2019 MRV Scientific Exchange Meeting – Report
The annual MRV Scientific Exchange Meeting was held on the 3rd December at the AMREP Centre in the Alfred Hospital complex. The evening began with the opportunity for some collegial catch ups over light refreshments. At 6:30pm Professor Grant McArthur opened the meeting and set the scene for the evening.
MRV metrics indicated that there are now: 2978 participants; 45 research projects; 23 investigators;74 research collaborators; 3779 primary melanomas; 1467 sentinel lymph node biopsies; and 1476 blood samples collected. MRV is involved in many projects covering multiple disciplines. In recent times we have begun collaborations with four international consortia. One being an extension of the AJCC’s 8th edition melanoma staging system. Many MRV participants are part of a 60,000 patient international study aiming to further refine staging. We have also begun working in health services area, with Professor Maarten Ijzerman, to better understand and map the myriad of treatment pathways for melanoma patients.
MRV was the recipient of Victorian Cancer Agency (VCA) funding to conduct two clinical trials in 2017. The CELEBRATE trial, which is looking at the combination of encorafenib, binimetinib and palbociclib, has had its start-up meeting and should be recruiting in the New Year. The BNC105 trial is hoping to see a benefit when PD-1 and a new agent known as BNC105 are combined.
Grant McArthur’s personal highlights for 2019 were: Adjuvant Therapy; a decrease in the number of melanoma cases and deaths in Australia; and preliminary trial data indicating that combining targeted therapy and immunotherapy is better than not. Grant completed his presentation by asking the audience to create a work cloud describing MRV and then contribute to the poll.ev question –“What are the research priorities for MRV?”
A/Professor Victoria Mar spoke about the work of the new Australian Centre of Excellence for Melanoma Imaging and Diagnosis (ACEMID). She is the Victorian lead for the project. ACEMID has three pillars: Diagnostic Intelligence; Health Services Evaluation; and Informatics. Fifteen 3D imaging systems will be installed in rural and metro locations across QLD, NSW and VIC. It is hoped that the research will eventually save considerable health care costs by detecting lesions earlier and preventing unnecessary biopsies.
A whole of population based screening program is not really feasible in Australia but this significant study should enable ACEMID to learn more about which patient groups should be targeted for regular screening. The project will embrace a telehealth network to better include rural sectors of each state involved. Each imaging system has 92 cameras which can process the images and line up lesions on a patient avatar in 12 minutes. Monash University, who have experience with the IBM
Watson project, are providing the IT expertise. All data will be stored on a central database.
In preparation a preliminary trial has been conducted through the Melanoma and Skin Cancer (MASC) Trials Group comparing total body photography and whole body 3D imaging. Computer algorithms have also been worked on with a recent Nature paper suggesting there was very little difference between the dermatologist and the computer’s review of skin lesions.
The imaging machines are to be installed in the second half of 2020 and patient cohorts will be recruited after that. The research team aim to stratify patients in groups such as family history, genetic biomarkers and histopathology in the hope of finding predictive indicators that will clearly identify high risk groups.
A/Professor Andrew Haydon is a medical oncologist at the Alfred hospital. He began his talk by clarifying the term Adjuvant Therapy. “An adjuvant therapy or treatment is given to a patient after they have already had a first treatment.” In oncology the first treatment is often surgery. Micrometastatic disease is impossible to detect and can sometimes remain after surgery. Adjuvant therapy is given to try and eliminate any microscopic disease. This practice is common in many other cancer types however pre-2018 there were no ideal treatments available for melanoma patients.
An update on some of the international clinical trials helped the audience. The CombiAD study has had 4 years of follow up data and has shown that BRAF patients on Dabrefenib/Trametinib have a 50% lower risk of recurrence. Unfortunately 25% of patients are affected by toxicity, which reverses when the drug is stopped. The data also hints that survival is better but the data still needs to mature. Novartis’s Dabrafenib/Trametinib was added to the PBS on the 1st November 2019.
The CA209-238 comparison of Nivolumab and Ipilimumab has shown that Nivolumab is better. In conjunction with the EORTC 1325/Keynote-054 data it has been concluded that one year of immunotherapy after surgery significantly reduces the risk of recurrence. As the drugs have improved over time patients are more tolerant of them but there is still a real risk of long term side effects. BMS offer compassionate access to Nivolumab for Stage III B/C/D patients. Ninety percent of
stage IIIA patients are generally disease free at 10 years.
Neo- adjuvant treatments are now being considered for stage III patients, where the patient receives drug treatment first for 1-2 months prior to surgery. Changes can be monitored by imaging and any shrinkage could potentially make surgery easier.
Although the field is advancing rapidly there is still room for improvement in the future. The availability of treatments for Stage II patients is not ideal. Combination immunotherapies are yet to show a marked improvement – but trials have not yet repoted. Liquid biopsies measuring ctDNA are being validated as part of many clinical trials and might become the means for predicting which
patients require adjuvant therapy.
The Chair of the MRV Consumer Reference Group (CRG), Mrs Alison Button-Sloan, outlined the work of the CRG, a group with a lived experience of melanoma. MRV has had consumers integrated in their program since 2010. The group are a conduit from Governance to Community and back. They facilitate collegiality, contribute to research and resource directions, disseminate research updates via social media and promote research and awareness. The CRG have 6 members listed on research grants. They have reviewed their Terms of Reference and are now attending some research laboratory meetings.
The Australian Melanoma Consumer Alliance (AMCA) is a national melanoma consumer group which had its genesis from the MRV-CRG. In 2019 the CRG and AMCA have reviewed 10 research projects and made 8 submissions to the PBAC. They are committed to improving patient outcomes, better patient engagement and enhancing the national profile of the disease.
Mr Paul White was officially recognised for his time as Chair of the MRV CRG andn was presented a MRV Excellence Award. The trophy read: Coming together is a beginning…keeping together is progress…working together is success. Paul’s 7 years as Chair has been instrumental in making everyone feel welcome and embedding consumers seamlessly into all aspects of melanoma research.
Professor Mark Shackleton, Morgan Mansell’s medical oncologist, revealed that he felt privileged to be entrusted with the care of people faced with a diagnosis and treatment of cancer. He said Morgan was a young woman whose focus was always outwards and on others. Morgan passed away from her melanoma at 25 years of age. Mark was delighted that Morgan’s parents, Peter and Julie, and her brother, Tristan, had chosen to create the Victorian Young Melanoma Researcher of the Year Award in her honour.
Mr Peter Mansell said the family were committed to keeping Morgan’s Blog going, to raise greater awareness and contribute to research. He thanked all researchers for the work that they do and congratulated the nine applicants on their excellent submissions. Three of the top applicants each provided a 5minute snapshot of their research:
1. Dr Simone Park from the Doherty Institute, University of Melbourne, speaking about the role of resident T cells in the skin and how they keep melanoma cells in check.
2. Dr Jessica Duarte from the ONJCRI, Austin Health, talking about B cells producing detectable antibodies in the blood in response to melanoma.
3. Dr Sara DeMenzes from the Victorian Melanoma Service, Alfred Hospital, discussing the recent increase in partial and shave biopsies numbers and the need for additional excisions for when a complete biopsy would have been more effective from the outset.
The winner was Dr Simone Park. The monetary prize was presented to Simone by Mrs Julie Mansell.
R to L: Prof Mark Shackleton, Dr Simone Park, Mrs Julie Mansell, Mr Peter Mansell, A/Prof Victoria Mar. Photo by MRV
Whilst all of the presentations were happening the poll “What are the research priorities for MRV?” begun by Professor McArthur continued quietly in the background. At the end of the meeting Grant informed everyone that 55 responses had been received. Grant thanked everyone for attending the meeting and actively participating in the live surveys. He closed the meeting by wishing everyone Season’s Greetings and a great 2020.
Addendum
Since the meeting we have grouped the suggestions into several large sets which are summarised in
the diagram below. Professor McArthur noted that this aligns well with the current focus of MRV
supported projects, with notable recent growth in projects looking at novel biomarkers and
development of new treatments through clinical trials supported by the Victorian cancer Agency.
The Topic group ‘Treatment’ includes: immunotherapy, toxicities, cures, targeted therapy, vaccines, and trials.
If you have any further suggestions please email MRV on info@melanomaresearchvic.com – we are always happy to hear from the wider melanoma community.