The aim of the Zero Childhood Cancer Program is to one day enrol all children with cancer at the point of diagnosis, regardless of risk type and cancer type. This would set off a tightly-choreographed chain of events involving experts around the country and culminating in a personalised treatment plan for that child’s best chance of survival. This is our hope for Zero Childhood Cancer, and with the announcement of a new partnership with AGRF (the Australian Genome Research Facility), we are one step closer to making it a reality.
Currently only available for children with the most high-risk cancer (<30% chance of survival), ZERO will be progressively expanded to include those with lower risk cancers as well. By the end of 2023, we hope that every child and young adult with cancer in Australia will have access to personalized medicine through ZERO. Key to the Program’s ability to cater to this increased number and range of patients will be the ability to analyse their cancers quickly and reliably, and this is where the AGRF partnership comes in.
Before a treatment recommendation can be made for a child, a sample of their cancer must be studied at a molecular level. The AGRF partnership will be key to this analysis, providing extensive ‘multi-omics sequencing data’ – detailed information about the genetics of a child’s cancer. Researchers use this information to identify the causes and drivers of the cancer. For example, they may be able to identify an alteration in the DNA of a tumour (a variant) that is causing it to grow and spread aggressively.
The main components of the ‘multi-omics sequencing’ to be done by AGRF are whole genome sequencing (WGS) and RNA sequencing (RNA Seq). To carry out WGS, a sample of the patient’s cancer cells is processed to extract the DNA contained. Then, using specialised equipment, the DNA is sequenced, meaning that the precise order of its millions of component bases are determined. This data is then sent to Children’s Cancer Institute, where our Computational Biology team analyse it to look for potential clinically-significant variants. RNA sequencing follows a similar process, mapping out the precise order of bases making up the RNA. This data is analysed by our Bioinformatics team, who look for aberrations that could have clinical significance.
In cases where a brain tumour or sarcoma has been diagnosed, an additional process known as DNA methylation profiling allows scientists to look for other significant alterations in the cancer’s DNA. This can help provide a more accurate diagnosis of the cancer subtype, as well as information about prognosis and likely treatment response.
AGRF will be completing their multi-omics sequencing work quickly − initially within a two-week timeframe, to be reduced to one-week over time − so that ZERO’s curation team has time to interpret the data and generate a report for the Multidisciplinary Tumour Board, who is ultimately responsible for making treatment recommendations.
This is true ‘data-driven medicine’ and holds the key to ZERO’s promising start as a personalised medicine program.