5 minutes with Associate Professor Georgina Long
17 December 2015
What research projects and trials are you currently working on?
There are many research projects and clinical trials that I am working on, most of which are collaborations across MIA, or collaborations with national and international colleagues. The projects cover a range of areas, including: the genetic characteristics of melanoma itself; why melanoma responds or becomes resistant to drug therapies (and we have projects looking at combined targeted therapies and combined immunotherapies); and projects as to why some people’s genetics might predispose them to certain side-effects with drug therapies.
We are working on numerous clinical trials many are MIA home-grown trials, including the neoadjuvant study of targeted therapy for bulky stage III BRAF-mutant melanoma. This study has a dual purpose: 1) to see if we can shrink the melanoma to become more easily resectable by the surgeons; and 2) whether we can give a course of drug therapy to prevent melanoma spreading to distant sites like the liver, lung and brain.
We are also in the midst of writing a protocol for a similar neoadjuvant approach, however using combined immunotherapy and targeted therapy. We have recruited more than half the number of patients required for the Australian Brain Collaboration, which is exploring combined nivolumab and ipilimumab versus nivolumab alone in active brain metastases.
In 2016 we will be opening trials of new combinations of immunotherapies for patients with metastatic melanoma. We are recruiting very well to an adjuvant study for stage III melanoma of pembrolizumab versus placebo because at the moment, the standard of care for stage III is observation with close monitoring. This gives you an idea of some of the projects, but I’ve really only touched on 10% of all the work we are doing. We have recently submitted the first results from our Genome Project to be reviewed for publication, and these results have very important implications for patients with acral or mucosal melanoma.
You presented world first research at the biggest melanoma conference in the world recently. Tell us about this research?
I presented some exciting results from several international phase 1 clinical trials that we have conducted here at MIA. The first was a phase 1 (first in humans) study of pembrolizumab, an anti-PD-1 antibody, combined with ipilimumab, an anti-CTLA-4 antibody. I reported on the first efficacy results and toxicities. It was well tolerated using a smaller dose of ipilimumab, and only 17% of patients developed a grade 3-4 immune related adverse event. The response rate, meaning those that had a deep response in their melanoma, was 56% which is similar to what has been reported in a large study of nivolumab, another anti-PD-1 drug, combined with ipilimumab, however with ipilimumab at a full dose.
The second study I presented was another world-first phase 1 study (first in humans) of the oncolytic virus T-VEC with pembrolizumab. This had a response rate of 56%; however this was only in 16 evaluable patients, so very small numbers. The combination was very well tolerated with no new side effects, but similar side effects to what you may see with each drug alone.
Another study I presented was a pooled analysis of over 600 patients who had received combined targeted therapy, a BRAF and MEK inhibitor (dabrafenib and trametinib), for BRAF-mutant melanoma across several randomised trials in stage IV. Interestingly, the greatest predictor of overall survival was the patient’s level of LDH before they started the drug. LDH is a protein that we produce when our normal cells turnover, however may rise above normal levels if the melanoma is particularly aggressive.
What are your goals for research in the future?
I have a very simple goal and that is to prevent and cure melanoma and hope that the results we see in melanoma can be used in other cancers.
What drives you to work so hard and achieve such amazing results?
My drive is doing something positive for the human race. Although I love doing things for individuals and I am driven by the patients I see in clinic, the greatest thing is to think that you may be impacting thousands of people, not only those with melanoma, but people with other cancers. It is hard work to conduct so many clinical trials: it’s not easy, it requires a lot of effort, expertise and teamwork, but it’s worth it when you see the results we have seen in the last 3-4 years. And we believe we are curing some people with metastatic or stage IV melanoma.
How will you celebrate Christmas this year?
I will be celebrating Christmas with my family. If it wasn’t for my family and their support, there is no way I could do what I do. My husband is an amazing support for me and the work I do. In fact, the results I see from the work I do with my colleagues at MIA, I really have to say are the result of his hard work as well.
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