The legacy of asbestos
"Western Australia is a hot spot for mesothelioma, due to mining and milling of asbestos in Wittenoom, and the subsequent transport and use of the product in the WA community. The working conditions at Wittenoom were terrible, where many young migrant men had their first experience of working in Australia. Some stayed for years, others just days or weeks and still developed mesothelioma due to a brief and heavy exposure to asbestos. In other parts of the world it is considered a rare cancer. In WA we have a particular opportunity and obligation to study mesothelioma because it’s not actually rare in our community, and we have a critical mass of researchers studying asbestos diseases and mesothelioma. The media has been very supportive of WA mesothelioma research.
My path to research in this disease was as a clinician, followed by a PhD in tumour immunology in mesothelioma. I treat a majority of people in WA with mesothelioma, and I am heavily involved in a range of research which truly spans bench to bedside. Our laboratory team at the National Centre for Asbestos Related Diseases has more than 25 scientists and I work with a number of PhD students and postdoctoral scientists on diverse projects such as biomarkers, tumour immunology, chemo-immunotherapy and tumour genetics. Most of my patients donate samples of blood, tumour and pleural fluid which are used in laboratory research. We also do a lot of work in murine models, trying to tease out the complexities of immunotherapy and find new ways to combine chemotherapy with immunotherapy. Where we want to go with all our research is into clinical trials in patients with mesothelioma, so many of our laboratory questions are focused on how we can best take treatments through to the bedside to benefit people with the disease.
At the moment, we are developing two novel clinical trials. One combines standard chemotherapy with a new immunotherapy drug which is similar to the drug ‘Keytruda’ that has taken melanoma treatment by storm. The other clinical trial uses an oral agent which blocks a disease pathway under study by my colleague Professor Gary Lee. Both of these concepts have been truly ‘bench to bedside’ at UWA.
Mesothelioma is not a common disease, but realistically in WA, we have all been exposed to asbestos. Everyone knows someone with mesothelioma, or someone who worries about getting mesothelioma because they drilled into an asbestos fence, took down an old shed or camped at Wittenoom. Hopefully our team’s research can provide hope to the broader community, as well as demonstrate that WA can lead the way internationally in some fields."
Quality over quantity
"Many of my patients express a preference for ‘quality over quantity’ when they are diagnosed with advanced cancer. Unfortunately, quality of life with untreated advanced cancer can be very poor. It comes as a surprise to people that effective treatments can improve quality of life by reducing symptom burden or tumour volume.
Quality of life research in cancer was established in the last 20 years and uses validated patient-rated questionnaires to measure quality of life from the patient’s perspective.
It helps us understand the balance between quality and quantity when choosing treatments, choosing to have treatment or understanding what symptoms and needs are most important to address. At the moment we are looking at how well patients’ symptoms are relieved when they have radiotherapy for painful chest wall masses from mesothelioma – surprisingly, a question which hasn’t yet been answered from the patient’s point of view.
I am also involved in clinical trials in patients with brain tumours, including quality of life in patients having radiotherapy for melanoma spread to the brain; and patients randomised to have two potential treatments for progressive primary brain cancers. Both of these national clinical trials are answering treatment and survival questions, but also helping to ensure, through adding quality of life research, that survival doesn’t come at an overwhelming cost.
There are so many opportunities for clinicians to be involved in research, because we see the patients and can identify the problems that are most important to them."
UWA and me
"Growing up in Perth, the beautiful UWA campus has been a part of my life for as long as I remember, from picnics on the Crawley foreshore to my mother’s role as an academic economist in the Business School for a period. UWA was the only university in WA offering medicine in 1985, in an era with a lot less student mobility, so it was an obvious choice for me. After graduating in 1990, I spent the next few years working as a junior doctor and oncology trainee before starting a PhD, again through UWA, in 1999. I bounced back to UWA again in 2005, after completing a postdoctoral fellowship to start my role as a clinical academic medical oncologist. I’ve now been here for the past 11 years."
Professor Anna Nowak is a medical oncologist and member of the Perth Mesothelioma Centre and National Research Centre for Asbestos Related Diseases (NCARD). She is internationally recognised for mesothelioma research over the past decade and works closely with other researchers at Sir Charles Gairdner Hospital and UWA.
Anna’s laboratory work in mesothelioma includes a PhD thesis on combination chemo-immunotherapy for which she received the International Mesothelioma Interest Group New Investigator Award in 2002. She returned to UWA in 2005 to pursue laboratory work and clinical translational work in mesothelioma after a postdoctoral fellowship in clinical trials research. Her clinical research culminated in the development of the Modified RECIST Criteria for tumour response which is now widely used in clinical trials.
Anna has been an invited speaker internationally on tumour measurement and clinical trials in mesothelioma. She produced the first published validation of the use of a quality of life tool in clinical trials in mesothelioma. She continues to investigate the role of PET scanning in prognostication and monitoring of treatment response in mesothelioma, and is the principal investigator in a phase II clinical drug trial for malignant mesothelioma. Her clinical research work outside of mesothelioma includes active participation in clinical trials, psycho-oncology, and translational research in high grade glioma.
Professor Anna Nowak treats the majority of people in WA with mesothelioma, a disease rare in most parts of the world but less so in the State.
Dr Marcus Tan is helping to solve complex issues for patients and providers in the health care system, through HealthEngine.
When Dr Chieh Cheng was a student at the Rural Clinical School in Geraldton she witnessed the birth of her supervisor’s first child, and in 2014 one of her own students helped to deliver her baby daughter.