2025 Clinical Fellowship Projects

What is the Clinical Fellowship Program

Developing new research ideas and supporting the next generation of researchers is at the heart of the Clinical Fellowship Program.

The Program is aimed at early career researchers, who have a high-level interest in clinical research, appropriate qualifications, and are working in the disciplines of medical oncology, pathology, psychology and other supportive care specialties, radiation oncology, radiology or surgery.

Fellows work on projects that are directly relevant to Breast Cancer Trials (BCT) that potentially involve:

• Research that will inform future trials including background and pilot work;
• Work on existing or future planned BCT clinical trials;
• Further analysis of data from existing trials; and
• Other projects that are related to the BCT Research Strategy.

In the fourth year of the program, five new Fellowships have been awarded and two Fellowships from previous years are continuing:

Dr Victoria Rayson (Medical Oncologist) – Electronic Patient-Reported Outcomes (ePRO) Remote Monitoring for Patients with Metastatic Breast Cancer

ePRO remote monitoring is a validated and practical solution for managing stable patients with metastatic breast cancer on systemic therapies like CDK4/6 inhibitors and anti-HER2 treatments. These drugs require regular safety monitoring, but many patients remain stable for long periods, leading to unnecessary clinical visits that burden both patients and the healthcare system.

This project aims to evaluate the feasibility, acceptability, and cost-effectiveness of using ePRO for stable metastatic breast cancer patients in Australia. By implementing ePRO remote monitoring, patient outcomes can be improved while reducing adverse events, hospitalisations, and healthcare resource strain. International guidelines endorse this approach, which has been shown to maintain clinical effectiveness and patient satisfaction.

Dr Michelle Li (Medical Oncologist) – Identifying Mechanisms and Biomarkers of Resistance to ADCs in the Treatment of Metastatic Breast Cancer

Antibody-drug conjugates (ADCs) are a new type of treatment for advanced breast cancer. They work by using special antibodies to deliver chemotherapy directly to the cancer cells. One example, called trastuzumab deruxtecan (T-DXd), has been very helpful for certain types of breast cancer, like HER2-low and HER2-positive.

Other ADCs, like datopotamab deruxtecan (Dato-DXd) and sacituzumab govitecan (SG), are also working well for other types of breast cancer, like HR+/HER2- and triple-negative breast cancer.

Even though ADCs have benefits, they also have some challenges. Sometimes, cancer cells can change in ways that make the treatment less effective. The treatment can also cause side effects that make it difficult for some patients to adhere to their treatment plan or reduce their quality of life.

Ongoing research at Peter MacCallum Cancer Centre is exploring potential biomarkers for ADC-related side effects, particularly the role of Growth and Differentiation Factor 15 (GDF15) in T-DXd-induced nausea and weight loss. If successful, this research could lead to changes in targeted therapies that reduce chemotherapy side effects, enhancing patient quality of life.

Dr Sim Yee (Cindy) Tan (Dietician) – Determining Barriers and Enablers for Participation in Healthy Diet Interventions

Lifestyle interventions such as diet and exercise have been shown to have positive impacts on clinical outcomes (e.g. tolerance to chemotherapy, fatigue, weight maintenance), and reduce the risk of cancer recurrence.

There is no one intervention that fits all. Maintaining healthy lifestyle activities such as following a healthy diet and being physically active can be challenging for some and reasons for non-adherence vary. Therefore, it is important to understand the barriers and enablers for breast cancer survivors to join a lifestyle intervention.

This is a mixed-method study consisting of an open questionnaire survey and a semi structured interview. Adult survivors of early-stage breast cancer who have completed chemotherapy will be invited to complete an online anonymous questionnaire to explore their interest in healthy diet interventions, preferred method of intervention delivery (online versus face-to-face), and the timing of this intervention (during or after chemotherapy). Following the online anaonymous questionnaire, participants will be invited to an optional semistructured interview that aims to explore in more depth responses from participants regarding enablers and barriers to joining such an intervention.

Ms Kathleene Dower (Radiation Therapist) – Coaching and Education for Deep Inspiration Breath Hold

Deep Inspiration Breath Hold (DIBH) is a breathing technique used during radiation therapy for breast cancer. It helps move the heart away from radiation, protecting it from damage.

DIBH requires patients to actively hold their breath, which can be difficult, especially for those experiencing anxiety. Studies show that better education and coaching can improve patient confidence and ability to complete DIBH. However, in rural areas, access to coaching is often limited.

This study will test whether virtual reality (VR) coaching and education can help patients learn DIBH more effectively. The VR experience will show patients what to expect during treatment, provide breath-holding practice, and be available both at the clinic and at home. The study will measure:

1. Feasibility – Can patients comfortably hold their breath for at least 20 seconds after VR training?
2. Acceptability – Do patients find the VR training helpful in learning DIBH and understanding their treatment?

The project will also explore adapting VR education for Arabic, Chinese, and Vietnamese-speaking patients. The findings will help design a larger study to further test the benefits of VR coaching for breast cancer patients receiving radiation therapy.

Dr Gabrielle Metz (Radiation Oncologist) – Optimising Radiotherapy in the Neoadjuvant Therapy Era (ORNATE)

This study aims to improve how radiotherapy is used for breast cancer patients who receive chemotherapy before surgery (neoadjuvant therapy).

The ORNATE study aims to create a multi-centre database to track breast cancer patients who receive neoadjuvant therapy and surgery. By analysing this data, researchers will assess whether radiation doses can be safely reduced for patients who respond well to chemotherapy.

The study will collect information on treatment outcomes, including side effects, cancer recurrence, and survival rates. Additionally, it will review axillary lymph node treatment to determine if less invasive options, such as targeted axillary dissection, can be as effective as full node removal or radiation Information regarding patient experiences and decision-making will be measured with the support of psycho-oncology experts to ensure treatment approaches align with patient needs and preferences.

Dr Tivya Kulasegaran (Medical Oncologist) – Improving the Early Detection of Invasive Lobular Carcinoma

Invasive lobular carcinoma (ILC) is the second most common sub-type of invasive breast carcinoma, accounting for up to 15% of all breast cancer cases, and yet is largely underrepresented in clinical studies. Patients with ILC initially respond well to endocrine therapy, with high 5-year survival rates. However, the long-term survival rates are similar or worse than those of patients diagnosed with Invasive Breast Carcinoma of No Special Type.

This tumour type can be highly invasive, underpinning many of the clinical challenges related to managing patients with this disease. The risk of patients being diagnosed with metastatic disease is constant over a long follow up period (>20 years) and yet there are no mechanisms in place to support ILC patients for the early detection of disseminated disease.

Circulating tumour DNA (ctDNA) is an emerging non-invasive biomarker that has been utilised for molecular profiling and disease monitoring across a range of malignancies, including breast cancer. Its clinical potential as a personalised biomarker is broad and can include tracking tumour evolution, treatment resistance, responses and, most importantly, a potential indicator for early relapse.

This current application aims to develop a diagnostic assay using ctDNA that could be used for long-term monitoring of ILC patients for the early detection of tumour recurrence to improve patient outcomes.

Click here for more information or to listen to our podcast with Dr Tivya Kulasegaran.

Ms Jenna Dean (Radiation Therapist) – Personalising Patient Positions During Radiation Treatment

Early breast cancer is the most common presentation of breast cancer in Australia. The majority of patients with early breast cancer receive breast conservation surgery and radiotherapy. Another Australian study demonstrated that the perceived burden of radiotherapy (access, cost, travel, time away from home or off work – typically 4-6 weeks) may influence the patient’s decision to access this treatment.

Accelerated partial breast irradiation (APBI) is a promising treatment option for some of these patients, minimising radiation exposure to normal tissue and reducing toxicity, without compromising cancer control. In addition, it is more convenient for patients (5 treatments vs conventional 15-25), and it allows for scarce radiation resources to be utilised more efficiently.

The aim of this study is to investigate the benefits and limitations of supine and prone treatment positions for APBI planned for the MR Linac. This will involve a comparison of the location of the tumour bed and its proximity to organs at risk (OAR) in each position, an assessment of the difference in geometric image distortion close to the target, and measurement of the magnitude of patient and breathing motion.

Click here for more information or to listen to our podcast with Jenna Dean.