What’s new in Research – across the campuses

Monash Health

Surgery in the New England Journal of Medicine!

Professor Julian Smith in conjunction with Professor Paul Myles (head of Anaesthesia Alfred Health) have had a landmark paper exploring the use of aspirin in cardiac surgery published in the New England Journal of Surgery.  They found among patients undergoing coronary artery surgery, the administration of preoperative aspirin resulted in neither a lower risk of death or thrombotic complications nor a higher risk of bleeding than that with placebo.  Check out the full article at: http://www.nejm.org/doi/full/10.1056/NEJMoa1507688

Monash Health pancreatic
surgeon Mr Dan Croagh

Pancreatic biobank

The major focus of research in the Monash Health HPB unit is pancreatic cancer, in particular, the application of targeted therapy to improve patient outcomes. The overall 5 year survival for pancreatic cancer remains dismal at 5% and pancreatic cancer is predicted to be the second commonest cause of cancer related mortality by 2030.

Future improvements in survival will only come with better systemic chemotherapy or earlier diagnosis. As our understanding of pancreatic cancer genomics improves thank to the work, among others, of the Australian Pancreatic Cancer Genome Initiative, it is likely that individual patients with specific genetic mutations, or patterns of mutations, will benefit from targeted of tailored chemotherapy. As yet this has not reached clinical practice. 

In collaboration with Brendan Jenkins at the Hudson Institute, we have been investigating the use of endoscopic ultrasound guided fine aspiration to obtain tissue from patients with pancreatic cancer to characterise their cancer genomics. Our work is currently being supported by a grants from the CASS Foundation, Mylan, and Cook Medical along with funding from the Department of Surgery and Monash University. This has allowed us to select a small group of patients with unresectable pancreatic cancer who may benefit from a specific form of chemotherapy.

Over the next 12 months, we are planning a pilot study to examine the efficacy of a novel targeted chemotherapy in this select group of patients. This study will also require screening virtually all patients with pancreatic cancer for the specific mutation thus allowing us to create a high quality biobank of pancreatic cancer samples. This biobank is currently being expanded to include other sites around Victoria to create The Victorian Pancreatic Cancer Biobank which will be linked to the Upper GI Cancer Registry, administered by the Monash School of Public Health. The linkage of the biobank and clinical data will provide an invaluable resource which will allow us to investigate other targeted chemotherapies as they become available. Hopefully by adding our contribution to this iterative process we can help improve outcomes for our patients. 

Eastern Health

Dr Sean Mackay, surgeon

The Eastern Health Surgical Research Group has the dual aims of supporting research and audit projects conducted by residents and registrars in clinical posts at Eastern Health, and of supporting higher degree students from the surgical stream. 

The EHSRG is convened by Adrian Fox and Sean Mackay, with the assistance of Salena Ward, and Professor Richard Cade. 

In terms of the work undertaken by residents and registrars in clinical posts, the aim is to pair a researcher up with a suitable supervisor from the EH/Monash senior staff, and then to facilitate the work undertaken.  EHSRG meetings are held weekly to keep the wider group abreast of the progress.

The supervision of the MS projects is conducted by the EHSRG senior staff in collaboration with other members of the EH/Monash senior/academic staff.  Current projects include:

• What is the rationale for, and the best way of delivering a pre-operative very-low-calorie-diet in patients being prepared for weight loss surgery?
• What is the role of percutaneous cholecystostomy in the management of complicated gallstone disease, and what is the best way to manage a cholecystostomy tube once it has been put in?
• Audit of outcomes from Whipple pancreatico-duodenectomy operations over the last 15 years.
• What is the role of liver MRI in cases of potentially resectable colorectal cancer metastases?
• Victorian data on post-oesophagectomy mortality – comparison with national and international data and commentary on the centralization debate.
• Analysis of functional pancreatic exocrine insufficiency after major upper GIT resection – patients with normal faecal elastase but elevated three day faecal fats.
• Audit of a group of patients who have had post-op (as well as pre-op) oesophageal pH testing – the role of testing in this group, and the potential role of pre-op testing on treatment as well as off it.
• What are the laboratory and research markers of metabolic syndrome, and can we use them to help us decide when to offer weight-loss surgery (MS project).
• What is the role of balloon sphincteroplasty at the initial ERCP, compared with a delayed sphincteroplasty, in the management of larger bile duct stones (RCT – MS project).
• What is the role of overall weight and weight/BMI in determining the optimal prophylactic dose of LMWH (MS project).

The group welcomes new members.  Please email  sean.mackay@monash.edu or adrianmfox@gmail.com with your enquiry.

Cabrini Health

Dr Simon Wilkins

Major Grant success!

A team of researchers from Cabrini health, Hudson Institute for Medical Research and Monash University have recently been awarded a $2 Million Translational Research Project grant for the next three years from the Victorian Cancer Agency (VCA).

This grant will start a Phase II clinical trial aimed at identifying which patients with bowel or prostate cancer will respond well to a new suite of anti-cancer drugs called BET inhibitors.

Project title: Super-enhancer templated RNAs as predictive biomarkers of BET inhibitor sensitivity in prostate and colorectal cancer

Dr Arun Azad (Lead Applicant), Dr Ron Firestein, A/Prof Helen Abud, A/Prof Paul McMurrick, Prof Gail Risbridger, Dr Simon Wilkins. 2016-2018 $2,000,000.

ADIPOSe Clinical trial commences

Professor Wendy Brown,
Head of Surgery, CCS/Alfred

ADIPOSe: Australian decrease in intra-pelvic obesity for surgery trial-Using VLEDs to reduce weight and improve outcomes in obese patients undertaking laparoscopic rectal cancer surgery, is a multicentre randomised controlled trial investigating a very low energy diet prior to laparoscopic surgery for rectal cancer in obese patients. ADIPOSe will recruit 100 obese rectal cancer patients over two years, randomising 50 to receive a Very Low Energy Diet (VLED) as an exclusion diet preoperatively. Ethics have been approved at sites in VIC (Alfred and Cabrini) and at multiple sites in NSW and QLD.  Patient recruitment has just commenced in the last month in VIC.

The trial has been funded in part by Cabrini Foundation Grant ($30,000) – awarded July 2015 and most recently a CSSANZ Foundation Grant: S. Bell, S. Warrier, A. Stevenson, M. Solomon, P. McMurrick, S. Wilkins. 2016-2017 $100,000

In addition a NHMRC project grant application for the trial has just been submitted: S. Bell, S. Warrier, A. Stevenson, M. Solomon, P. McMurrick, W. Brown, S. Wilkins, K. Oliva, M. Staples, K. Wilson. 2017-2018 $279,630

Publications

Yap, R, Oliva, K, Wilkins, S, McMurrick, P.  Colorectal Cancer in the very elderly: nonagenarians. Diseases of the Colon & Rectum. 2016 In Press-May issue

Wilkins, S, Haydon, A, Porter, I, Oliva, K, Staples, M, Carne, P, McMurrick, P, Bell, S.  Complete pathological response after neoadjuvant long course chemoradiotherapy for rectal cancer and its relationship to the degree of T3 mesorectal invasion. Diseases of the Colon & Rectum 2016 In Press-May issue

Alfred Health

Less painful prostatic biopsies 

Alfred urologist A/Prof Jeremy Grummet (pictured) is lead investigator of an ANZUP team conducting a study looking at pain relief for prostate biopsy. ANZUP is the peak body for conducting clinical research on urological cancers in Australia and New Zealand and A/Prof Grummet's team was awarded an NHMRC grant of nearly $600,000 to run this multi-centre trial.

The study, called Painfree TRUS B, is a double-blinded randomised trial comparing the standard method of pain relief for a transrectal ultrasound-guided (TRUS) prostate biopsy with a novel approach of analgesia.

TRUS biopsy is usually performed with local anaesthetic infiltration of the tissue around the prostate. However, sometimes this doesn't provide enough numbing, nor does it address the discomfort of the initial passage of the transrectal probe. As a result, many men find TRUS biopsy a painful and distressing experience.

This trial, which started accruing patients in December 2015, compares the standard approach of local anaesthetic with local anaesthetic plus the addition of a Penthrox inhaler, which acts as a systemic painkiller. Penthrox inhalers have been used by paramedics in the field in Australia for many years and appear to be safe and effective. They have only recently been approved for use in minor procedures in hospital.

A/Prof Grummet is also site investigator of another ANZUP randomised trial running at the Alfred on the use of BCG with Mitomycin for bladder cancer.