The first thing that strikes me about Dr Nicole McCarthy is her willingness to be interviewed. Only a few hours after I email her asking if I could interview her for Upfront, she responds with a simple "happy to help".
Nicole McCarthy is a medical oncologist and the Breast Cancer Research Trust's first research "fellow". She is the result of all those t-shirts you and thousands of other New Zealand women bought in the first year of the Glassons-BCRT fundraising campaign. She is just over a year into a three-year tenure, dividing her time between Auckland University and Auckland Hospital.
Although I've done some background research and armed myself with prepared questions, our 'interview' quickly becomes a very organic beast.
Nicole did her training as a medical oncologist in Brisbane, working with all cancers, then worked in the US at the National Cancer Institute for three years, predominantly on breast cancer projects. While there she undertook a small pilot study on 20 women with inflammatory breast cancer. The study used two different chemotherapy drugs and an antibody (antiVEGF) treatment.
"Four years later," she says, "this antiVEGF treatment [bevacizumab or Avastin] has been shown to be associated with a survival benefit for women with metastatic breast cancer."
I express an interest in her work with inflammatory breast cancer and say that in the last week the topic has come up a couple of times. Concern has been expressed about delays in diagnosis and treatment. In fact, inflammatory breast cancer is on my plan for the next issue of Upfront.
"What happens with inflammatory disease is, more often than not, the typical presentation is a red, swollen, tender breast. Patients and doctors often assume that it's infection, something like mastitis and it is treated with antibiotics initially. So it's really common for there to be a delay in diagnosis," she explains.
Nicole taps away on her keyboard for a few moments and pulls up a number of windows on the screen.
"There's a paper that has just come out - Trends in Inflammatory Breast Cancer" she tells me as she hits print. She leaves her office and comes back with a copy of the paper. While I'm having a quick peruse of the abstract she is busy pulling up more papers and information. She leaves several more times, in between telling me about the symptoms, the incidence and the research into inflammatory breast cancer, including a pilot study that is part of her current research. We've barely started the interview, but already I have enough material in my lap for the lead article in the next Upfront. And she has agreed to at least edit the article and possibly write a piece on drug treatments for inflammatory breast cancer to go with it.
Back in Brisbane after her stint in the US, Nicole worked as a staff medical oncologist at the Royal Brisbane Hospital and ran the clinical trials unit undertaking a broad range of trials looking at new treatments for early stage breast cancer, metastatic disease and hormone sensitive cancers in pre and post-menopausal women.
When I ask why she wanted to work with breast cancer she explains that it is a "huge disease"; it affects the very young, the very old, there is hormone responsive disease, non-hormone responsive disease, and there are so many different treatment options.
"As a scientific community we are becoming more clever, trying to individualise treatments." She is clearly enthusiastic about the direction in which breast cancer treatment is heading, and has herself been working with innovative treatments.
"While I was doing my oncology training there was a lot of interest in high dose myelo-ablative chemotherapy and autologous [self-sourced] bone marrow transplants - this was very powerful treatment associated with major side effects. We were all very excited about this as we thought being able to give more chemo would result in better survival. Clinical trials eventually showed that this was not the case and the treatment was just very toxic."
Since then Nicole has become more interested in "targeted" therapies - drugs like Avastin and Herceptin - which represent a move away from the traditional "sledgehammer" approach towards something more delicate.
"The plan is to gain a better understanding of the biology of breast cancer and how different cancers respond to different treatments so that we can tailor specific treatments for an individual's specific cancer subtype. One would hope that eventually we will be able to do specific tests on tumours that will be able to tell us whether your tumour is likely to respond to this chemotherapy combination or that chemotherapy combination, or just hormone treatment alone and which type."
This sort of work requires access to breast tumour tissue so that tumour characteristics can be determined, and is where some of Nicole's current research fits in. One of her New Zealand projects is a "bench to bedside" link between the university and the hospital which involves collecting tumour tissue in a pilot study of 40 women with breast cancer. This is typical of her work here - developing studies that link the scientific expertise at the university with the breast cancer clinic at the hospital, linking the scientists with the surgeons: helping take the science done in the laboratory and translating it into something clinically relevant.
The other pilot study involves blood tests on 50 cancer patients (not necessarily breast cancer) and looks at the way in which just having cancer can affect the metabolism of chemotherapy drugs, in particular cyclophosphamide (commonly used in breast cancer).
"We are interested in one specific liver enzyme and believe that its activity may be reduced by having cancer," she explains.
This is important because if this enzyme is not working properly drugs may not be broken down appropriately and this may result in either reduced or excessive effects of drugs. Understanding how cancer impacts upon this enzyme may be important for developing better ways of dosing chemotherapy and reducing side-effects.
One of two clinical trials involves comparing two different drug regimens, back to back, in 147 women in New Zealand and Australia who have locally advanced breast cancer. The first regimen uses standard chemotherapy, and the second a new combination of drugs currently not available in New Zealand for women with early stage breast cancer. The trial will include Herceptin for women with HER2 positive tumours, which is a big deal for women here who can only get Herceptin for advanced breast cancer.
The last of the four studies with which Nicole is involved takes us back to inflammatory breast cancer. A Phase II clinical trial will evaluate the efficacy and safety of a new drug in women with newly diagnosed inflammatory breast cancer. The study aims to see whether or not Lapatinib (a new drug showing promising results in advanced breast cancer, used alone for two weeks, and then together with standard treatment using Paclitaxel, for 12 weeks before surgery) will cause tumour cells to shrink or disappear. The study will involve up to 60 women worldwide and Auckland Hospital is one of 25 locations participating in the study.
Nicole is clearly excited to be part of the advances in breast cancer treatment and is committed to improved outcomes for women. As part of this commitment to a better future for women with breast cancer she has been heavily involved with the formation of the Breast Cancer Advocacy Coalition and represents BCRT on the BCAC Steering Committee. She has also been outspoken about drug funding and has readily accepted requests to talk to people and publicise these issues and her research.
Nicole wondered at one point in our interview whether or not we have room for a regular "column" on clinical trials in Upfront. A column that will let women know, not only what clinical trials are going on, but what impact their results will have on breast cancer treatment for women in the future. I plan to stay in touch with her and I'm sure that we haven't heard the last of Dr Nicole McCarthy.
Copyright © 2005 Sue Claridge