How personalised medicine is guiding a new approach to liver cancer

I’ve always been fascinated by how things evolve. Tumours are constantly changing, which is how they manage to evade treatment. A better understanding of tumour plasticity would help the development of more effective treatment options for liver cancer, which is the third leading cause of cancer-related deaths worldwide. I joined the Liver Cancer Collaborative to lead its precision genomics initiative, where I bring my expertise from the Singapore Liver Cancer Consortium to the incredible research being done here in Australia.

More than 3,000 Australians are diagnosed with primary liver cancer every year, with men three times as likely as women to suffer from this fatal disease. Unfortunately, due to a lack of effective treatment options, more than half of these patients succumb to disease within two years of being diagnosed. I believe that by employing precision genomics in liver cancer, we can significantly improve outcomes and survival rates.

Science is a team sport and, in our quest to defeat liver cancer, we collaborate extensively with clinicians from across Australia, Singapore, Britain, France and India. Liver cancer is a particularly big problem in the Asia-Pacific region — there are many reasons for this and chief among them is that many patients have historical hepatitis B infections dating back to before the vaccine became widely available in the early 1990s. I lead an international genomics initiative aiming to develop diagnostic tests with the overall purpose of guiding personalised, clinical decision-making in hepatocellular carcinoma, the most common form of liver cancer. The Liver Cancer Collaborative is contributing comprehensive genomic and clinical data to that global effort.

Cancer is a heterogenous disease where every individual patient’s tumour is unique and every patient’s response to treatment varies. As with all cancer treatments, some patients respond and others unfortunately do not. What we don’t understand is why this is so. We are developing a bespoke approach for cancer treatment and identifying molecular patterns in individual tumours to guide clinical practice. My laboratory uses cutting-edge single-cell genomics approaches to identify cell types associated with therapy response, which will allow us to develop a personalised genomics approach to liver cancer treatment — the right drug to the right patient at the right time.

Even when diagnosed at an early stage, liver cancer remains untreatable in more than 80 per cent of patients. We need reliable molecular biomarkers, such as the presence of a specific cancer cell type, to diagnose liver cancers early and treat them with the right drugs. Every individual is unique and the same applies to their tumours. It’s why a ‘one-size-fits-all’ approach doesn’t work. Our proposed diagnostic tests will develop a fast-track pipeline to the right drug for the right patient and, more importantly, the correct follow-up during treatment to understand the effectiveness of the drugs on the tumours. There is so much scope to improve survival rates and it’s what encourages and drives all of us at the Liver Cancer Collaborative.

A tumour is made up of hundreds of thousands of cells, which come in different shapes and sizes. Anti-cancer treatments work directly on these cells. So, for a personalised medicine approach, it is important to know the exact shape, size and location of individual cells in any given tumour. Our lab has developed the expertise to identify the different cancer cells and their locations in liver tumours by employing technologies which allow us to profile individual cells in tissue and the environment in which they thrive. We are starting to understand why some therapies do not work in a particular group of patients and, more importantly, what new drug might be best suited to them.

Growing up, I wanted to become a cricketer. I remember waking up 3am to watch almost every international cricket match, and I’d practise during the innings breaks on an ‘eat, sleep, cricket, repeat’ cycle. I think I am a scientist because I failed as a cricketer!

For more information, visit the website of the Liver Cancer Collaborative.