Associate Professor Sarah-Jane Dawson is on a journey to demonstrate the value of blood-based circulating tumour DNA testing in better treating and monitoring cancer patients. It's a journey which started as part of her NHMRC/Menzies Fellowship in Cambridge and has just been given a major boost with the CSL Centenary Fellowship.
Sarah-Jane, who has joint appointments as a consultant oncologist and clinical-scientist with the Peter MacCallum Cancer Centre and the University of Melbourne, heads up the Molecular Biomarkers and Translational Genomics Laboratory, which she established on her return from Cambridge in 2014.
The joint clinical and research role within Victoria's Comprehensive Cancer Centre (VCCC), allows Sarah-Jane to oversee the full range of research and clinical trials required to demonstrate whether a new approach to testing will reduce the requirements for biopsies and help guide better treatment decisions.
"One of the ways we get information about the genetic make-up of a cancer at the moment is usually by doing a biopsy which is an invasive test and not always possible because of the location of the cancer. You can't repeat them regularly and there can be complications.
"The other major problem with biopsies is that cancers are heterogeneous - tumours can vary even within the same patient and a biopsy is only done in one small area, so it is not necessarily representative of the whole tumour.
"Blood-based tests may give a more complete picture. And they are much easier to perform."
Over 400,000 Australians are living with a cancer diagnosis and Sarah-Jane's aim is to give them the opportunity for better outcomes.
"We know that healthy cells in our body release small amounts of DNA into the blood stream. In cancer patients the amount of circulating DNA is much higher because the cancer itself can release small amounts of tumour DNA into the blood stream. This is something we've known for about 40 years.
"Technology has now improved so much, we can more reliably identify these small amounts of DNA to measure, analyse and understand particular genetic changes and hopefully use the information to guide treatment decisions," Sarah-Jane said.
These decisions may include the best treatment for an individual patient, when a switch of therapy is needed because the disease has become resistant to a particular treatment, or more effective surveillance of patients in remission to identify relapses earlier and treat more quickly.
"The advantage of the technology is that it's applicable to the vast majority of cancer types.
"A lot of my early work focused on breast cancer and I still have a strong focus there in my clinical work. But the expansion of the research and the CSL Centenary Fellowship will enable us to start looking at the applications of the technology in different cancer types as well."
Sarah-Jane's 2012 NHMRC/RG Menzies Fellowship proved to be a key time in her career both in terms of the type of research she is expanding on now and in terms of seeing that she could marry her interests in the clinical and research aspects of treating cancer.
"It was very much the beginning of an explosion of research in this area.
"We actually had a very influential publication that came out of my research fellowship, published in the New England Journal of Medicine in 2013, and it was really the first demonstration of this kind of technique, using circulating tumour DNA to monitor patients with advanced breast cancer.
"It was the first time that these tests had been shown to provide a molecular means of monitoring the disease.
"We didn't discover the presence of circulating tumour DNA - that had been known for quite some time - but we applied these tests in a disease setting where it hadn't been used before."
Sarah-Jane's earlier medical training had stirred an interest in providing the best of care to cancer patients and she felt research would be the key to greater advances in care.
"When I did my medical training, I very much liked looking after cancer patients and I also liked palliative care.
"But I was always still intrigued on a research front. I saw the benefits of clinical trial research but I thought fundamental advances in cancer research through laboratory based research had huge potential to make a difference.
"I think that's what motivated me when I finished my oncology training to go overseas to Cambridge.
"I had been very well trained clinically here as an oncologist, but I also needed training as a scientist - it was an opportunity to see whether I enjoyed laboratory research - and after that time I realised there was the opportunity to combine both of these fields," Sarah-Jane said.
The place for her top class scientific training was the Cambridge Research Institute.
"It was a great environment scientifically to be able to try new things. There was a great sense of ambition that anything was possible. You really could try novel things that hadn't been done before and feel like you could succeed in that. It was an amazing environment to be exposed to and to see the research take off.
"Having had that experience it's been very nice to bring those skills back to Melbourne. I've been back four years and the environment the VCCC has created has been fantastic. I've been able to have all the resources and tools at my disposal that I had when I was in Cambridge, and been able to rapidly progress the research.
"It's the kind of research that patients make a huge contribution to. They very generously donate their blood samples to us all the time so we can learn more about their circulating tumour DNA and what it's telling us about their disease.
"Being in a research institute located alongside a public hospital where we can conduct this work is really important and helps us drive the research forward at a quicker pace.
"The environment enables high quality research of an international standard. It allows us to collaborate more effectively than we could before."
From the start of her lab in 2014, Sarah-Jane's team has grown very quickly to include three post doctoral scientists, two research assistants, and five PhD students.
"There is a lot of interest in the technology and that has enabled us to grow very quickly, thanks to the funding we've been able to secure through the NHMRC, National Breast Cancer Foundation and others."
If the team helps prove the value of these tests in cancer patients, they are likely to repay the value of their funding many times over.
"The health economics of this we haven't really touched on yet but biopsies do cost money; if we could reduce the frequency of biopsies and inpatient time then that potentially has economic benefits. These tests may also be better for patients in rural and remote areas without access to the full range of services - a blood test is accessible for all."
Take a look at CSL's video released as they awarded Sarah-Jane their Centenary Fellowship.
Pictured above: Sarah-Jane Dawson in the lab at Peter Mac, with her NHMRC/RG Menzies Fellowship medallion.