2024 Clinical Fellowship Projects

What is the Clinical Fellowship Program

Developing new research ideas and supporting the next generation of researchers is at the heart of the Clinical Fellowship Program.

The Program is aimed at early career researchers, who have a high-level interest in clinical research, appropriate qualifications, and are working in the disciplines of medical oncology, pathology, psychology and other supportive care specialties, radiation oncology, radiology or surgery.

Fellows work on projects that are directly relevant to Breast Cancer Trials (BCT) that potentially involve:

• Research that will inform future trials including background and pilot work;
• Work on existing or future planned BCT clinical trials;
• Further analysis of data from existing trials; and
• Other projects that are related to the BCT Research Strategy.

In the third year of the program, three new Fellowships have been awarded and three Felloships from previous years are continuing:

Dr Tivya Kulasegaran (Medical Oncologist) – Improving the Early Detection of Invasive Lobular Carcinoma

Invasive lobular carcinoma (ILC) is the second most common sub-type of invasive breast carcinoma, accounting for up to 15% of all breast cancer cases, and yet is largely understudied. Patients with ILC initially respond well to endocrine therapy, with high 5-year survival rates. However, the long-term survival rates are similar or worse than those of patients diagnosed with Invasive Breast Carcinoma of No Special Type.

This tumour type can be highly invasive, underpinning many of the clinical challenges related to managing patients with this disease. The risk of patients being diagnosed with metastatic disease is constant over a long follow up period (>20 years) and yet there are no mechanisms in place to support ILC patients for the early detection of disseminated disease.

Circulating tumour DNA (ctDNA) is an emerging non-invasive biomarker that has been utilised for molecular profiling and disease monitoring across a range of malignancies, including breast cancer. Its clinical potential as a personalised biomarker is broad and can include tracking tumour evolution, treatment resistance, responses and, most importantly, a potential indicator for early relapse. This current application aims to develop a diagnostic assay using ctDNA that could be used for long-term monitoring of ILC patients for the early detection of tumour recurrence at a potentially more treatable stage. Click here for more information or to listen to our podcast with Dr Tivya Kulasegaran.

Ms Jenna Dean (Radiation Therapist) – Personalising Patient Positions During Radiation Treatment

Early breast cancer is the most common presentation of breast cancer in Australia. The majority of patients with early breast cancer receive breast conservation surgery and radiotherapy. Another Australian study demonstrated that the perceived burden of radiotherapy (access, cost, travel, time away from home or off work – typically 4-6 weeks) may influence the patient’s decision to access this treatment.

Accelerated partial breast irradiation (APBI) is a promising treatment option for some of these patients, minimising radiation exposure to normal tissue and reducing toxicity without compromising cancer control. In addition, it is more convenient for patients (5 treatments vs conventional 15-25), and it allows for scarce radiation resources to be utilised more efficiently.

The primary aim of this study is to investigate the benefits and limitations of supine and prone treatment positions for APBI planned for the MR Linac. This will involve a comparison of the location of the tumour bed and its proximity to organs at risk (OAR) in each position, an assessment of the difference in geometric image distortion close to the target, and measurement of the magnitude of patient and breathing motion. Click here for more information or to listen to our podcast with Jenna Dean.

Dr Thi Thuy Duong Pham (Senior Researcher) – Improving the Treatment of Paclitaxel Neuropathy in Early Breast Cancer Patients

As neoadjuvant and adjuvant chemotherapy enable patients with early breast cancer to survive longer, issues such as peripheral neuropathy becomes a significant issue both in the short and long term. Research estimates frequencies ranging from 11% to greater than 80% of patients having persistent neuropathy at one or more years post their breast cancer chemotherapy.

Patients who have persistent peripheral neuropathy report poorer quality of life, increased psychological comorbidities such as anxiety and depression, have a greater falls risk, and were less likely to be active, which are all important factors that impact breast cancer.

The aim of this project is the improve the detection, prevention, and treatment of peripheral neuropathy in people receiving weekly paclitaxel as treatment for early-stage breast cancer.

Dr Adam Ofri (Surgeon) 

Project 1 – Reducing the Side Effects of Surgery

Patients with axillary node positive breast cancer are often treated with neoadjuvant chemotherapy (treatment before surgery) and conventional axillary dissection. However, many patients experience arm morbidity and reduced quality of life with this approach and new research suggests that less radical surgical strategies may improve patient outcomes. This study will ascertain the safety and efficacy of targeted axillary dissection (TAD) as an alternative to conventional axillary dissection, in patients who undergo neoadjuvant chemotherapy. It will also collect data on breast cancer patients to help establish a new registry specifically focused on TAD treatment.

Project 2 – Identifying Patients Who May Be Able To Avoid Radiation Therapy

The development of biologic signatures to assess recurrence risk for invasive breast cancer initially and later DCIS have been developed over time. A new combined clinical and genomic risk assessment test recently available in Australia is DCISionRT. This test prognosticates the 10‐year risk of DCIS recurrence or invasive breast cancer (IBC) developing, with or without radiation therapy. If we confirm the efficacy and impact of DCISionRT in tailored patient care, we could identify those that can avoid unnecessary radiotherapy, whilst identifying those at higher risk than initially presumed and provide beneficial RT. There have been multiple validation studies for DCISionRT, including a Melbourne based study, all showing impressive outcome prediction even when counter intuitive based on standard van Nuys type criteria [8, 9].

Currently, DCISionRT is only available for patients receiving therapy at one private RT company. In the Australian environment for the test to become widely available and funded, following on from the lack of success in Oncotype DX being MBS funded, a randomised trial (RCT) showing improvements in outcome for test users is likely to be necessary. The proposed outcome is development of a BCT‐led randomised control trial study protocol to evaluate the safety and efficacy of using DCISionRT in patient management decision making. Click here for more information or to listen to our podcast with Dr Adam Ofri.

Dr Janice Yeh (Radiation Oncologist) – Improving Radiation Treatment and Planning in Early Breast Cancer

Radiation therapy after breast conserving surgery plays an important role in the management of early breast cancer, decreasing the risk of breast cancer returning and improving mortality rates. This research project aims to evaluate the technical feasibility and clinical performance of the novel NASHA gel compared to standard surgical clips as a fiducial marker, to assist in the delineation of post-lumpectomy tumour bed in early breast cancer for radiation therapy planning. Click here for more information or to listen to our podcast with Dr Janice Yeh.

Dr Anna Sokolova – Developing New Treatments for Invasive Lobular Carcinoma

Invasive Lobular Carcinoma (ILC) is the second most common subtype of breast cancer, with 2,400 new cases each year in Australia. Patients with ILC may have a poorer outcome over time and the cancer has a tendency to metastasize to atypical sites such as the gastrointestinal tract, gynaecological organs or orbit (eye). This research project will examine a new treatment approach directed at ILC. Click here for more information or to listen to our podcast with Dr Sokolova.