Below the Belt Cancer Research Highlights Professor Dickon Hayne

Professor Dickon Hayne is a clinical academic who leads urological research and education in urology, at the University of Western Australia. He works as a consultant urological surgeon and is the Head of Urology for the South Metropolitan Health Service, WA. He PROFESSOR DICKON HAYNE is Chair of the Bladder, Urothelial and Penile (BUP) Cancer Sub-committee of the Australian & New Zealand Urogenital & Prostate Cancer Trials Group (ANZUP), a Scientific Advisory Committee (SAC) member, leads the BCG+MM trial and is widely engaged in other sub-committees, trials, and activities of ANZUP. His major clinical and research interests are urological cancer, in particular bladder cancer. Professor Dickon Hayne touches on the importance of clinical trials, the work of ANZUP in improving the outcomes for people affected by below the belt cancers, and an insight into the future of medical practices.

Can you please tell us about some of the latest research projects that you have been involved in?

Perhaps one of the main ones that I am still very much involved in is the BCG Mitomycin (BCG+MM) trial, which is now the largest Australian initiated bladder cancer trial that has been undertaken. We’ve got over 415 patients on the study, 15 centres around Australia, and now also open in the UK.

This trial looks at standard treatment for non-muscle invasive bladder cancer and BCG treatment, comparing that with a combination treatment of BCG and a chemotherapeutic agent called Mitomycin.

I’m also leading SUBDUE-1, a study looking at a new route of administering the checkpoint inhibiting drug durvalumab for bladder cancer. It’s a drug used in metastatic bladder cancer, and we are trying to bring these drugs earlier into the treatment paradigm. In the study, increasing doses are injected directly into the bladder wall. In the future this may become a new treatment for early bladder cancer.

Checkpoint inhibitors are a type of immunotherapy. They block proteins that stop the immune system from attacking the cancer cells.

I’m also involved in the ZIPUP study, which is a new PET scan staging trial for bladder cancer. We are using an antibody that sticks to bladder cancer attached to a radioactive substance that shows up on a PET scan. It is important to try to see how far a cancer is spread to decide what the best treatment is for patients.

What do survival rates look like at the moment?

I’m going to answer about bladder cancer specifically. The most recent up to date data we have, indicates that we are going backwards and that survival rates in bladder cancer in Australia are getting worse. The whole impetus behind bladder cancer research is to try and reverse that alarming trend. We do have a number of new agents and therapies that are available for bladder cancer that are only just emerging and haven’t made it into clinical practice yet. This is where clinical trials come into effect.

What have been some of the major breakthroughs that came out of clinical trials for below the belt cancers?

It depends on how far back we look – we didn’t even have hormonal therapy for prostate cancer until Huggins and Hodges won a Nobel Prize for it in 1966. That may seem like a long time ago, but it was a gamechanger.

Platinum based chemotherapy for testicular cancer was another one that revolutionised treatment – metastatic testicular cancer was almost always fatal but with the arrival of platinum-based chemotherapy it’s now very unusual to die from. Those are two massive leaps in two of the below the belt cancers.

PROFESSOR DICKON HAYNE

In recent years there have been a lot of advancements with immunotherapy, which is one of the new and exciting areas in oncology. The immunotherapeutic drugs and other new agents that are used are often targeted, appropriate for patients that have specific mutations in their DNA and require certain drugs suitable for their individual case.

Immunotherapy is a type of cancer treatment. It uses substances made by the body or in a laboratory to boost the immune system and help the body find and destroy cancer cells.

Another recent trial, the proPSMA PET trial, implemented a new staging scan for prostate cancer showing that it was accurate and superior to conventional staging. It’s important to note that in terms of survival rates, prostate cancer is the second most common in terms of cancer deaths, so it’s important to be able to stage these patients properly. Staging is a way to describe a cancer. The cancer’s stage tells you where a cancer is located and its size, how far it has grown into nearby tissues, and if it has spread to nearby lymph nodes or other parts of the body. Before starting any cancer treatment, doctors may use physical exams, imaging scans, and other tests to determine a cancer’s stage. Staging may not be completed until all the tests are finished.

The other thing that is changing the face of cancer therapy is theranostics, where you can image a patient with a pet scan and if the cancer is visible, you can add on a killer radioactive molecule that will hunt down, stick to the cancer, and kill it.

Theranostics is a combination of the term’s therapeutics and diagnostics. Theranostics is the term used to describe the combination of using one radioactive drug to identify (diagnose) and a second radioactive drug to deliver therapy to treat the main tumor and any metastatic tumors.

We have been talking about targeted therapy and personalised medicine for years but now it is becoming a reality. The trials we are focusing on now will inform the basis of future treatments.

How does Australia stack up against the rest of the world when it comes to trials and research into below the belt cancers?

Australia punches above its weight in terms of clinical trials. With ANZUP as a coordinating centre for urogenital cancers and trials into below the belt cancers, we are starting to make some proper inroads to cancer care that are practice changing.