Prof Richard Scolyer Photo: supplied
Pathologist professor Richard Scolyer's melanoma research is credited with saving tens of thousands of lives, but now he's in a race to save his own.
While in Poland on a work trip in May of this year, Scolyer, who is co-director of the Sydney-based Melanoma Institute Australia, suffered a seizure.
Subsequent scans showed he had stage four IDH wild-type glioblastoma, a brain cancer that is usually fatal within six to nine months.
The disease, he told Saturday Morning, was "the worst of the worst, as far as brain cancers go".
"It's incurable and the standard treatment hasn't changed in 18 years."
Ordinarily, the treatment after being diagnosed with brain cancer would be to have surgery to excise the tumour as soon as possible, before embarking on courses of radiotherapy and chemotherapy, he said.
But the pioneering work on pre-surgery immunotherapy treatments he and his colleague professor Georgina Long had undertaken at Melanoma Institute Australia made Scolyer want to try a different approach.
"We know from our work in melanoma that if you give immunotherapy, which are drugs that activate the immune system to recognise the tumour, they work better if you give them whilst the tumour's on board, because there's more tumour there for the immune system to be activated against."
Fifteen years ago, he said, the prognosis for people with advanced stage melanoma was "dismal", with fewer than 5 percent of patients still alive five years later, but "because of discoveries that we've led at Melanoma Institute Australia ... the prognosis has changed, so more than 55 percent of people are alive five years later".
Attempting to treat brain cancer by delivering immunotherapy to a patient before their tumour was taken out had never been tried before, Scolyer said, but based on the results they had seen in their melanoma research, it seemed to him and Long like "the right thing to do".
However, it was not an easy task to convince the neuro oncology team tasked with his care to agree.
"My wife and I had to write long letters to explain that we ... understood the risks, and I guess as a world leader in the field, I know what the risks are," he said.
"We put these letters together and then the neuro oncology team gradually got on board and were happy to support this as a plan."
It helped, Scolyer said, that he and Long had worked with his neurosurgeon, Dr Brindha Shivalingam, closely for more than a decade.
"She was excited when we brought this to the table; she had seen the discoveries that we'd made in melanoma which had transformed the disease; she was excited about giving it a crack."
Following an open brain biopsy, the decision was taken to try immunotherapy treatment "up-front" and to delay the surgical resection of Scolyer's tumour by 16 days, he said.
Shivalingam was "a little bit nervous" about taking that approach, Scolyer said, "because a sub-group of tumours can take off, even within a couple of weeks and it could have gone from bad to worse, but thankfully that didn't happen".
Instead, when the tumour was excised two weeks later, "we saw incredible things", he said.
"The number of immune cells that were in the tumour went up ten-fold; the types of immune cells that were in the tumour were activated against the tumour, and we were also able to show that the immunotherapy had crossed the blood-brain barrier and was attached to lymphocytes as well as the tumour cells."
In addition to the neoadjuvant (before surgery) immunotherapy treatment, Scolyer received a personalised brain cancer vaccine based on the RNA and DNA of his tumour.
"I'm the first person in the world, as I understand it, to have a cancer vaccine with combination neoadjuvant immunotherapy," he said.
"The idea of these vaccines is that they're not like vaccines that we have against infection ... so what they are, are a way of stimulating the immune system against your cancer ... to try and help mop up or kill off cancer cells that you already have."
It was too early to tell whether the treatments would mean any improvement in his clinical outlook, Scolyer said, and he acknowledged there were risks associated with making himself a human guinea pig, but he was happy to take them.
"There's risks that it could have shortened my life more quickly ... I was told my prognosis was about nine months, and yeah, there's a risk that it could go badly and my life would end more quickly, or indeed my life expectancy wouldn't change but I'd be left with side effects which would make the remaining time I've got dismal," he said.
"From my perspective, I'm happy to take those risks; I'm happy to be the guinea pig."
Ultimately, Scolyer hoped to see clinical trials of neoadjuvant immunotherapy treatments in brain cancer patients undertaken.
"This has excited the brain cancer neuro oncology community and the bio-pharmaceutical industry, so hopefully some clinical trials will start very soon," he said.
"I'm excited and very proud, to be honest, of the data we've produced already that is changing the field, but it's early days."
