Melanoma: Finding a cure

Cricket tragic Adnan Khattak remembers selling raffle tickets for Khan’s cancer appeal — then out of little more than a sense of duty to his childhood hero. But as Adnan concedes now, it “planted the seed”.

That seed has flourished, and Adnan has gone on to become an accomplished oncologist and celebrated researcher who is changing and saving lives with his relentless, almost obsessive passion for uncovering new treatments through groundbreaking clinical trials.

Clinical trials mean he can stay ahead of the game and offer cutting edge therapies to patients who may not have the precious time to wait for the often lengthy regulatory approval process. Trials, he says, can offer almost instant gratification to those who crave it. “It can make an immediate difference in their wellbeing.”

Raised in Abbottabad (Pakistan), the so-called city of schools (it’s also, he says with a laugh, where Osama bin Laden was found) young Adnan had two choices: “you are either a doctor or an engineer.” His three brothers clearly shared a similar disdain for engineering: they, too, are doctors.

Adnan says Australia was always “a dream place to visit” and he arrived here in 2006 after interning in London. He would later return — this time for a game-changing two-year stint at the Royal Marsden Hospital, a centre of excellence for cancer care in the UK.

It was there that the oncology registrar was schooled in the immense value of clinical trials and the “bench to bedside” approach of bringing emerging science directly to patients.

“I really got a better understanding, where a patient who came to see us, we would offer them the clinical trial first before the standard of care,” he says.

Adnan, who was integral in the internationally recognised Keynote 054 melanoma trial, is at the vanguard of oncology research. He says the speciality provides unique opportunities for research and innovation.

“Other specialities like cardiology, respiratory and gastroenterology, I think they have travelled the maximum amount of their mileage already whereas oncology, there’s a lot to do still,” he says.

“In cardiology, for example, the way we used to treat heart attack has changed over the last few years but the pace hasn’t been as quick and practice hasn’t been revised as much, whereas I have to revise my clinical practice pretty much every six to twelve months for managing melanoma for example, because there is so much research and there are so many clinical trials happening to try to stay up to speed with clinical data.”

The change is exciting and rapid, and the father of two, who also happens to be married to fellow breast cancer oncologist Hilary, says this highly connected world means patients and their families research treatment, and demand the best and newest.

“They will come and ask you what about that clinical trial in that hospital or ‘What do you think of that treatment, why can’t I get it?’ Patients are quite educated and to provide them the best evidence-based care, you really need to be on top of your game.”

Still, Adnan admits some patients initially balk at being involved in a clinical trial, concerned they’re being used as “a guinea pig.” “But I think once you tell them what the clinical trials are about they have a better understanding.”

And this is what he tells them:

“Clinical trials are something I am quite passionate about mainly because … we offer that opportunity of that novel therapy to our patient much earlier than what they would be offered by the time that drug gets approved. They might not be alive to see that opportunity because they need something done right now.”

Another compelling pitch is that these therapies, which can cost a staggering $10,000 per dose, are free. And because of the strict protocols around trials, the level of attention and care is so high that even those who might receive a randomised placebo will still have better outcomes.

In a psychologically fraught field, Adnan says clinical trials provide many a bright moment.

“It can be quite emotionally challenging … but at the same time it can be quite emotionally rewarding as well if you make a difference in the lives of those people,” he says, smiling warmly.

“When you see a young patient with young children, to rescue them from their terminal cancer … or at least to buy them extra time to reach some short-term milestone that they wanted to achieve, is really good as well.”

Simply, he says, clinical trials provide hope.

“How I treat melanoma now compared with how I used to treat it in 2016, just three years ago, is completely different, and it’s likely to change again in the next few years.The long term outcomes, for example, for melanoma what we used to quote to our patients not that long ago was that there was only a 25 per cent chance that they’ll be alive at the one year time point from the diagnosis of metastatic disease. Now I’m quoting the statistics of about 40-45 per cent five-year survival and I do have some patients under my care who stopped their melanoma treatment about two to three years back and … they’re still alive, so they’ve gone potentially into remission.

“So it’s encouraging for us and encouraging for the patient that things are changing. And all this data has obviously come through clinical research.”

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