Clinical research is how we look at different ways of preventing, diagnosing and treating cancer and the complications that can arise during and after treatment. Clinical trials are usually undertaken in a large number of patients in many centres and often across different countries. We work with Irish (ICORG) and international (EORTC, GCIG) clinical research groups in these studies. Women with gynaecological cancer are invited to participate if they are suitable.
Basic Science /Laboratory Research
Gynaecological cancer biobank
Our group has an extensive biobank [DISCOVARY bioresource] of serum, blood and plasma from malignant and benign tumours. This biobank underpins all of our translational research and provides important material for investigating tumour markers which can help in early diagnosis and in more targeted treatments. The bioresource is a collaborative effort between St James’s and Trinity College Dublin. This biobank is linked to a dedicated database which provides full clinical information and follow-up data on each patient. This allows us to do studies looking at deteminants of survival and treatment response. To date it has recruited over 1000 patients and recruitment is ongoing. A recent epidemiological review of 583 cases from our bioresource reveals our figures are in line with the national averages so we are confident our sample population is representative of the gynaecological cancer cases that present in Ireland
Biomarkers for ovarian cancer
We challenge the “one size fits all” approach to the management of ovarian cancer as research has shown that ovarian cancer is actually several diseases or subtypes. Within these subtypes, which look similar under the microscope, we observe different patient outcomes. Further stratification is needed so each woman can receive the appropriate treatment and not suffer the side effects of an ineffective treatment. We have identified a panel of markers in individual studies which are associated with poor survival outcome for ovarian cancer patients. In an approach similar to breast cancer which has had survival rates transformed, we now want to determine the best combination of markers to use that will give us more accurate information about the tumour type and the appropriate treatment. This individualised approach will ultimately improve survival and quality of life for women diagnosed with ovarian cancer. We are also looking at these markers for use in the early detection of ovarian cancer where screening markers are much needed.
A risk model for venous thromboembolism gynaecological cancer patients following surgery
Blood clotting in the veins or lungs is a common and serious complication of cancer. This is called venous thromboembolism (VTE) and is a leading cause of death among patients with malignancy. The risk of VTE is particularly high in women with gynaecological cancer and is aggravated by their need for major surgery and chemotherapy. Patients usually get a preventative medication called heparin after major surgery but despite this many patients will still get a VTE. Scientists and doctors have tried to find a way of identifying cancer patients most at risk of VTE by studying which factors are most important in determining the risk of VTE and scoring each patient based on these risk factors. A new technique called the CAT thrombin generation assay is a global test of blood clotting and studies have shown that it can predict VTE in different groups of patients. Our pilot data suggests that it might be a good predictor of VTE in gynaecological cancer. The aim of this study is to develop a risk score model specifically for gynaecological cancers. This model will combine risk factor scores available in the patients chart with CAT test results. By using this model we would hope to more accurately identify gynaecological cancer patients at high risk of VTE.
Determination of the role of coagulation proteases in the pathogenesis of Type 1 ovarian cancer
It is well established that blood clotting is increased in all patients with cancer in particular those with pancreatic, brain and ovarian cancer. As well as causing clots in the legs and lungs, we now know that that some of the clotting proteins also are involved in the growth and spread of tumours. Our group has recently found that several of these proteins are found in tumours particularly in Type 1 ovarian cancer tumours to a greater extent than in patients with a benign tumours. Our study has also shown that the level of these proteins in malignant tumours is related to the survival of the patients. Our research will now focus on the role these proteins play in the growth and spread of ovarian type 1 cancers and try to understand what makes these different from other types. Ultimately it is hoped that targeting these proteins may provide a new type of therapy specifically for Type 1 cancers who often respond poorly to chemotherapy.
HE4 as a biomarker for Endometrial cancer.
HE4 is a protein which comes from the tumour and circulates in the blood. There has been some research showing that HE4 might be a good biomarker for ovarian cancer, which could potentially be more sensitive than CA125. Recently our group has started to look at HE4 levels in the blood from endometrial cancer patients and early results show that it may have potential as a prognostic marker in women with the disease.
INNOVATION – the Irish National Network for Ovarian Cancer Collaboration
Our research team are founder members of a new initiative, INNOVATION the Irish National Network for Ovarian Cancer Collaboration. The mission of INNOVATION is the integration of patient clinical management with cutting edge research to improve the diagnosis and treatment of ovarian cancer. Further details here.
International Society for Thrombosis and Haemostasis Issues in Cancer
Dr. Lucy Norris and Dr. Feras Abu Saadeh presented their research at the International Society for Thrombosis in Cancer in Bergamo Italy. Dr. Abu Saadeh spoke of his research looking at the use of Low Molecular Weight Heparin in the prevention of thrombosis in Gynaecological cancer among gynae-oncologists in Europe. This research has recently been published in the journal, Thrombosis Research. Dr. Norris presented her research which showed that blood clotting genes and proteins are altered in tumours from patients with endometrial and ovarian cancer and that these proteins may be involved in how the disease occurs.
Patient information leaflet on Thrombosis risk in Gynaecological cancer patients
Many patients don’t know that gynaecological cancer is associated with a particularly high risk of thrombosis and often confuse symptoms of thrombosis with those of their cancer. Thrombosis is preventable if caught early. Our research group have produced a patient information leaflet specifically for gynaecological patients explaining the risk of thrombosis and what to look out for. The leaflet was launched at the OvaCare patient information day held in Cork. Ovacare is a patient support group for women with ovarian cancer www.ovacare.ie . A presentation on the signs and symptoms of thrombosis in ovarian cancer is available on the website. The leaflet is available from gynaecological cancer centres and from all Irish Cancer Centre Daffodil centres.