Could a simple blood test determine if a cancer patient will respond to treatment? That question could soon be answered by Auckland medical researcher, Dr Cherie Blenkiron.
She is trying to determine if analysing blood from a patient diagnosed with malignant melanoma can detect whether they would respond to immunotherapy treatment prior to it being administered – or if blood tests could help determine whether they're responding to the therapy.
The University of Auckland cancer biologist has been given funding from Auckland Medical Research Foundation (AMRF) to explore her hypothesis.
She believes it could be a game-changer not only for melanoma, but also for treating other cancers: "Immunotherapies are expensive. It's expensive to buy the drug, it's expensive for the patient in terms of travel, they can have side effects and there's inconvenience – they must have repeated three-weekly infusions, in some cases for up to two years."
"We're trying to develop a blood test to give people the best treatment and best care," says Blenkiron. "We want it cheap, we want it reliable, and we want it to be quick so you can use it more frequently. I think of them as 'peace of mind tests'.
"Immunotherapy is the most incredible revolution in treatment. Around the world, there are trials going on proving that it also works for lots of other cancer types too. It's been shown to work really well for lung cancer.
"We're measuring an immune protein that's not specific to the cancer type and we are keeping our fingers crossed it's applicable to other cancers."
Ten per cent of all registered cancers each year are melanoma; it's the third most common cancer type diagnosed in New Zealand – over 2500 people a year.
Blenkiron's project focuses on malignant melanoma, where the cancer has spread away from the primary skin site. Malignant melanoma is rare but New Zealand has the highest incidence rates in the world due to UV exposure.
Blenkiron and her team, based at the University of Auckland's Faculty of Medical and Health Sciences, approach patients about to receive immunotherapy to treat their malignant melanoma – the only cancer type in New Zealand that has immunotherapies Keytruda and Opdivo funded by Pharmac.
These immunotherapies block proteins that the cancer uses as camouflage from a patient's own attacking and protective immune system. The treatments re-awaken the body's immune system to then attack the cancer.
If proven successful, the test will not only provide a targeted treatment plan more likely to be successful for the patient, it will also mitigate the wasted cost for patients whose cancer is unlikely to respond to immunotherapy. That money can be invested into other treatments, or extended to other cancer types.
AMRF, New Zealand's largest independent research funder, has awarded Blenkiron $159,937 for the project. Now into the second year, it has been impacted by Covid-19 lockdowns, forcing her to apply for an extension to complete the work.
"We've been impacted in two ways," she says. "One has been limited lab access and the other has been the fact that, for the past couple of years, recruitment of new patients has been really challenging.
"That's because of the increased rules around access to hospitals and patients moving to telehealth for follow up – so we haven't been able to go to the clinic to take another blood sample. In addition, some of our team converted into helping out with Covid testing."
"So an extension is essential. We need another year to be able to complete the study to a point that we can do more."
AMRF recognised the need for an emergency Covid-19 Relief Fund, to ensure research projects impacted by the pandemic could recover from months of Auckland's extended lockdowns.
The 2020 and 2021 lockdowns caused major disruptions for researchers. More than 70 projects funded by AMRF are now significantly stalled and need additional support to pay salaries to complete their work.
Pre-Covid, Blenkiron's trial was expected to recruit about 50 patients in one year. Immunotherapy is typically given every three weeks for two years – this project involves assessing blood samples taken every three months.
"We are still collecting patients who were recruited pre-Covid, they're the ones who are continuing on the treatment, or they have finished the treatment," Blenkiron says.
AMRF previously provided a grant to Blenkiron for research into Merkel cell carcinoma (MCC), a more rare and aggressive form of skin cancer. Australasia has the highest incidence of MCC in the world.
"We were able to access a new technology, only available overseas, to analyse some of these new immune proteins. This method, Digital Spatial Profiling, showed us there are many camouflage proteins present within each patient's cancer. It also pinpointed possible new targets for trials of up-and-coming immunotherapies. Together, this information could tailor new treatments to improve the lives of people diagnosed with MCC worldwide," she says.
Blenkiron presented the findings at the first international Merkel Cell Carcinoma Symposium in Florida just prior to the first lockdown in 2020.
"It's at the point where it's being used to leverage new funding. AMRF are really good at giving people seed funding to kick-start projects and support them to grow into something bigger," she says.
The Auckland Medical Research Foundation's key focus is to financially support medical researchers and their projects led out of the greater Auckland region. AMRF was established in 1955 and has invested more than $84 million into a wide range of medical research. AMRF relies on public donations to help support researchers; an endowment funds AMRF's administration costs, enabling 100 per cent of donations to go directly to research.
To find out more about and other research projects including neuro conditions such dementia, cancer, bone health, heart disease and public health, go to medicalresearch.org.nz