28/07/2019
Dr Rachel Conyers was considering a career in paediatric plastic surgery when a medical professional gave her some sound advice.

“In the nicest possible way, he said ‘I don’t think surgery is the go for you’, and it was the best career advice anybody ever gave me,” she explains.
 
“I was uncoordinated, and the questions I was asking were the kinds that would come from a physician rather than a surgeon. A few weeks later, I visited an oncology ward as part of my rotations, and it was at that point that I realised exactly what I should be doing.”
 
Rachel is a paediatric, adolescent and young adult malignant haematologist oncologist, meaning she looks at how cancer effects the blood of young people and children.
 
In 2016, she was awarded a Clinician Scientist Fellowship at Murdoch Children’s Research Institute, where she is currently working on a research project that aims to unlock the reasons why a chemotherapeutic drug class, known as anthracyclines, has a devastating effect on the heart cells of around seven per cent of patients.

Straight to the heart

Anthracyclines are used to treat more than 70 per cent of childhood and adolescent cancers and have significantly improved survival rates. However, for reasons Rachel is aiming to uncover, they can also switch off, and ultimately kill, heart cells.

“What I'm looking for in my research are ways to identify those patients with a propensity for this kind of side effect,” explains Rachel. “Are there genetic components that make some more likely to get these heart complications?  If we can identify the children at risk, we can either not give them the drug, or give them a protective medication.”

As part of her research, Rachel has conducted a retrospective study of 300 former patients at two of Melbourne’s leading paediatric medical institutions - The Royal Children’s Hospital and Monash Children’s Hospital. Most had acute lymphoblastic leukemia and small number suffered other cancers, such as bone sarcomas.
 
The Kids’ Cancer Project began funding Rachel’s research last year. She says it came at a crucial time. “We were completely out of funding and had just made a discovery of the genes we want to verify,” she says. “Now we’re at a point of clinical trial.”

Caring for kids

Rachel was drawn to medicine at a young age. “I really liked the patient aspect of it as well as the science,” she says. “I also love interacting with kids.”
 
Rachel completed her medical degree at Monash University in 2003 and received a fellowship in paediatric oncology at Melbourne’s Royal Children’s Hospital. After completing further fellowships in the UK, she returned to Australia in 2010 and began an Adult and Adolescent fellowship in Haematology at Peter MacCallum Cancer Centre. 
 
“I chose oncology because it is complex and multi-system medicine,” she says. “I also get to know families intimately and help them when they're in a really terrible space. If you can navigate that space with families well, you can at least make part of their journey a bit more tolerable.”

Research into action

As survival rates have improved dramatically in recent decades, attention is now turning towards minimising long-term side effects of childhood cancer treatments.
 
Rachel’s research focuses on cardiomyopathy, a condition that occurs when the heart cannot pump blood efficiently, often causing sufferers to require a heart transplant. Her research has progressed to become a national study and a clinical trial opened to enrolments at The Royal Children’s Hospital in February this year, followed by Peter MacCallum Cancer Centre.
 
There are genetic and radiology streams in the clinical clinic, as well as a health economics arm, which will include a cardio-oncology clinic.
 
“The aim is to centralise these patients in one clinic and have one approach for how we treat them to see if that is better for them, rather than having ad hoc practises,” says Rachel.

“We are in the middle of refining our approach to verifying the genetic findings. We're working with the genetics team at Victorian Comprehensive Genetics Service on appraising those genes as either causative or not, and then how we will feed that information back to families, which is another very complex area.”

Rachael says that funding from The Kids’ Cancer Project has provided enough money to complete the genomic analysis of trial participants. “Genomic analysis is the expensive part,” she says.

“This funding has been critical. Our original [clinical trial] cohort was 16 patients and we’ve doubled that with our next patient cohort. We’re hoping to send another 30 [for genomic analysis] by the end of the year."
 
“Once you reach numbers close to 100, then you can say that this is a real finding,” adds Rachel. “At that point, we can start to implement it into some kind of clinical practise that hopefully protects these kids’ hearts.”

 
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