As a newly qualified surgeon in Sydney, Australia, Dr Biankin’s first experience with pancreatic cancer changed his career path. The patient was a 39-year-old woman who had presented with a small, 1cm pancreatic cancer with no spread to any other organs. The operation went well and under the microscope the prognosis was favourable, yet the cancer recurred rapidly and only 10 months from her initial diagnosis, the patient died.
‘Despite our assessments using the latest scans and world’s best pathologists, we still couldn’t predict pancreatic cancer behaviour, nor could we offer anything other than a general treatment’, said Professor Biankin.
At that point, he approached Professor Rob Sutherland, Director of the Cancer Research Program at Sydney’s Garvan Institute of Medical Research to see if he might do PhD in pancreatic cancer research there. The project was an early personalised medicine approach that questioned why patients respond differently to treatment, despite the similarity of the tumours under the microscope.
He finished his PhD at the end of 2002 and published several papers. This led to an invitation to speak at a conference at Johns Hopkins University in the USA, where he was also presented with an award for excellence in translational research and offered a postdoctoral position there.
Dr Biankin returned to Sydney in 2005 to start a pancreatic cancer program at the Garvan. With less common cancers, such as pancreatic cancer, which is also a very high-mortality cancer, it is very difficult to gather patients in sufficient numbers to run trials, especially in a country like Australia with a low population. Collaboration with other researchers around the country is essential and Dr Biankin established the New South Wales Pancreatic Cancer Network, and then the Australian Pancreatic Cancer Network.
With senior surgeon Dr Neil Merrit, he established a hepatobiliary unit at Bankstown Hospital which grew rapidly, establishing a reputation as a skilled surgical unit for complex cancer surgery, and attracting funded fellows from around Australia and internationally. In 2007, in a move that was to become a signature strategy, Andrew then began integrating this clinical practice with the research he was conducting and developing the precision oncology agenda.
The large collaborative International Cancer Genome Consortium (ICGC) was established at this time and with Professor Sean Grimmond from the Institute for Molecular Bioscience in Queensland, Professor Biankin established the pancreatic cancer arm of the ICGC – the Australian Pancreatic Cancer Genome Initiative (APGI). The APGI went on to map and upload the complete DNA read-outs for around 400 pancreatic cancers to the ICGC project, making it one of the largest sets of genome sequences for any cancer type. This work took pancreatic cancer from one of the least genetically characterised cancers to one of the best.
The capacity to sequence cancer genomes at large scale enabled Professor Biankin and his team to understand much more about the molecular diversity of pancreatic cancers and tumour evolution and much more about what was clinically and translationally relevant.
At that time, Professor Biankin’s mentor Professor Sutherland was diagnosed with pancreatic cancer. Following his surgery, Professor Biankin’s group sequenced the tumour, began a patient-derived xenograft project where the cells were used to grow the identical tumour in mice, made cell lines from it, and explored every millimetre of it to find the best treatment for him. Professor Sutherland recovered well from his surgery, but then suffered a recurrence, and while potential therapeutics had been identified, he delayed starting treatment due to work commitments and died in 2012.
From this experience, Professor Biankin focused on analytics and the importance of developing a molecular diagnostic/prognostic test that could guide treatment and accelerate the development of new treatments. This work began in the USA, but quickly encountered issues of the reliability, timeliness and cost of existing tests and scalability.
Following his move to Glasgow in 2013 to take up the Directorship of the Wolfson Wohl Cancer Research Centre at the University of Glasgow, Professor Biankin established the Glasgow Precision Oncology Laboratory (GPOL) to develop a molecular test to drive his planned precision oncology clinical trials program for pancreatic cancer – Precision-Panc. This has now become the Glasgow Cancer Test, which is currently being evaluated in the real-world setting of the NHS and will be available from November 2019 from Agilent Technologies.
Professor Biankin is a strong supporter of the concept of ‘learning healthcare systems’ that deliver the kind of large datasets that precision medicine needs to allow researchers to continually refine current treatments and develop new ones.
‘Finding the right way for precision medicine to work in healthcare systems is a bit like breaking a wartime code – the stakes are high and time is against us. Breaking the cancer code that connects the cancer genomes to the patient’s treatment is what drives me as a scientist and a doctor.’