Paediatric brain tumours in South Africa – Prof Anthony Figaji
Prof Anthony Figaji
Title of the project
Paediatric brain tumours in South Africa.
Brain tumours are the second commonest cancer in children, but little is known about them. Even though in children they account for about as much as all the other solid tumours in the body combined, the general public and clinicians tend to know much less about brain cancer in children than leukaemia.
Despite some progress being made over the last 2 decades, overall patient outcomes remain poor when compared with other childhood cancers. Even in the so-called developed world, brain tumours accounts for most of the cancer-related deaths in children.
There remains much uncertainty about the nature of various brain tumours and their prognosis. In particular, virtually nothing is known about children with brain tumours in a South African setting and no current research projects address this. Fortunately, there is a growing awareness of the lack of research in non-communicable diseases in South Africa, which is timely because there has been exciting progress in tumour biology research elsewhere, especially in the last 5 years, that promises to open new avenues to better classify and treat various brain tumours. These are revealing important genetic origins of these cancers and may lead to targeted treatment for individual subgroups of brain tumours. These subclassifications likely will be a requirement in the future for international clinical trials.
In South Africa we have not yet engaged in any brain cancer biology research and so we need to urgently build a foundation, not only to be able to conduct our own molecular biology research, but also to be able to participate in international trials. Through this project, we expect to generate substantial epidemiological and clinical information which will be novel for South Africa.
We will examine geographic differences in brain tumours between children from Africa compared with North American and European data. We expect this project to establish a foundation for paediatric brain tumour research in South Africa and generate further interest in the field.
Importantly, we will establish a foundation for molecular biology in brain cancer research and we will develop a biobank of cancer specimens which has become almost routine at leading centres in the world but not in South Africa. The novel development of capacity for tumour molecular biology will establish important bench-to-bedside research in a neglected area of cancer in South Africa.
We have formally completed our study of brain cancer profiling in children. We took two common brain tumours in children – one benign and one malignant – and profiled these according to international standards to reveal molecularly distinct subgroups. These methods have become standard for correct identification of clinically important subgroups but has never been performed on an African cohort. These are the first results in Africa for this important landscape-shifting new approach. In the future this will be standard of care all over the world, including Africa.
Over the last 3 years we have established first prospective biobank dedicated for brain cancer. We have now prospectively collected 3 years of childhood brain cancers. This is the foundation for all future work, which increasingly requires advanced laboratory molecular studies to be combined with not only clinical trials, but also clinical decisions in individual patients. We have led the way in this for Africa.
In addition we have gone beyond the conventional profiling, the aim of which was to match the standard in leading centres, we used this as a platform to conduct a prospective hypothesis-generating study by looking at the largely unexplored proteomics basis of these cancers (the protein expression in the cancers). This has generated new ideas about pathways of cancer development and progression that can be used to better understand how and why these cancers develop and also explore novel treatments to intervene based on these pathways.
This comprised much of the work of our PhD student, Omesan Nair. His thesis was submitted and is currently undergoing review by international leaders in the field.
We have also been part of a growing international consortium of key researchers across the world focused on developing guidelines for clinical care of children with different types of brain cancer. Our recent manuscript has just been accepted for publication by a leading journal in the field. The three senior researchers in this project are all authors on this paper.
We are also developing national protocols for the different brain cancers that occur in children. We have been using our annual national Paediatric Brain Tumour Workshop that is hosted by us to canvas opinion, discuss, and disseminate this information nationally. In 2016 November we hosted a successful workshop with one of the world leaders in the field from the University of Toronto.
Radiotherapy, Paediatric oncology and Paediatric Pathology, collaborating with Prof Jeanette Parkes, Prof Alan Davidson, and Prof Komala Pillay.