It’s not hard to spot Mum Melissa Eastgate at the beach. Melissa’s children are the kids in full length rashies, protected from the sun with their faces covered in zinc.
As one of Queensland’s leading researchers in Melanoma, the deadliest of skin cancers, Associate Professor Melissa Eastgate is fully aware prevention is still the best insurance in Australia’s skin cancer capital.
When Associate Professor Eastgate began at Royal Brisbane and Women's Hospital (RBWH) as an intern in 1996, Melanoma was not a popular area of research.
Survival rates were low, most patients died within a year, and treatments had stalled.
Refusing to be deterred, Dr Eastgate has spent her 15-year career slowly improving patient life expectancy and quality-of-life.
“Fifteen years ago, advanced melanoma was a death sentence. Now, fifty percent of patients are still alive at five years. We still have a group that don’t survive for long and for me, research is about those patients.”
Associate Professor Melissa Eastgate
Operations Director of RBWH Cancer Care Services
Associate Professor Eastgate is now the Operations Director of RBWH Cancer Care Services and the hospital has established itself as one of the leading Melanoma research centres in the country. Skin cancer is also proving one of the most popular specialities for prospective oncology trainees.
Q: Is Melanoma a skin cancer?
Associate Professor Eastgate: Melanoma is a skin cancer for the vast majority of people. There are some rare subtypes, occasional melanomas that start in the back of the eye, for example, or on parts of your skin that don't normally see the sunlight - the palm of your hands or inside of your mouth - but they're pretty uncommon. I would say 95-99% of melanoma is found on exposed skin and the biggest risk factor is sun exposure.
Q: Is family history a risk factor?
Associate Professor Eastgate: It's rare, there are occasional families, but it's not a big factor.
Q: So if you were talking to a group of schoolchildren, what message would you leave them with?
Associate Professor Eastgate: Stay out of the sun! There is some evidence suggesting sun exposure as a child predisposes you towards melanoma later in life. My kids have full length rashies and wear zinc (sunscreen) to the beach - everyone looks at them and thinks they're funny!
Q: What fascinated you about Oncology as a junior doctor?
Associate Professor Eastgate: Oncology is a great mixture because it's a specialty where you get to know your patients and follow them over time. I really like building a relationship with someone and following them through the journey. But it's also an area where there's lots of exciting science happening all the time. Our treatments are constantly moving and changing, we're always looking for new treatments and doing research.
Cancer care for regional and remote patients
Dr Eastgate has been instrumental in the improved delivery of oncology services for regional patients. She has provided outreach services to Bundaberg for the past nine years and is currently leading the Tele-chemotherapy Service for patients in Longreach and Barcaldine.
Tele-chemotherapy service allows regional nurses to administer cancer-fighting drugs while being guided and advised over a video link by medical oncologists and expert chemotherapy nurses at RBWH.
Dr Eastgate is also involved in teaching Registrars and is the chair of the Medical Oncology Group of Australia.
Despite Queensland being the Skin Cancer Capital of Australia, melanoma was not a popular area of research when Dr Eastgate chose her speciality.
Associate Professor Eastgate: The average survival for metastatic melanoma, at that time, was about nine months. It was very difficult, and we were often looking after patients who were going to die from their disease, without making a big impact.
The treatments did not prolong survival, they were aimed at improving quality of life. If you've only got nine to 12 months left, you want to have the best quality of life during that time.
Now we can offer more treatment options and patients survive much longer, which is great. But obviously there are still some patients who don't survive, and for me, the research is about those patients.
Q: Over the past 15 years, what have been the international breakthroughs?
Associate Professor Eastgate: There have been two big breakthroughs. The first was the development of immunotherapy drugs which essentially boost a patient's own immune systems to attack the melanoma.
The second breakthrough was targeted therapies. We know that about 40% of melanomas have a particular mutation called the (BRAF) mutation and drugs that target that mutation were developed and have made a big contribution.
A BRAF mutation is a change in a gene that allows a melanoma to grow more aggressively. Approximately half of melanomas carry this mutation and are referred to as mutated, or BRAF positive.
Q: Was lack of funding for research an obstacle when you first started?
Associate Professor Eastgate: There's two parts to research. The first is you need funding. The second is you need to have all those patients in one place to be able to do the research with them.
Fifteen years ago, RBWH didn’t have a melanoma team. I was seeing some patients, and some surgeons were seeing some patients, but we didn't collaborate. You need to build those collaborations so you can conduct clinical trials and other research.
Funding from RBWH Foundation helped us establish a Multidisciplinary Team (MDT). Our MDT has two medical oncologists (including Dr Eastgate) and a radiation oncologist, as well as plastic surgery, general surgery and neurosurgery.
The MDT means that we can identify patients early in their journey and discuss which treatments are going to work best for each different patient.
Another critical step was funding of an RBWH Foundation Melanoma Fellowship.
Associate Professor Eastgate: Fellowships are a crucial way to build up research knowledge and research expertise. Clinicians who are doctors, seeing patients all day every day, have little spare time to build the expertise needed to conduct clinical research. To have some paid, protected time, for one or two years, really helps a doctor build knowledge so when they become practicing oncologists, they continue to research throughout their career.
The latest RBWH discovery, in collaboration with QIMR Berghofer, has identified high levels of a protein found in melanoma cells which could explain why some patients do not response well to treatment.
Associate Professor Eastgate: We are looking for proteins in melanoma tumors that can help predict whether immunotherapy is going to work for those particular patients. This work will also help us develop new targets for new treatments. That work hasn't reached the next milestone yet but it’s certainly ongoing.
The RBWH Foundation Fellowship is also allowing the Melanoma MDT to evaluate patient outcomes over the past eight years.
Associate Professor Eastgate: Eight years ago, patients who had surgery to remove tumors from their brains, still had a very high risk of dying. What the evaluation has shown is that new treatments have really helped those patients as well. The reason that's important is because up until recently, patients who have melanoma of the brain were excluded from clinical trials.
If they are excluded, we don't know what happened to them, as it's not published. By assessing the data, we can see that eight years ago, even with surgery, they often did badly. Whereas now, with new treatments, they’re actually doing much better, which is really important.
Q: Why do you think it’s so important to donate to melanoma research?
Associate Professor Eastgate: Research costs money. RBWH gets funded for the care of the patients but research needs funding from external sources.
We've already shown we can make big improvements in this space but while some of our patients are doing well, we’ve still got a whole group of patients who die of melanoma. Research is crucial to ensure those patients become survivors as well.
The more funding there is, the sooner these advances will happen.
If you would like to support the work of RBWH clinician researchers, such as Associate Professor Eastgate, please donate today here.