Lung cancer is the leading cause of cancer death in Western Australia, and is also the most common and one of the least survived cancers in Aboriginal people.
Associate Professor Andrew Redfern, Binjareb woman, Ms Leanne Pilkington, and the team at The University of Western Australia and the Harry Perkins Institute of Medical Research are investigating the interaction between Aboriginality, remoteness of residence, and cancer biology to explain eventual cancer outcomes - a combination that has been unexplored until now.
This research will use existing health datasets combined with individual genetic changes in lung cancers and other critical aspects of cancer biology to explain why survival rates are lower in Aboriginal patients diagnosed with lung cancer. With this data, they aim to better understand how to treat lung cancer in Aboriginal people. They hope that this research will ensure that each person receives the most effective targeted treatments for their type of lung cancer to increase lung cancer survival for Aboriginal people and for others living in rural and remote areas.
We spoke with A/Prof Redfern and Ms Pilkington, to learn more about this exciting new research.
Can you explain your research?
"Our research is looking at understanding how we can improve treatment outcomes for Aboriginal people with lung cancer.
Special tests are available that can find some lung cancers where certain targeted treatments are very effective at improving patient survival. However, if patients miss out on testing, then they will likely also miss out on the opportunity to receive these treatments. We're aiming to understand lung cancer testing rates, and the type of treatment received by Aboriginal people, and those living in remote areas to try and make sure everyone receives these useful tests." A/prof Redfern shares.
"Beyond this we're exploring a range of other features of a person's cancer, including how far the cancers have spread, and the tumour's genetic mutations that control how it behaves. We are interested in whether Aboriginal people have cancers controlled by different genetic mutations that make their cancers behave more aggressively and might affect treatment." he explains.
Genetic differences might also mean that some patients experience different side effects from treatments. Knowledge of this could also help us choose the best drugs for each person.
We're also interested in how the immune system responses to try and combat the cancer and whether this is different in Aboriginal patients. This could guide us in deciding who would benefit from immune therapies." he shares
Why is your research important?
"If we start seeing more people surviving lung cancer in the community then people might be more likely to go to the doctor or take part in screening. This research will help us to say, 'we've checked your lung cancer type, and this is the best way that we can treat it'." Ms Pilkington shares.
"It's really hard when someone can't see a difference after treatment, and they may not see a difference because the treatment is not the most effective for their specific type of lung cancer. I'm hoping that through this research, we can provide targeted treatments, potentially leading to better outcomes.
"I really appreciate how important this research is to everybody. It's not just Aboriginal people, and it's not just people who live in rural and remote areas – it's everybody." she says.
What have you discovered so far?
"So far, we've found that there are several biological and genetic variations in Aboriginal people compared to non-Aboriginal people. Aboriginal people show stronger immune responses which suggests that immunotherapy may be more effective than other therapies. We saw a similar result in previous research into breast cancer, where Aboriginal people also had cancer types that do well with immunotherapy. So, we're now thinking there might be a place for an immunotherapy-specific breast cancer trial in Aboriginal people and potentially different immunotherapy initiatives in lung cancer also. We are hoping it will lead to a more focused way of treating these cancers." A/Prof Redfern shares.
"In lung cancer, there are two key genes (EGFR and ALK) which specific drugs can target, and which can help patients live longer. However, Aboriginal people have fewer of these specific gene-related cancers, making the cancer more complex to treat, because you don't have a single gene that you can target." he explains. We hope by studying Aboriginal lung cancers in more detail we may find new targetable genes that we also have effective therapy for."
Translating these findings into the community
A/Prof Redfern, Ms Pilkington, and their team are currently working on developing a statewide Aboriginal cancer advisory service which will provide a more integrated approach to treatment.
"We hope to identify each person close to when they are diagnosed with cancer which will then allow a multidisciplinary team will put together a treatment plan. This plan will be reviewed with added cultural expertise and biological considerations, potentially altering drug choices, targets, or supportive measures to better suit the person's needs." A/Prof Redfern shares.
"By centralising everyone's treatment through this service, we'll also be able to deliver specific educational materials and resources statewide to Aboriginal people, ensuring these reach local healthcare providers across the state, regardless of the patient's remoteness." he says.
"We hope that this will ultimately reduce the gap that exists for Aboriginal patients with lung cancer, leading to better treatment outcomes", he shares.
The research team will also engage Aboriginal community members to ensure that community voices are heard, and that research recognises and values diverse cultural perspectives.
"My focus is on making sure that Aboriginal voices are heard throughout the research, right from the start and even before the ethics review and ensuring that the language that is used in the research is culturally appropriate." Ms Pilkington shares.
"The outcomes for the people on the ground are what's so important for me, as well as making sure that we get there safely and respectfully." she adds.
Incredible local research such as this would not be possible without generous support from the Western Australian community. If you'd like to make a difference, please donate today.
