18Dr DavidChangPancreatic <strong>Cancer</strong> <strong>Research</strong> Group, Garvan <strong>Institute</strong> of Medical <strong>Research</strong>Clinician and laboratory researcher Dr David Chang is well placedto ensure that two key areas essential to the future of cancer servicedelivery – the lab and the clinic – do not remain worlds apart.David’s work is a pioneering shift away from the ‘one size fits all’approach to cancer prognosis and treatment, toward individuallytargeted therapies based on a patient’s specific underlying biology.His research recognises that cancer is a heterogenous disease– that is, different patients can have different outcomes, despitepresenting the same clinical grade and stage of a particular cancer.This direct investigation of a patient’s unique biological make-uphas led to David’s groundbreaking work with molecular biomarkersand genetic sequencing – both of which have great potential forimproving patient prognosis and more accurately predicting anindividual’s response to a particular course of therapy.“What attracted me to cancer research was the possibility thatthe underlying biology of cancer may directly influence the care ofpatients that surgical oncologists like myself face on a daily basis,”says David.Immigrating to Australia from Taiwan with his family when he was only14, David’s career began with a degree in Medicine at the Universityof Sydney. Late 2006, after surgical training, he became a fellow of theRoyal Australasian College of Surgeons (FRACS) and in 2007, wasawarded a <strong>Cancer</strong> <strong>Institute</strong> <strong>NSW</strong> Clinical Training Fellowship.In the same year, David also completed a Masters of Surgery throughthe University of Sydney, with a dissertation studying the patterns ofcare in pancreatic and upper gastrointestinal cancer in <strong>NSW</strong>. Duringthis time, he was exposed to various aspects of cancer researchthrough one of his supervisors, Professor Andrew Biankin.It was at this pivotal point in his career that David, increasinglyfascinated by the potential benefits of research for patients, decidedto embark on four years of doctoral studies in cancer research atthe Garvan <strong>Institute</strong>. Some notable achievements marked thisperiod: he established that a surgical resection margin of more than1.5 mm is important for the long-term survival of patients withpancreatic cancer – a finding that was presented at various nationaland international conferences and published in Journal of ClinicalOncology, the highest ranking clinical oncology journal.David also recently received the ASCO <strong>Cancer</strong> Foundation MeritAward at the <strong>2011</strong> GI <strong>Cancer</strong>s Symposium in San Francisco forhis oral presentation on how biomarkers could be used topredict outcome before surgery. Further recognition came whenhe was presented the Young Investigator Award for showing howbiologically related biomarkers can be used for betterprognostication and stratification of patients for chemotherapy.“As a laboratory researcher as well as a clinician I have frontlineexposure to both aspects,” explains David. “My research workaims to improve the understanding of tumour biology with theaim of subsequently translating this to better management ofpatients in the clinic.”<strong>Cancer</strong> is primarily a disease of the genome. As such, efforts bythe international scientific community to sequence the mostcommon cancers offers great potential for understanding thegenetic aberrations which characterise the disease. TheAustralian Pancreatic <strong>Cancer</strong> Genome Consortium (APGI, whichDavid is a part of) for instance, is contributing to this initiative bysequencing 400 pancreatic cancer genomes.“I envisage that with the explosion of data in this genomic era, wemay start to reclassify cancers based on their underlying genomicdifferences, rather than their tissue of origin. This will allow us tobetter match drugs that are designed to attack a particular geneticabnormality, rather than where the cancer starts, and have a muchgreater chance of being effective.”For the future, David envisages specialised cancer centres will forma closer, and better integrated interface between research and clinicalcare. In such centres, the molecular and genetic characteristics ofboth the patient and the tumour would be comprehensivelyidentified using the latest technologies such as Next GenerationSequencing. The result would be individualised therapies that adaptand evolve based on the treatment responses over time.“This will facilitate rapid implementation of discoveries and changethe very architecture of health service delivery for cancer, sincethe trial itself is part of the cancer care,” he says.
EARLY DETECTION“What attracted me to cancer research was thepossibility that the underlying biology of cancer maydirectly influence the care of patients that surgicaloncologists like myself face on a daily basis.”Dr David Chang
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