- 3 years ago
19 May 2023
Professor David Thomas has dedicated the past 40 years of his life to helping cancer patients and as the project that he believes offers the best hope for Australians with incurable cancers finally gets off the ground, he reveals how his own cancer diagnosis has not deterred him but rather reinforced his belief he is on the right track.
At the Our Moment in Time event in Sydney on Monday, Professor Thomas, undoubtedly one of Australia’s most pre-eminent and highly respected oncologists, bravely revealed he is also a cancer patient after being diagnosed in the past 12 months.
The revelation came as the PrOSPeCT project – the brainchild of Professor Tomas – finally kicks off, arguably reflecting Thomas’ life’s work in bringing lifesaving therapies to cancer patients.
Professor Thomas told MedNews that his personal cancer journey had only served to reinforce his belief in the benefit of clinical trials.
“I’m wholly committed to trying to reach my mission, which is to see Australians not go to their graves without having had a chance to take part in research-led studies that will improve their future,” he said.
“I guess all of my clinical life I’ve tried to think about my research and how it would help patients in front of me, or how it might be informed by the challenges of patients in front of me.
“As a sarcoma specialist, there were never any trials for this patient population and as a consequence, I tried to think of ways of designing research studies that would provide access for patients with rare cancers, which is a very significant fraction of the population. There’s no reason why that logic shouldn’t apply to all cancers, which effectively is what we’ve done.
“The irony is I’ve then gone and developed a cancer, and I don’t find a flaw in the logic from the other side of the table.”
Professor Thomas went public with his diagnosis as the first 100 patients were enrolled in the PrOSPeCT project, a public-private partnership that will see 23,000 Australians with incurable cancers enrolled in targeted clinical trials by mid-2025.
Funded with $61.2 million from the Federal Government through its Modern Manufacturing Initiative and $20 million from Roche, PrOSPeCT will gift thousands of patients their best shot at survival through access to world-leading therapies.
The road to PrOSPeCT
Thomas initially studied Arts, transferring into medicine after his first year and noting he got through the course “by hook or by crook”.
An internship in oncology, a PhD on the molecular biology of cancer, and a post-doctorate in osteosarcoma at Harvard University followed, Thomas returning to Australia in 2000 and commencing his practice as a sarcoma specialist.
Soon realising there was little being done to understand genetic factors that contributed to sarcomas, Thomas pulled together an international cohort to map inherited mutations that increased the risk of sarcomas developing.
The advent of rational drug development with therapies targeting specific biomarkers turned the attention of the cohort to the use of genomic molecular profiling to identify patients most likely to benefit from targeted therapies and direct them into trials.
Seeing the response rate for cancer patients increase sixfold when given access to the correct therapy, Professor Thomas became even more determined on getting more Australians onto trials, noting 92 per cent currently miss out on what is their best chance at survival.
Making Australia a trials destination
Drug development is extraordinarily expensive at around $1 billion, making approved drugs also expensive as companies look to recoup their costs. Professor Thomas believes if more people are directed into trials, not only do they get access to high-cost drugs for a much lower price, it improves their outcomes while lowering the cost for companies and society.
“If science works, if we can show that you can offer hope to patients, even in Phase 1 studies with this new era of rationally designed drug development, then why aren’t we making this stuff more rapidly available?” he asked.
“Why in Australia do we only have approvals for only three out of the 11 drug targets which are almost certainly extending survival in patients with lung cancer today? That’s because there’s got to be value for money.
“In essence, it’s not a problem of the science, it’s not understanding cancer biology, it’s not even drug development. The issue is the whole model is essentially unsustainable, and that’s a social issue, not a scientific issue.”
Professor Thomas says Australia is a very small market globally, but the trials conducted here are excepted by the world’s top regulators, meaning the country can benefit from being a place where trials are conducted as larger markets such as the US and Europe foot more of the bill for the approved products.
“Any country which has the nous to become the incubator for rational drug development so that its patients essentially get onto trials, to make itself a more efficient place to run those trials, is almost certainly going to pay less for the total health benefit to the community because they are not paying the final price,” he says.
“What we are doing is playing the system and trying to tackle this problem from the perspective of the cancer patient by using the tools of both the public sector and industry and saying, if we all pitch together, can we do this more efficiently? Can we treat more patients?”
While Professor Thomas’ cancer is not expected to impact his research in the near future, the pragmatic scientist in him notes his personal circumstances have not changed his enduring belief that every cancer patient who becomes incurable should have access to both tumour profiling and targeted drugs either through clinical trials or other mechanisms.
“Research is still going to be very important to me in the future and the opportunities research is providing,” he says. “I believe that science offers the best chance of coming up with drugs that will ultimately make a difference, and the fact that I’m on the other side of the equation hasn’t given me a terrifying insight that I was wrong all along.
“If anything, it’s a comfort to me that it hasn’t had any effect on my commitment to the concept of science-led clinical care, and it hasn’t changed my belief in its efficacy.”
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