Clinical Fellowship Program 2024

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.

In the third year of the program, three new Fellowships were awarded.

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.

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.

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.