memorial travelling exhibition and has worked across a variety of sectors from military to entertainment.
2018 ANZUP GU PRECEPTORSHIP (KIDNEY, BLADDER, TESTICULAR) Applications are now open for the 2018 ANZUP GU Preceptorship (Kidney, Bladder, Testicular)! Places are limited and expected to fill quickly and applications will close Friday 28 September 2018. Date: 30 November – 1 December 2018 Location: Novotel Melbourne Glen Waverley Convenor:
Eva Segelov
Preceptors: Ian Davis, Craig Gedye, George Hruby, Jarad Martin, Declan Murphy, Shomik Sengupta, Ben Tran Registration for all attendees is $250. The Preceptorship is an interactive learning model for the education of medical oncology trainees and junior consultants in the evidence-based management of genitourinary (GU) malignancies. The specific objective for participants is to develop an understanding of the evolution of GU cancer treatment through review of landmark clinical trials, with mentorship by experts in the field.
The 1½ day course will cover landmark clinical trials in kidney, bladder and testicular cancers. Target participants are trainees and junior consultants (first 5 years of practice) in medical, radiation and surgical oncology. Areas to be covered are multimodality management of early, locally advanced and metastatic disease and supportive care. To apply you must state why you would like to do the course, which papers you would like to present, and have a case study ready to present. The first fully completed applications will be the first to be confirmed. To apply and for more information on the Preceptorship, go to https://www.anzup.org.au/ content.aspx?page=gupreceptorship2017 Successful applicants will be supported (with travel and accommodation) to attend this exciting initiative.
Feedback from the 2017 ANZUP Prostate Cancer Seminal Advances Preceptorship: as that this w d e v lo y ll “I rea isciplinary.” id lt u m ly u r t
“…interactive, g ave us a chance to apply the facts we had lear nt about into hyp othetical scenarios with exp ert guidance.”
finitely “Would de to recommend my peers.”
ANZUP UPdate Spring 2018 | 33
UPCOMING EVENTS 11-12
OCTOBER
SYDNEY CANCER CONFERENCE, INTERNATIONAL CONVENTION CENTRE
OCTOBER
24-26
USANZ NEW ZEALAND SECTION MEETING AND NZUNS CONFERENCE 2018, PALMERSTON NORTH CONFERENCE CENTRE
COSA ASM, PERTH CONVENTION & EXHIBITION CENTRE
NOVEMBER/ DECEMBER
ANZUP BLADDER, KIDNEY, TESTICULAR PRECEPTORSHIP, NOVOTEL, GLEN WAVERLEY
34 | ANZUP UPdate Spring 2018
OCTOBER
ESMO 2018 CONGRESS, MUNICH, GERMANY
25-28
OCTOBER
NOVEMBER
14
31-2
OCTOBER/ NOVEMBER
AGITG ASM, BRISBANE CONVENTION CENTRE
23-25
NOVEMBER
ESMO ASIA 2018 CONGRESS, SINGAPORE
ANZUP BEST OF GU, BRISBANE VENUE TBC
17
21-24
OCTOBER
ASTRO ANNUAL MEETING, HENRY B. GONZALEZ CONVENTION CENTER, SAN ANTONIO
RANZCR ASM, NATIONAL CONVENTION CENTRE, CANBERRA
NOVEMBER
13-15
30-1
19-23
MARCH 2019
BELOW THE BELT PEDALTHON, SANDOWN, MELBOURNE
21-23 ANZUP ANNUAL SCIENTIFIC MEETING, HILTON, BRISBANE
JULY 2019
CORPORATE SUPPORTERS Thank you to our 2018 Corporate Partners and Supporters We are very grateful for the infrastructure support we receive from Cancer Australia; however the funds are not sufficient to support ANZUP’s increasing research activities. In 2017/18 many of our events, grants and activities required significant help. Fortunately our Corporate Supporter program has continued to grow. For an extraordinary year of partnerships we thank Active Display Group, AFI Branding, The Saturday Paper and Bloke as well as our fantastic corporate partners:
ANZUP UPdate Spring 2018 | 35
DONATE HERE
Like cycling? Don’t like cancer? Join us in the race to defeat prostate, testicular, kidney and bladder cancers. Since 2014, the Below the Belt Pedalthon has welcomed over 1,200 people, riding to raise awareness and funds for ANZUP, below the belt cancers and clinical trial research. “The wonderful thing about this fundraising initiative is that all the funds we generate go back to support research. We are trying to support the projects that are going to lead to future ANZUP trials and these will help generate the evidence we need to care for our patients better with these diseases.”
Professor Ian Davis, ANZUP Chair
Every cent we raise through the Below the Belt Pedalthon and our supporters’ kind donations goes directly towards clinical trial research via the Below the Belt Research Fund. In 2017, it provided muchneeded seed funding to support seven ANZUP members to progress new trial ideas to the point of becoming full scale studies.
Together we can defeat below the belt cancers.
SAVE THE DATE!
Like cycling, don’t like cancer? Help us defeat below the belt cancers by riding or supporting the Below the Belt Pedalthon #BTBPEDAL19 #MELBPEDAL19
Sunday 17 March 2019 Sandown Racecourse, Springvale, Victoria www.belowthebelt.org.au
Venue Partner:
Every cent we raise through the Pedalthon goes directly towards clinical trial research for testicular, prostate, kidney and bladder cancer.
