Personalised medicine, implementation of the Australian Cancer Plan and expansion of Teletrials are just some of the factors predicted to further shape oncology in 2024.

The limbic gathered the perspectives of a number of medical oncologists on the drivers of practice change and improved outcomes for patients in the near future.

MOGA chair Associate Professor Melissa Eastgate told the limbic that personalised medicine was coming to the forefront of cancer treatment.

“The funding of the Precision Oncology Screening Platform Enabling Clinical Trials (PrOSPeCT) program is a great step forward for our patients so they have access to comprehensive genomic profiling of their tumours which will enable increased access to targeted treatments and clinical trials for patients across Australia,” she said.

Associate Professor Eastgate, Operations Director – Cancer Care Services at the Royal Brisbane and Women’s Hospital, also welcomed the comprehensive Australian Cancer Plan which has been designed to improve cancer outcomes for all Australians.

“2024 will see the beginning of the implementation of the plan, which not only talks about how we can do better for our patients, but also about how we value and support our workforce who are under increasing pressure due to the rising number of patients, the increasing complexity of care and looming workforce shortages.”

Decentralising care

Professor Sabe Sabesan, clinical director of the Queensland Regional Clinical Trial Coordinating Centre in Townsville, is looking forward to a near future in which teletrials become routine practice and improve clinical trial access to all cancer patients.

He says it’s an area in which Australia is already a global leader and that several trial groups and pharmaceutical companies have also adopted the model as part of their health equity agenda.

“For the first time, all states and territories have set up the regional clinical trial coordinating centres and trial support units to embed the Teletrial model as a way of enhancing regional and rural access to clinical trials,” he said.

As well, in many states and territories, Teletrial clusters have been set up for trials involving oral and intravenous therapies.

The TARGET-TP trial, conducted in Melbourne and at four regional centres across Victoria, has demonstrated the efficacy of risk-directed thromboprophylaxis to reduced thromboembolism in patients with lung and GI cancers. [link here]

The trial has also demonstrated financial benefits for patients from a networked teletrial model compared to traveling to a metropolitan centre [link here].

Professor Sabesan also highlighted the MOST-CIRCUIT trial of combination immunotherapy in immunotherapy-sensitive advanced rare cancers.

“The MOST-CIRCUIT trial has enabled two patients from Cairns to enrol locally with Townsville as the primary site. This not only provided patient benefits; but also enhanced collaboration between cancer centres,” he said.

“Based on the success of this COSA-initiated model of care, ASCO has included the COSA model in their telehealth guidelines and the Canadian cancer trial unit has incorporated it into their Remote Access Framework for clinical Trials (CRAFT) and activated three trials using this model. New Zealand has funding to activate the model and trans-Tasman clusters may be a reality.”

“Leveraging the Australian Teletrial Program and the NSW/ACT RRR program, the Australian clinical trial sector has an opportunity to finalise and implement rapid approval processes to create a workforce-enabling and truly patient-centred clinical trial system in Australia.

He said trial groups and pharma have the opportunity to incorporate Teletrial model as a formal recruitment mechanism within their protocols themselves to speed up the health equity agenda.

Paediatrics 

Professor Nick Gottardo, Head of Paediatric Oncology and Haematology at the Princess Margaret Hospital for Children in WA told the limbic that 2023 saw two major practice-changing reports in paediatric neuro-oncology.

A phase II study [link here] in children with low grade glioma harbouring a BRAFV600e mutation found the combination of dabrafenib and trametinib in the first-line improved outcomes compared to the standard of care chemotherapy arm of carboplatin and vincristine.

“This prompted the FDA to approve this combination, resulting in a major change in the way clinicians can now treat such tumours,” he said. 

As well, the results of the Molecular Neuropathology 2 study [link here] which included Australian paediatric cancer centres, revealed that the integration of DNA methylation with histological and molecular tumour profiling for CNS tumours improved diagnostic accuracy. 

“In addition, the platform also provided a refined diagnosis with prognostic subclassification of tumours, which will help improve patient management. This landmark study paves the way for the implementation of DNA methylation profiling into routine neuropathological assessment of childhood and adolescent CNS tumours.”  

He said paediatric oncologists were also looking forward in 2024 to the results of clinical trials of CAR-T therapies in aggressive incurable childhood brain tumours “…as it is hoped this therapy will transform the therapeutic landscape for brain tumours as it has done for leaukaemia.”

Geriatric and end-of-life care

Associate Professor Christopher Steer, from the Albury Wodonga Regional Cancer Centre, welcomed the revised and updated ASCO supportive care guidelines, published last year [link here], that recommend a geriatric assessment in older adults with cancer being considered for systemic therapy.

“Given the mounting evidence that a geriatric assessment improves clinical outcomes the guidelines provide practical, considered evidence-based advice.”

“The guidelines document has been designed and endorsed by members of SIOG, CARG and ASCO,…. and are published with a companion article in the Journal of Oncology Practice [link here] that details what the assessment entails and suggestions on how to manage the vulnerabilities and deficits found during the assessment process.”

“In the field of geriatric oncology, ‘adequate assessment yields appropriate care.’ We should all be striving to improve the care of older adults with cancer using this approach. This is one way of moving towards the goal of person-centred, age-friendly cancer care.”

Associate Professor Steer said as an oncologist working on the border between Victoria and NSW, the Voluntary Assisted Dying Act which came into effect in NSW from 28 November 2023 will probably have an impact in 2024.

“I have not had many patients access the Victorian service over the years.…. and this may be partially due to the difficulties in assessing patients from a clinic physically located in NSW as the consultation needs to take place in Victoria.”

“There are subtle differences in the legislation between Victoria and NSW and it will be interesting to see if the process is made easier with the “harmonisation” of regulations. Regardless of the position each individual clinician takes on the issue and their decision to engage in the process, I think this will provide eligible patients with a choice and another pathway to relieve suffering at the end of life.”

Practice-changing trial

Meanwhile, the prestigious Nature Medicine journal has included the NADINA clinical trial as one to watch in its short-list of 11 clinical trials that will shape medicine in 2024 [link here].

The international study, to run across Australia, Europe, and the US, compares neoadjuvant combination immunotherapy with the current standard approach of single agent adjuvant immunotherapy in preventing recurrence in stage III melanoma.