When Dr Elizabeth Hovey was four years old, she declared a strong ambition to her family. “I’m going to cure cancer when I grow up,” she told them.
Dr Hovey, who is a Senior Staff Specialist in Medical Oncology at Prince of Wales Hospital, Conjoint Senior Lecturer at UNSW and Honorary Associate of the University of Sydney, had been exposed to the disease at a young age when her great aunt died of breast cancer.
“I don’t remember saying it to my family, but they assure me that I did,” she said.
With the help of funding from The Kids’ Cancer Project, Dr Hovey is moving a step closer to her early ambition at the Nelune Comprehensive Cancer Centre.
Read more: Personalised targeted therapy for adolescent and young adult medulloblastoma patients
Along with her co-lead, Associate Professor David Ziegler, she is heading up the Australian arm of an international study that aims improve cure rates and reduce therapy related toxicities for adolescents and young adults diagnosed with medulloblastoma - a cancerous brain tumour that starts in the lower back part of the brain.
While medulloblastoma is the most common childhood malignant brain tumour, it is relatively rare in adolescents and young adults (AYA).
As AYA medulloblastomas have a distinct tumour biology, the best treatment for this group is unclear and there is a wide variation in clinical outcomes.
This landmark trial is the first collaborative, international study of personalised therapy in newly-diagnosed AYA medulloblastoma patients. It focuses on those with the Sonic Hedgehog (SHH) subgroup of medulloblastoma, which account for about 70 per cent of this group of patients. It will give them access to state-of-the-art tumour profiling and targeted therapies in order to ensure optimal treatments.
“It's such an uncommon tumour that it's impossible for any single country to get a study up and running, so it needs to be an international effort,” said Dr Hovey.
“I think it's going to bring together the neuro-oncology community who are treating these patients and will help to standardise treatments,” she said.
Elizabeth added that although the study focusses on the SHH subgroup, other AYA medulloblastoma subgroups without that mutation will also be included.
“There will be a control arm with standard radiation and chemotherapy versus an experimental arm looking at a lower dose radiation and the same chemo as control arm,” she said.
“The purpose is to see if it is feasible to use a lower dose of radiation with the same outcomes but less side effects.”
An art and a science
Although her father suggested she become a dermatologist, Dr Hovey said oncology felt like a natural fit.
“I wanted to help people who were at a difficult crossroads in their life,” she said.
“There’s more art to oncology than some other areas of medicine. You have to tailor the treatment a lot more to the patient and to their desires. Communication is also very important in oncology, because you’re often breaking bad news and there's a lot of difficult concepts to explain. I also wanted to look after people who really needed a doctor.”
After completing advanced training at Royal Prince Alfred Hospital, Dr Hovey went on to further post-graduate training at Columbia-Presbyterian Medical Centre in New York and received a full scholarship to complete a Master of Biostatistics in Patient-Oriented Research at Columbia University School of Public Health.
She returned to Australia in 2001 and took up a role as a consultant at Liverpool Hospital, where she worked for six years before joining Prince of Wales Hospital.
“Oncology is quite an exciting field and there's been amazing breakthroughs, not only in anti-cancer drugs, but also in the supportive-care drugs,” said Dr Hovey.
“I think it's much more feasible for patients to live closer to a normal life when they're going through treatment, because we can manage their nausea and their pain a lot better today,” she said.
Preparing for trials
Clinical trials for this project, which is being run under the auspices of the Cooperative Trials Group for Neuro-Oncology (COGNO), are expected to begin in the first quarter of 2020. Dr Hovey estimates there will up to 33 patients in the trial. As it will include the use of a drug called Sonidegib, which targets the SHH medulloblastomas, only those who have reached puberty will be eligible.
“One of the uncommon toxicities of the drug is that it can make your bone growth plates fuse early,” said Dr Hovey. “That’s one of the main reasons it’s not being used much in the paediatric setting.”
“We're hoping that by using it in patients whose growth plates are already fused due to puberty, it’s not going to be a toxicity of concern in that older age group.”
Dr Hovey describes funding from The Kids’ Cancer Project as vital.
“It will help us to recruit patients, follow up and manage sub-studies,” she said.
“Hopefully we'll cure quite a few of them as well as follow up many for years to come. It’s a long and ambitious undertaking, so the funding is very much appreciated.”
“It’s very expensive to run studies and this funding will turn the project into a reality,” she added. “It means that this group of Australian patients will be able to access an international gold standard approach to treatment and care.”