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Advancing treatment of lymphoma

Dr Gareth Gregory

Dr Gareth Gregory is a haematologist involved in Melbourne Genomics’ Lymphoma project, which is providing genomic sequencing to selected patients and assessing its impact on patient care. The project is being jointly led by Professor Stephen Opat from Monash Health and  Professor Miles Prince from Peter MacCallum Cancer Centre.

We asked Gareth a few questions about the project.

What is lymphoma?

Lymphoma is the most common form of blood cancer in Australia, and the sixth most common cancer overall. Around 90% of lymphoma is non-Hodgkin – the focus of our project. Even with the best of available treatment, up to half of patients with high-risk advanced lymphoma will die of their disease – so it remains a challenging area of cancer care.

What is your role in the Alliance’s Lymphoma project?

I have been working alongside the Melbourne Genomics Health Alliance team to co-ordinate the project, from its planning stages through to patient recruitment – which is now commencing.

I co-ordinate the multi-disciplinary team meetings which discuss patient recruitment and review genomic sequencing results. The meetings bring together an exceptional team of clinicians, genetic counsellors, pathologists, bioinformaticians and molecular haematology staff from Monash Health, Austin Health and the Peter MacCallum Cancer Centre. I am very excited to be working with this highly committed team.

What do you hope to achieve?

Access to genomic sequencing may lead to more accurate diagnosis at an earlier stage, as well as a greater capacity to tailor treatment for each patient.

It is anticipated that about half the patients we test will have genetic variants that may help guide treatment. Genomic sequencing can also provide evidence to support a patient’s pre-selection for clinical trials or compassionate drug access initiatives.

We hope to identify the most important driver mutations for each patient’s lymphoma, so that if their disease is resistant to standard treatment, we can personalise their subsequent therapy. This potentially has a range of benefits: most importantly in improving patient outcomes, along with reducing the emotional and cost-burden of enrolling patients in clinical trials without knowing whether their lymphoma is likely to respond.

What excites you about this work?

Around a quarter of patients with subtypes of aggressive B-cell lymphoma (and an even higher proportion of patients with T-cell lymphoma) will experience a relapse of their disease which is typically resistant to standard chemotherapy and radiotherapy treatments.

In recent years, an enormous amount of preclinical research has identified the cancer-causing pathways and components that are driving these patients’ lymphoma, as well as the landscape of genetic variants that drives these pathways. As a result of this research, a growing number of genomically targeted treatments are now coming through to the clinic.

Projects such as ours are very exciting in helping to identify which variants and associated drug targets are important for each particular patient, and helping to make the most effective use of these treatments for patients who experience lymphoma relapse.

The exciting potential here is more durable remissions and (dare I say it?) cures for a greater proportion of patients with lymphoma.

Can you tell us a bit about you?

I am a haematologist and the clinical lead for aggressive lymphoma at Monash Health, as well as a clinician-scientist working between Monash University and the Peter MacCallum Cancer Centre.

I have been researching molecular dependencies of aggressive lymphoma and novel therapeutic approaches to overcome resistant disease. My PhD studies focused on development of a drug for use in resistant diffuse large B-cell lymphoma, which has resulted in an international phase one clinical trial currently underway in Melbourne and the USA.