ANZUP’s 2022 Below the Belt Research Fund Recipients

2022 Below the Belt Research Fund Recipients

Overview - Below the Belt Research Fund

The Below the Belt Research Fund was established to support ANZUP members in the development of investigator-initiated studies. The funds raised from Below the Belt events, and donations from our supporters, go directly towards clinical trial research via the Below the Belt Research Fund.

The Below the Belt Research Fund was established to provide much needed seed funding to support ANZUP members to progress new trial ideas to the point of becoming full scale studies.

Since 2015 the Below the Belt Research Fund has supported many members in the development of investigator-initiated studies and turn an idea into a fully-fledged trial.

At the ANZUP Annual Scientific Meeting the 2022 recipients of the Below the Belt Research Fund were announced. Congratulations to:

• Louise Emmett • Chun Loo Gan • Weranja Ranasinghe • Shomik Sengupta

Professor Louise Emmett

Director of Theranostics and Nuclear medicine, St Vincent’s Hospital Sydney

The RE-SPECT project: Development of interim response biomarkers in Lu PSMA therapy.

Lu PSMA therapy is a new therapy for people with metastatic castrate resistant prostate cancer (mCRPC) that has been shown to be better tolerated than and equally effective to cabazitaxel chemotherapy (TheraP). However, not all people respond to the treatment identically, with some people demonstrating dramatic responses and others progressing early. Personalising treatment for the individual requires response bio-markers that can accurately measure dynamic changes in treatment response, allowing intensification or de-intensification of treatment. In people with exceptional response, treatment can be paused, while in people with cancer growth despite treatment, treatment can be intensified or changed.

Currently we use PSA, CT scans and bone scans to determine whether a person is responding well to treatment. However, Lu PSMA treatment emits a gamma wave that enables a whole-body image evaluating all tumour sites after each therapy injection (24 hours); this picture is called a SPECT scan. Work on the LUPIN trial at St Vincent’s has shown that any increase in tumour volume on Lu PSMA SPECT predicted cancers that were not responding to treatment, even when the PSA had not yet risen.

The concept of using images from the therapy itself (SPECT imaging) – is unique to theranostics approaches like Lu PSMA. The potential for these SPECT scans to provide dynamic treatment response information has not been fully assessed.

While this initial evaluation shows that Lu PSMA SPECT has the potential to be an effective response biomarker, many questions remain to properly validate its role and optimise its potential uses. ANZUP has unique clinical trials in Lu PSMA with stored SPECT data and the associated treatment response data for each patient. Analysing these data would allow us to fully evaluate the role and benefit of SPECT as an interim response biomarker – potentially further improving the lives of patients through better, faster clinical decision making.

Dr Chun Loo Gan

Early career GU medical oncologist, Royal Brisbane and Women’s Hospital and Greenslopes Private Hospital

PREDICTing treatment response to first-line immunotherapy-based combinations with PSMA and FDG PET in advanced Renal Cell Carcinoma

More than 4000 people in Australia are diagnosed with kidney cancer each year. While anti-cancer medications such as oral tyrosine kinase inhibitors and intravenous immunotherapy have prolonged lives for patients with metastatic kidney cancer (cancer that has spread from the kidney to another part of the body), it is difficult for doctors to work out which patients will respond to which drug or drug combination. More research is needed to identify individual patient factors (biomarkers) that may provide additional information to determine the best treatment for patients with metastatic kidney cancer. In some cancers, positron emission tomography or PET scans are better at identifying cancer deposits than computerised tomography (CT) and are commonly used. In some hospitals in Australia, PET scans are already being used to inform the management of patients with kidney cancer, but this approach is not well studied.

This research project aims to find out if PET scans can provide doctors with more information in selecting the best treatment for patients with metastatic kidney cancer. Using information from this study, we will develop a follow-up study using PET scans to help choose between available therapies for patients to achieve the best outcomes.

Dr Weranja Ranasinghe

Urologic-oncology surgeon, Monash Health

Utilising a pro-inflammatory gene signature and immune cell markers to identify non-muscle invasive bladder cancer patients at high risk of intravesical BCG failure.

Almost 80% of patients who are newly diagnosed with bladder cancers have tumours limited to the superficial layers of the bladder. The more aggressive forms of these superficial bladder cancers are commonly treated with an immunotherapy medication called BCG which is put into the bladder. This medication, an inactivated bacterium resembling tuberculosis (BCG), has been used effectively for decades, reducing the likelihood of bladder cancer coming back or spreading outside the bladder. However, 30-45% of patients, this BCG treatment will fail with the cancer progressing into deeper layers or spreading outside the bladder despite treatment. If the cancer progresses to the bladder muscle despite BCG, even curative treatments such as removal of the bladder result in poor outcomes. Therefore, it is vital to identify patients who will not respond to BCG treatment early. BCG works by activating our immune system to target cancer cells in the bladder. Studies suggest that recruiting more immune cells in the cancer environment can benefit patients receiving BCG treatment.

However, in patients who have an exaggerated inflammatory response with a large number of immune cells present before BCG treatment, it can cause exhaustion of these immune cells rendering these cells dysfunctional and unable to mount a response when BCG is administered.

This study aims to utilise genetic pro-inflammatory gene markers and immunostaining to help identify which patients will not respond to BCG treatment. This will enable better selection of patients for this treatment and allow for future research to develop other therapies for bladder cancer.

Professor Shomik Sengupta

Professor of Surgery and Deputy Head of School at the Eastern Health Clinical School, Monash University & consultant urologist & Uro-Oncology lead at the Department of Urology, Eastern Health.

Non-muscle invasive bladder cancer registry

Bladder cancer is a common condition. Reliable sources of information on bladder cancer treatment and outcomes in Australian patients are not limited. This proposal is to develop a platform for collecting information on patients diagnosed and treated for bladder cancer. The main aim will be to utilise the information to improve treatment in the future. The platform would also allow us to plan and run some studies to compare and assess different ways of treating bladder cancer.