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Australian New Zealand Breast Cancer Trials Group® Breast Cancer Institute of Australia® Annual Report 1 April 2008 - 31 March 2009 Celebrating 30 years ANZ Breast Cancer Trials Group Limited Registered Address: Level 2 NBN Telethon Mater Institute 82 Platt Street WARATAH NSW 2298 AUSTRALIA Telephone: Business Administration Department: (+61) 2 4925 5255 Trials Coordination Department: (+61) 2 4985 0136 Web: www.anzbctg.org ACN 051 369 496 ABN 64 051 369 496 ATO N0939 Breast Cancer Institute of Australia Fundraising and Education Division of the ANZ Breast Cancer Trials Group Ltd Telephone: (+61) 2 4925 3022 Web: www.bcia.org.au ©2009 This report cannot be reproduced without the permission of the ANZ Breast Cancer Trials Group Ltd. All rights reserved. Contents Chairman’s Report 3 Chief Operating Officer’s Report 5 Research Report 7 Research Achievements and Highlights 11 Clinical Trials Open for Patient Entry 19 Prevention Trials 19 Pre-operative Systemic Therapy Trials 22 Surgical Trials 24 Systemic Therapy Trials 25 Consumer Advisory Panel Report 35 Fundraising and Education Report 37 Fundraising Achievements and Highlights 39 Education Achievements and Highlights 53 Governance and Footprint 55 Contributors, Members and Supporters 63 Financial Report 79 Publications 85 Glossary of Terms 91 ANZ BCTG Annual Report 2008-2009 1 The Australian New Zealand Breast Cancer Trials Group (ANZ BCTG) has for 30 years conducted Australia’s only independent, national breast cancer clinical trials research program for the treatment, prevention and cure of breast cancer. The research program involves multicentre national and international clinical trials and brings together over 500 researchers in 80 institutions throughout Australia and New Zealand. Working together, resources are pooled so that answers to important research questions can be made sooner, and with greater scientific integrity for the benefit of women. The ANZ BCTG has made, and continues to make, significant contributions to the control of breast cancer and these are highlighted throughout this report. Our Mission: To eradicate all suffering from breast cancer through the highest quality clinical trials research. Our Vision: To be a global and regional leader in research collaboration committed to a world without breast cancer. Our Values: Excellent, relevant, transparent, reputable, inclusive, innovative. Researchers and members of the ANZ BCTG commemorate the 30th anniversary of the Group at the 2008 Annual Scientific Meeting. 2 ANZ BCTG Annual Report 2008-2009 Chairman’s Report The Australian New Zealand Breast Cancer Trials Group (ANZ BCTG) has conducted national and international clinical trials in breast cancer since 1978. The Group is the leading breast cancer research organisation in our region and our clinical trials program continues to make a major contribution to breast cancer research globally. As Chair of the ANZ BCTG’s Board of Directors I am pleased to be able to report excellent results for the year from both a scientific and operational perspective. Highlights have been: ■■ celebrating our 30 year anniversary at our Annual Scientific Meeting in Wellington, New Zealand; ■■ implementation of new trials designed to answer clinically important questions that provide better outcomes for women; ■■ peer-reviewed publication and dissemination of our research results that change clinical practice; ■■ continued excellent financial performance; and ■■ completion of a five year strategic plan, together with a supporting business plan. Our membership, which is multidisciplinary and representative of all Australian states and territories and New Zealand, has grown with 47 new members this year. In addition, our central office in Newcastle NSW continues to offer employment opportunities for graduates and newly qualified oncologists interested in pursuing a career in clinical research. Strategic Planning The ANZ BCTG’s five year Strategic Planning Framework (2009-2014) has been completed and approved by the Board of Directors. The framework provides a clear articulation of the Group’s goals over the next five years and the decisions, relationships, and tasks required to successfully achieve these goals. As a part of this process the ANZ BCTG’s Mission, Vision and Values statements have been reviewed. These statements reflect the essence of the Group and the principles which support the organisation. Our mission “to eradicate all suffering from breast cancer through the highest quality clinical trials research” and our vision “to be a global and regional leader in research collaboration committed to a world without breast cancer” are very powerful, active words; words which truly describe the ANZ BCTG’s current purpose and future directions. Governance The Group’s Constitution was reviewed and updated in 2008 to allow a change in Board membership and the inclusion of up to three external appointed directors. The aim of these new appointments is to broaden and strengthen the skills set of the Board, which has to date consisted solely of clinicians. The number of elected directors has now reduced to eight (from nine, and will eventually reduce to six) and the Nominations Committee of the Board is currently in the process of identifying potential new appointed directors. A reduction in the number of elected Board Directors saw the retirement of one of our founding Board Directors, Professor John Forbes. John has dedicated his professional career to the furtherance of breast cancer research and the success of the ANZ BCTG. His remarkable ANZ BCTG Annual Report 2008-2009 3 commitment to his patients and to those who are touched by breast cancer and his contributions to the Group over 30 years is unsurpassed. John continues in the important role of Director of Research and as a member of the Group’s Scientific Advisory Committee. Financial Position The Group’s financial position continues to improve with an increase in total revenue of 26% this year. Equity has increased by just over 30% and financial performance ratios are indicative of an excellent financial position. A significant part of this improvement was attributable to the success of our fundraising activities (Breast Cancer Institute of Australia), the growth and prudent management of our clinical trials research program and sustained infrastructure funding from Cancer Australia and Cancer Institute NSW. Our members benefitted from the Group’s biannual Discretionary Funding opportunities and annual Avon Travel Grants to attend our Annual Scientific Meeting. The Discretionary Funding awards supported pilot or new research projects (in development or initial recruitment phase) and provided seed funding to new institutions participating in our clinical trials program. For more information on the ANZ BCTG’s financial position please refer to the Financial Report on page 79. The Future The future holds many opportunities to develop and expand the current ANZ BCTG clinical trials research program for breast cancer. This is particularly so because of the Group’s healthy financial position. We are working on the development of an increased ‘footprint’ (geographical and multidisciplinary spread), active engagement with stakeholders, a branding and communications review and further development of collaboration with other groups including consumers. We are also exploring ways to further develop our mutually beneficial relationship with the pharmaceutical industry. This relationship is critical to ensuring the Group continues to have access to new drugs for incorporation into clinical trials with the potential to further improve breast cancer treatments and outcomes for women with breast cancer or at risk of the disease. In Summary This has been a year of achievement and strategic development. The highlights have been an increased availability of trials to women and members, a sustained increase in patient recruitment to clinical trials, a continued improvement in our financial position and an increase in opportunities for growth and research collaboration. There are many exciting projects on the horizon and innovative proposals which will enhance the Group’s research program. The ANZ BCTG’s activities are multi-faceted but fundamentally the Group’s core values are to be excellent, relevant, transparent, reputable, inclusive and innovative. We will, therefore, continue to share what we learn and appreciate the contribution of others in the pursuit of our research goals. Finally, I would like to thank all the women who support and participate in ANZ BCTG clinical trials; all the clinicians and ancillary medical staff who contribute to our research activities; the donors, funders and other sponsors who sustain us; and the hard working committee and staff members who make it all happen. Dr Jacquie Chirgwin Chairman, Board of Directors 4 ANZ BCTG Annual Report 2008-2009 Chief Operating Officer’s Report The ANZ BCTG is celebrating its 30th anniversary and, as mentioned elsewhere in this report, much has been accomplished by the Group over this period. I personally am very proud to be associated with the ANZ BCTG and to be part of this dynamic research organisation. My role as the Chief Operating Officer of a large collaborative, academic breast cancer clinical trials group is both challenging and very rewarding. I am responsible for the ANZ BCTG’s overall business performance and I am supported in this position by a dedicated team of professionals who routinely go ‘above and beyond’. The ANZ BCTG has grown substantially over the past ten years and a lot of work has been done to develop an operational framework that effectively and efficiently supports this expansion. The Group now employs 48 staff members at our central offices in Newcastle across three departments Business Administration, Trials Coordination and Fundraising and Education - and we aim to provide career opportunities for those interested in clinical trials research, clinical trials management and notfor-profit fundraising. Our achievements over the past year are summarised below. Operations ■■ The ANZ BCTG Board of Directors approved the Group’s five year Strategic Planning Framework (2009-2014) and identified four priority areas for 2009/2010 – Footprint (focussing on collaboration), Relevant Trials Based on Excellent Science, Key Stakeholder Confidence and Brand and Position. These priority areas and other strategic goals have been distilled into a Business Plan which delivers the intent of the Framework according to predefined milestones and objectives. An annotated version of the ANZ BCTG Business Plan is available from the members section of our website. ■■ We moved to additional premises in January 2009 after outgrowing our offices at the NBN Telethon Mater Institute, Waratah NSW. The new offices are located in central Newcastle and house the Business Administration and Fundraising and Education departments. The relocation is supported by integrated telephone and computer networks which ensure optimal communications can be maintained. ■■ We reviewed our operational Policies and Procedures (PnPs). The PnP review involved a needs analysis, staff consultation, updating of existing PnPs, development of new PnPs, creation of an improved ‘search’ facility and uploading of the final PnPs and associated attachments to the ANZ BCTG intranet. The review process took five months and was a resounding success. ■■ We streamlined the use of character recognition software in our clinical trials data collection processes. The system reduces the amount of manual data entry required and improves the Group’s data query and resolution timelines. We also continued development of the ANZ BCTG Clinical Trials Management Database (TMD). The TMD centrally manages standard clinical trials documentation and monitoring activities and eliminates the repetition of administrative tasks which are common across all ANZ BCTG trials. ANZ BCTG Annual Report 2008-2009 5 Financial Position and Awarded Grants ■■ The ANZ BCTG completed the financial year (April 2008 – March 2009) in a strong position. The Group was independently audited following the closure of the financial year and the surplus reported is committed to current and future research projects. I would particularly like to highlight the success of our fundraising activities which support essential research, education and capacity building initiatives. For more information on the Group’s financial position please see the Financial Report included in this Report. ■■ We were awarded additional competitive research grants from the National Health and Medical Research Council (NHMRC). These grants are administered for the Group by the University of Newcastle. We were also awarded a new competitive infrastructure grant from Cancer Australia as part of the Strengthening Cancer Care - Support for Cancer Clinical Trials Program initiative. The additional awards bring the Group’s grant holdings to just over $2 million for the reporting period. In Summary The Group is in a favourable position and ideally situated to take advantage of the potential opportunities available from both a research and fundraising perspective. I look forward to enabling the Group to make the best of these opportunities and to building the relationships necessary to achieve them. I am forever grateful for the support of our funders, donors, members and collaborators. Without their support we would not have such a successful research program. I am also thankful for the women who, everyday, embrace our clinical trials and make such a vital contribution to improving breast cancer outcomes for everyone. Wendy Carmichael Chief Operating Officer 6 ANZ BCTG Annual Report 2008-2009 Research Report The ANZ BCTG commenced its clinical trials research program in 1978 with two trials in advanced breast cancer (ANZ 7801/2). Today, we are celebrating 30 years as a leading national and international clinical trials research organisation with the following major achievements: ■■ A robust research program encompassing more than 50 clinical trials (in various stages of recruitment, follow-up, analysis and publication) for the prevention of breast cancer and for the treatment of early and advanced breast cancer. ■■ Extensive research collaborations with more than 500 researchers and members representing 80 institutions throughout Australia and New Zealand and engagement with over 15 countries and other international clinical trials groups. ■■ Involvement of more than 12,000 women from Australia and New Zealand in ANZ BCTG research programs. ■■ Publication of 740 papers in peer-reviewed journals and continuous peer-reviewed grant support since the inception of the Group. The foundation of any successful research organisation is high quality scientific processes and an inherent pursuit of excellence. The ANZ BCTG has always embraced these principles and they are integral to everything we do. The Group ensures adherence to Good Clinical Research Practice guidelines, unbiased scientific evaluation and review of research projects, and engagement with eminent, experienced researchers and skilled trials management personnel. The ANZ BCTG has a governance structure to enable the achievement of its mission - “to eradicate all suffering from breast cancer through the highest quality clinical trials research”. It is the responsibility of the ANZ BCTG Scientific Advisory Committee (SAC), chaired by Associate Professor Fran Boyle, to set the Group’s research direction and the responsibility of the Group’s Director of Research, Professor John Forbes, to manage the scientific and clinical conduct of the clinical trials program. The Chair of the SAC and the Director of Research work together to drive the research agenda of the Group and to foster the development of new research proposals. The extent of the ANZ BCTG’s activities also requires a dedicated team of professionals to manage the Group on a day to day basis. The central office in Newcastle NSW is managed by the Director of Research and Chief Operating Officer and has three departments. It is the responsibility of the Trials Coordination Department (TCD) to develop, activate and coordinate ANZ BCTG clinical trials. This department has 29 staff members and is supervised by the Head of Trials Management, Mrs Dianne Lindsay. The ANZ BCTG’s Statistical Centre is located at the National Health and Medical Research Council Clinical Trials Centre at the University of Sydney. The Statistical Centre provides statistical advice on new projects, randomisation processes for current trials and statistical analyses of study results for publication. ANZ BCTG Annual Report 2008-2009 7 Along with our 30th anniversary, the ANZ BCTG has a number of other research highlights over the past year. New Trials This year the Group had its largest number of open clinical trials available for patient entry. One new trial was commenced and in total 14 trials were open during the reporting period. This is a tremendous achievement and testament to the hard work of the SAC, Director of Research and the TCD. Recruitment to Trials The enrollment of trial participants is vital for the successful completion of clinical trials. The ANZ BCTG has initiated a number of successful recruitment strategies to identify and invite women to consider participating in our research programs. The implementation of these strategies and the support of the dedicated study coordinators and investigators at our participating institutions resulted in the ANZ BCTG recruiting its largest number of clinical trial participants for more than five years – 581 new participants. New Publications As new trials begin, other trials reach their accrual targets, progress into follow-up phase and become ready for analysis. During the reporting period, the ANZ BCTG added a further 46 publications to its impressive track record of peer-reviewed publications. Annual Scientific Meeting In July 2008, the Group held its 30th Annual Scientific Meeting (ASM) in Wellington, New Zealand. The ASM was attended by over 200 delegates and included workshops on patient communication and presurgical treatment, a consumer mentor program, two full days of scientific presentations and discussion. We were delighted to welcome many international and local guest speakers to the ASM, who together with distinguished members of the ANZ BCTG shared their knowledge with those in attendance. The meeting celebrated the Group’s 30 year contribution to breast cancer research, culminating in the conference dinner where Professor Forbes and Associate Professor Boyle presented a humorous retrospective of the ANZ BCTG and its many contributors. Moving Forward One of the key challenges in optimising the care of women with breast cancer is personalising therapy – identifying which drug treatments are likely to work best for which women. A new study, TAILORx, will assess the usefulness of a new test (a gene ‘signature’) in predicting the benefit of chemotherapy in early breast cancer. In advanced breast cancer, strategies to improve control of the disease include the use of new drugs which target the blood vessels which feed the cancer. This has the potential to improve the effectiveness of chemotherapy – tackling cancer on two fronts simultaneously. The CIRG TRIO-012 study will test one such ‘antiangiogenic’ therapy. Important new research will be incorporated into the IBIS-II Prevention trial. High breast density, which refers to a higher proportion of tissue to fat as seen on a mammogram, is strongly associated with an increased risk of breast cancer. Breast density will be included as an eligibility criterion for patient entry to the IBIS-II Prevention trial. 8 ANZ BCTG Annual Report 2008-2009 The Future Clinical trials are the key to determining whether new treatment ‘discoveries’ from the laboratory can be translated into clinical practice. All current breast cancer treatments will have been rigorously tested by clinical trials before being made widely available to women in the community. For 30 years, the ANZ BCTG has provided an effective framework for the conduct of collaborative breast cancer clinical trials research in Australia and New Zealand. The Group’s longevity demonstrates its ability to adapt in an ever-changing world, to seize opportunity and to consistently produce high quality research results which can change clinical practice. New research technologies, the discovery of new biological breast cancer ‘markers’ and other clinical advances will affect the types of clinical trials that can be undertaken in the future. The depth of the ANZ BCTG’s research expertise and the strength of its global relationships will ensure the Group’s research program continues to be at the cutting edge and conscious of emerging discoveries and opportunities. We can be confident that our clinical trials will remain a crucial source of relevant and reliable scientific data and will continue to provide important results that can be translated into better outcomes for women. Professor John F Forbes Director of Research Associate Professor Fran Boyle Chair, Scientific Advisory Committee Mrs Dianne Lindsay Head of Trials Management ANZ BCTG Annual Report 2008-2009 9 This page is intentionally blank. 10 ANZ BCTG Annual Report 2008-2009 Research Achievements and Highlights The ANZ BCTG research program encompasses more than 50 clinical trials in various stages of recruitment, follow-up, analysis and publication. It was the first Group in the world to include quality of life and cost effectiveness questions in its research protocols and these activities remain a key component of the Group’s research focus. Currently, there are over 500 active ANZ BCTG members, representing 80 institutions throughout Australia and New Zealand. The membership of the ANZ BCTG is representative of all relevant medical disciplines including surgeons, medical oncologists, radiation oncologists, pathologists, endocrinologists, haematologists, pharmacists, geneticists, psychologists, counsellors, study coordinators, research nurses, consumers and other clinical trials management personnel. Research achievements and highlights during the reporting period have been considerable and are summarised below. Clinical Trials Program This year the ANZ BCTG had a record 14 clinical trials (including substudies) open for patient entry (see Open Trials on Page 19). This, together with new recruitment processes, helped the ANZ BCTG recruit 581 new participants to its clinical trials research program over the reporting period. The support of research staff in the Trials Coordination Department and ANZ BCTG participating institutions was essential to achieving this excellent result. We were delighted to approve the participation of two new regional hospitals in the ANZ BCTG research program - the North West Regional Hospital in Burnie, Tasmania and St Andrew’s Toowoomba Hospital in Queensland. The first patients were entered to two very important clinical trials during the reporting period and these trials are briefly summarised below. ANZ 0702 / BIG 2-06 / N063D / EGF106708 Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation study (ALTTO) Many breast cancer cells have growth receptor molecules on their surface. One particular type of growth receptor is known as HER2. Patients with HER2-positive breast cancer have a greater risk of the cancer returning after their initial treatment with trastuzumab. Lapatinib is a new oral HER2 blocking drug which has been shown to slow or stop the growth of HER2-positive breast cancer which has spread to other parts of the body (advanced breast cancer). Lapatinib has also been effective when trastuzumab has not worked and in treating breast cancer that has spread to the brain. The ALTTO trial will extend our knowledge of optimal HER2 therapy in women with HER2-positive breast cancer, by comparing treatment with trastuzumab alone to lapatinib alone, or combinations of trastuzumab with lapatinib. The first ANZ BCTG patient was entered to this study in April 2008. For the first time we have a truly global trial as it involves collaboration with research groups from North America, Europe and the ANZ BCTG all working together. This is the first such collaboration for an adjuvant study and it will help to provide reliable results at the earliest opportunity. ANZ BCTG Annual Report 2008-2009 11 IBCSG 35-07 / BIG 1-07 Study Of Letrozole Extension (SOLE) After initial treatment for hormone-responsive breast cancer, standard long term treatment usually includes at least five years of hormone treatment. For postmenopausal women, hormone treatment usually consists of an aromatase inhibitor such as letrozole. Half of all the recurrences in these women occur between five and 15 years after their initial diagnosis, when the five years of hormone treatment has been completed. Research has shown that extending hormone treatment beyond the usual five years may prevent or delay breast cancer recurrence and may prolong survival, but the best treatment plan and length of treatment is still unclear. Results from some smaller studies indicate that short breaks from letrozole treatment may make letrozole-resistant breast cancer cells more vulnerable to letrozole treatment when the treatment is restarted. The international trial SOLE, is evaluating whether having three-month treatment-free periods, during five years of extended letrozole treatment, will further prevent or delay breast cancer from returning. The first ANZ BCTG patient was entered to this study in February 2009. Patterns of Recurrence The ANZ BCTG conducted a ‘Patterns of Recurrence Survey’ during the reporting period. It is hoped that by identifying the characteristics of consecutive relapsing patients the survey results will: ■■ support the design of new relevant ANZ BCTG clinical trials in the metastatic disease setting; and ■■ help the ANZ BCTG to design clinical trials in the adjuvant setting that address the needs of women at greater risk of recurrence. Survey responses were completed in December 2008 and data analysis is underway. Publications During the reporting period, the ANZ BCTG added a further 46 publications to its portfolio (see Publications on Page 85). Eight of these publications are summarised briefly below. ATAC 100 month follow-up The 100 month follow-up analysis of the ATAC (Arimidex®, Tamoxifen, Alone or in Combination) trial was published in The Lancet in 2008 (9:45-53). These results showed that anastrozole (Arimidex®), compared to tamoxifen, can significantly reduce the risk of recurrence and minimise serious side effects for postmenopausal women with hormone-sensitive early breast cancer. The data also showed that the protective effect of anastrozole lasts well beyond the standard treatment period of five years. Overall, women in the ATAC trial taking anastrozole were 24% less likely to have their breast cancer return compared with those taking tamoxifen. This data strengthens the evidence for the use of anastrozole in preference to tamoxifen, soon after diagnosis for five years, to give postmenopausal women with hormone-sensitive early breast cancer the best chance of remaining breast cancer-free long term. Internationally, 9,306 women were recruited to the ATAC trial and 11 ANZ BCTG institutions participated. 12 ANZ BCTG Annual Report 2008-2009 ATAC – a retrospective analysis of some early side effects of hormone treatment Women who experience side effects from their treatment for hormone-sensitive breast cancer may derive greater benefit from this treatment. The aim of this research was to conduct a retrospective analysis of side effects, such as joint pain and hot flushes, reported by women taking part in the ATAC (Arimidex®, Tamoxifen, Alone or in Combination) trial to see if there was a relation to breast cancer recurrence. It was published in Lancet Oncology in 2008 (9(12):1143-1148). The data showed that the appearance of new side effects during the first three months of hormone treatment suggested that the patient was experiencing a better response. Women who received either tamoxifen or anastrozole (Arimidex®), and experienced early joint symptoms, hot flushes or sweats after starting hormone treatment, had fewer breast cancer recurrences in the longer term. Awareness of the relation between the appearance of early side effects and the potential longer term benefits of hormone treatment may reassure women, and help improve treatment compliance. BIG 1-98 / IBCSG 18-98 This analysis, which explored potential differences in efficacy, treatment completion and adverse events in postmenopausal women taking part in the international trial BIG 1-98, was published in the Journal of Clinical Oncology in 2008 (26(12):1972-1979). BIG 1-98 evaluated an aromatase inhibitor, letrozole, as adjuvant endocrine therapy for postmenopausal women with receptor (ER and/or PgR) positive early breast cancer. The objective of this analysis was to assess the monotherapy arms, letrozole alone and tamoxifen alone (4,922 patients), and the age of the patient at the time of diagnosis and treatment. Age groups of women ‘younger than 65 years’, ‘65 to 74 years’ and ‘elderly, 75 years or older’ were reviewed. Results from this study showed that, for a small number of women older than 75 years, tamoxifen may be a better treatment option if there are existing risk factors for cardiovascular disease, or a prior diagnosis of osteoporosis. In contrast, letrozole may be a better treatment option for older women who have a prior history of thromboembolic disease. The most important information obtained from this analysis was that letrozole is a more effective treatment than tamoxifen for all age groups of postmenopausal women. IBCSG VIII and IX – Ki-67 analysis Prior studies suggest that the presence of a high percentage of Ki-67 expression (a biomarker) in breast cancer tumour cells predicts a better response to adjuvant chemotherapy. The goal of this research was to test Ki-67 levels in tumour samples collected from women with lymph node-negative, hormonesensitive breast cancer who were participating in the IBCSG VIII and IX trials. Internationally, 1,111 women were recruited to IBCSG VIII with the ANZ BCTG contributing 20% (228) of this total, and 1,715 women were recruited to IBCSG IX with the ANZ BCTG contributing 19% (330). The two studies were conducted between 1988 and 1999 and compared adjuvant endocrine therapy alone with sequential chemotherapy followed by endocrine therapy alone. The aim of the Ki-67 analysis, published in the Journal of the National Cancer Institute in 2008 (100:207-212), was to examine the tumour samples to determine if Ki-67 could identify patients who might benefit from receiving endocrine therapy and chemotherapy. The data showed that levels of Ki-67 did not predict which patients may benefit from receiving chemotherapy in addition to endocrine therapy in the adjuvant treatment setting. A high Ki-67 level was associated with worse disease-free survival in all treatment groups. The authors noted that there were limitations in this study, and that other biomarkers are needed to identify which women with hormone-sensitive, node-negative, early breast cancer should receive treatment with both endocrine therapy and chemotherapy. ANZ BCTG Annual Report 2008-2009 13 BIG 2-98 / IBCSG 20-98 Results of the international trial BIG 2-98 were published in the Journal of the National Cancer Institute in 2008 (100:121-133). This trial tested two significant questions: 1. C an incorporation of the taxane docetaxel (Taxotere®) into anthracycline (doxorubicin)-based adjuvant chemotherapy reduce the risk of relapse in node-positive breast cancer? 2. If docetaxel does confer an advantage, what is the best way to deliver this treatment? Is it in combination with doxorubicin or sequentially after doxorubicin? This trial demonstrated that the timing of docetaxel treatment may be of significance, with sequential treatment after doxorubicin appearing to produce better disease-free survival than if it was given at the same time as doxorubicin based chemotherapy. These results may be of more importance for women who have oestrogen receptor-negative breast cancer or women whose breast cancer has spread to several lymph nodes. A total of 2,887 women were recruited internationally to this trial and 605 (21%) of these women were enrolled by ANZ BCTG institutions. IBCSG 11-93 The ten year update of trial IBCSG 11-93 was published in Breast Cancer Research and Treatment in 2009 (113:137-144). This phase III trial involved premenopausal women who after surgery for their breast cancer were found to have tumours which are hormone-sensitive and positive axillary lymph nodes. For these women it was not known whether hormonal treatment alone was sufficient, or whether the addition of chemotherapy would be beneficial in reducing the incidence of disease recurrence and improve survival. Internationally, 174 women were recruited to this study and 13 ANZ BCTG institutions participated. The trial was closed before the target accrual was reached due to a low accrual rate. IBCSG 11-93 is the only published randomised comparison addressing the role of chemotherapy in this group of premenopausal patients. Although small, it offers no evidence that anthracycline chemotherapy provides additional disease control for premenopausal patients with lower-risk node-positive, endocrine-responsive breast cancer who receive adequate adjuvant endocrine therapy. Another large, well-designed trial is needed to determine whether this group of patients derive benefit from the addition of chemotherapy. IBIS-II DCIS – Decision Aid This pilot study aimed to improve the process of obtaining informed consent from patients to enter clinical trials. A Decision Aid booklet was designed for the IBIS-II DCIS trial, which compares the efficacy of the aromatase inhibitor anastrozole with tamoxifen in women who have had surgery for Ductal Carcinoma In Situ (DCIS). Women participating in an earlier prevention trial, IBIS-I, were selected to evaluate the booklet. The results published in Health Expectations in 2008 (11:252-262) suggest that a Decision Aid would be acceptable to potential participants in the IBIS-II DCIS trial. It was acknowledged that the process of obtaining informed consent is complex, and that there are a number of factors which may motivate women to take part in a clinical trial. 14 ANZ BCTG Annual Report 2008-2009 Group Clinical Trials – Standards for Specimen Collection The adoption of unified standards for the collection and storage of tumour tissue and blood specimens is essential to maximise specimen based diagnostic testing and research. Experts from leading international collaborative groups, including the ANZ BCTG, formed a working group to assess and improve current tissue collection procedures. A set of procedures was agreed and documented in a paper published in the Journal of Clinical Oncology in 2008 (26(34):5638-5644). Standard guidelines for specimen collection, handling and shipping are documented in the paper. These guidelines will help to ensure that the quality of valuable trial specimens is maintained and that important translational research can be performed for global clinical trials. Other goals that were initiated by the working group include sharing trial designs and strategies, combining analyses, sharing ideas about future translational research and collaboration on translational research projects. Annual Scientific Meeting The ANZ BCTG held its 30th Annual Scientific Meeting (ASM) in July 2008 at the Te Papa Tongarewa Museum of Wellington, New Zealand. The ASM facilitates the global sharing of research knowledge and information which is critical to the control of breast cancer. More than 200 researchers and specialists from throughout Australia and New Zealand attended the Wellington meeting. We are particularly grateful to our international and local colleagues (listed below) whose participation in our meeting was of great benefit to all those in attendance. ■■ Professor Robert Baxter, University of Sydney ■■ Professor Richard Gelber, Dana-Farber Cancer Institute, Boston US ■■ Professor Ian Kunkler, Edinburgh Cancer Research Centre, Edinburgh UK ■■ Professor Peter Lobie, Liggins Institute, Auckland NZ ■■ Dr Kevin Lynch, Celgene Pty Ltd, Melbourne ■■ Ms Margo Michaels, ENACCT, Silver Spring US ■■ Associate Professor Cristin Print, The University of Auckland, NZ ■■ Dr Kathy Pritchard, Sunnybrook Regional Cancer Center, Toronto Canada ■■ Associate Professor Papaarangi Reid, The University of Auckland, NZ ■■ Professor John Robertson, University of Nottingham, UK ■■ Dr Hope Rugo, UCSF Breast Care Center, San Francisco US ■■ Associate Professor Linda Vahdat, Weill Cornell, New York US ■■ Professor William Wilson, The University of Auckland, NZ ASM Awards and Travel Grants This year the ANZ BCTG Board of Directors established the John Collins Medal and Travel Grant to encourage potential academic breast surgeons and registrars to become involved in clinical trials research. In 2007, the Data Manager Award was established to recognise outstanding commitment to the ANZ BCTG by a study coordinator. The ANZ BCTG Board also established Travel Grants to assist breast cancer researchers and study coordinators to attend the annual ASM, who might otherwise not have had the opportunity largely due to funding issues. Both these initiatives are sponsored by Avon, which together with the ANZ BCTG is committed to encouraging and fostering the best, new breast cancer researchers. ANZ BCTG Annual Report 2008-2009 15 The 2008 recipients are as follows: John Collins Medal and Travel Grant: Miss Anita Skandarajah, Royal Melbourne Hospital, VIC Travel Grants: Miss Leeanne Greenhalgh, St Vincent’s Hospital, VIC Mr Mafizul Hoque, Bankstown-Lidcombe Hospital, NSW Miss Laura Mackay, Auckland City Hospital, New Zealand Mrs Sharon Maliepaard, Frankston Hospital, VIC Mrs Jennifer McGuiggan, Launceston General Hospital, TAS Dr Kate Richards, Peter MacCallum Cancer Centre, VIC Mrs Judith Silcock, The Breast Centre, NSW Mr Allan Smith, University of Sydney, NSW Mrs Suzanne Wegecsanyi, Sir Charles Gairdner Hospital, WA ANZ BCTG Data Manager Award: Ms Jenni Scarlet, Waikato Hospital, New Zealand New Appointments and Processes Clinical trials coordination is an exciting and challenging activity which requires interaction with many different people, groups and organisations. The ANZ BCTG Trials Coordination Department (TCD) has responsibility for many facets of the Group’s research program including: development of new trial protocols; inclusion of new participating institutions; activation of trials; monitoring, collection, entry and cleaning of clinical trial data; coordination of trial quality assurance activities; organisation of trial data analyses in liaison with the Statistical Centre and Independent Data Safety and Monitoring Committee; formatting of trial publications and dissemination of clinical trials results to our membership; and education and training of study coordinators, research nurses and investigators in ANZ BCTG trial processes. The TCD is continually reviewing its procedures to ensure maximum support can be provided to our participating institutions and activation of ANZ BCTG trials can be as seamless as possible. In 2008, for example, new technologies were implemented to streamline our data collection processes. This new technology uses Optical Character Recognition software to reduce the amount of manual data entry required and improve the Group’s data query and resolution timelines. The design of the members’ area of the clinical trials section of the ANZ BCTG website has also been improved. This online resource provides valuable information and materials necessary for the activation and ongoing management of ANZ BCTG clinical trials at all participating institutions. A new database has been designed to assist the TCD to further improve the management of clinical trials during the activation, treatment and follow-up phases. Maintaining compliance with regulatory requirements for clinical trials research is critical. This new database is unique and will standardise the collection of complex information across the entire research program. It will also assist research staff at participating institutions as reports will be available to these staff on the ANZ BCTG website, reducing the administrative workload associated with conducting clinical trials research. In December 2008, the ANZ BCTG appointed a Medical Fellow, Dr James Bull. The Fellow position aims to provide educational, research and career development opportunities for young clinical researchers in the field of breast cancer through participation in the development, implementation and conduct of the clinical and translational components of trials conducted by the ANZ BCTG. The position is funded by the Cancer Institute NSW and the input provided by Dr Bull has been invaluable. 16 ANZ BCTG Annual Report 2008-2009 Discretionary Research Funding During the reporting period the ANZ BCTG provided opportunities for its members to apply for Discretionary Research Funding. This funding is available to pilot projects or projects which require some seed funding to get started. The proposals must have Scientific Advisory Committee approval and be either related to existing ANZ BCTG research activities or relevant to the overall research agenda of the ANZ BCTG. Funding for this initiative comes from public donations made to the Group, without which these important projects could not be supported. Dr P Francis, Trial BIG 2-98 / IBCSG 20-98 – An application was approved for funding to support data management services and statistical services for an unplanned analysis of outcomes for women in this study according to loco-regional treatments received relative to other relevant variables (eg nodal status, age). Dr P Francis, Trial IBCSG 25-02 / BIG 3-02 (TEXT) retrospective sample collection – An application was approved for funding to support retrospective blood sample collection (which is part of the TEXT protocol re-activation amendment) for the 191 ANZ BCTG patients currently enrolled in the TEXT trial. Assoc Prof K Phillips, Triple-negative phase II trial – An application was approved for funding to support the pilot stage of a phase II clinical trial to evaluate the efficacy of tamoxifen in triple-negative but oestrogen receptor β positive breast cancer. Prof M King, Pilot patient preferences substudy for the ANZ 0702 (ALTTO) trial – An application was approved for funding to support the pilot phase of a Discrete Choice Experiment to assess patient preferences to treatments in the ALTTO trial. Discretionary Site Infrastructure Funding During the reporting period the ANZ BCTG provided opportunities for its members to apply for Discretionary Site Infrastructure Funding. Funding for this initiative comes from public donations made to the Group, without which these essential requests could not be supported. Sir Charles Gairdner Hospital (WA) – An application was approved for funding to assist with the activation of the ANZ 0501 (LATER) trial at this centre. St Andrew’s Toowoomba Hospital (QLD) – An application was approved for funding to assist the establishment of a new research centre and activation of ANZ BCTG trials IBCSG 34-05 / SWOG S0230 (POEMS) and IBCSG 24-02 / BIG 2-02 (SOFT). North West Regional Hospital (TAS) – An application was approved for funding to assist the establishment of breast cancer research at this new centre and activation of ANZ BCTG trials IBCSG 35-07 / BIG 1-07 (SOLE), ANZ 0501 (LATER), IBCSG 24-02 / BIG 2-02 (SOFT) and ANZ 0701 (Co-SOFT). ANZ BCTG Annual Report 2008-2009 17 This page is intentionally blank. 18 ANZ BCTG Annual Report 2008-2009 Clinical Trials Open for Patient Entry Prevention Trials Prevention clinical trials have mainly involved women with an increased risk of breast cancer, usually due to a strong family history of the disease. The recruitment of women to these trials requires support from many different quarters including surgeons; medical, radiation and surgical oncologists; study coordinators; general practitioners and the public. Women who are invited to participate in prevention clinical trials have either never had breast cancer or are long term breast cancer survivors. Our prevention research is threefold: to prevent breast cancer in women at high risk, to prevent breast cancer recurrence in women who have had the disease, and to ultimately prevent breast cancer for all. The first international breast cancer prevention trial, IBIS-I, began in 1992 and involved seven countries and 7,154 women. The ANZ BCTG enrolled 2,674 women from Australia and New Zealand. In 2002, results from IBIS-I demonstrated that tamoxifen, a well established therapy for the treatment of breast cancer, reduced the occurrence of hormone receptor-positive breast cancer by about one third in pre and postmenopausal women at increased risk of the disease. The landmark results of the IBIS-I trial paved the way for the next generation of prevention trials. This research, together with ongoing data from our treatment clinical trials, provides us with new strategies for use in the prevention setting. ANZ 02P2 / IBIS-II Prevention and IBIS-II DCIS International multi-centre trials of anastrozole versus placebo in postmenopausal women at increased risk of breast cancer and tamoxifen versus anastrozole in postmenopausal women with hormone-sensitive DCIS. These international clinical trials test the potential of a once-a-day hormone treatment for five years in postmenopausal women who are at increased risk of breast cancer. IBIS-II builds on results from the first prevention study, IBIS-I, an international trial which showed that tamoxifen could prevent breast cancer in some women at increased risk, but was associated with some side effects. Oestrogen can stimulate the growth of breast cancer cells. Hormone treatment with tamoxifen or the aromatase inhibitor anastrozole, may prevent breast cancer developing by blocking the effects of oestrogen. An international clinical trial, called ATAC (Arimidex®, Tamoxifen, Alone or in Combination), showed that anastrozole (Arimidex®) was effective for the treatment of breast cancer. It also showed that anastrozole was better tolerated and more effective in preventing breast cancer recurrence than tamoxifen overall, thus making it a suitable candidate for use in the prevention setting. The IBIS-II Prevention trial evaluates whether anastrozole can prevent the development of breast cancer in postmenopausal women at high risk of the disease. The trial includes a substudy to investigate the effects of anastrozole on bone mineral density. The IBIS-II DCIS trial compares anastrozole with tamoxifen in postmenopausal women who have recently undergone surgery to remove a form of pre-invasive breast cancer called Ductal Carcinoma In Situ (DCIS). The purpose of this study is to investigate which drug is most effective at preventing the breast cancer returning or a new breast cancer developing. It will also show which drug is better tolerated. ANZ BCTG Annual Report 2008-2009 19 Women who are postmenopausal, not taking hormone replacement therapy, aged 40-70 years and are at increased risk of breast cancer, either because of a family history of breast cancer or because of other defined risk factors, may consider taking part in IBIS-II. There must have been no previous diagnosis of breast cancer, unless this was a particular form of breast cancer called DCIS. The ANZ BCTG has enrolled 401 women to the IBIS-II Prevention trial and 93 women to the IBIS-II DCIS trial (31 March 2009). The IBIS-II trials are supported by a National Health and Medical Research Council (NHMRC) Project Grant (2009-2013). Lead International Group: Cancer Research UK (CRUK) ANZ BCTG Study Chair: Prof John F Forbes (Calvary Mater Newcastle) First ANZ BCTG Participant Enrolled: 22 March 2006 (IBIS-II Prevention) 18 November 2005 (IBIS-II DCIS) Patient Population Prevention: Postmenopausal High risk 40-70 years DCIS: Postmenopausal Hormone-sensitive DCIS (without mastectomy) 40-70 years R A N D O M I S A T I O N anastrozole 1 mg daily for 5 years placebo daily for 5 years tamoxifen 20 mg + anastrozole placebo daily for 5 years anastrozole 1 mg + tamoxifen placebo daily for 5 years IBIS-II Prevention Bone Subprotocol (1000 Women) T-Scores T ≥ -1.0 -2.5 < T < -1.0 -4.0 ≤ T ≤ -2.5 or 1-2 low trauma vertebral fractures Stratum 1:* RANDOMISATION Stratum 3: risedronate** Stratum 2: risedronate** vs placebo * Women in all strata will be monitored with dual energy x-ray absorptiometry (DXA) scans and vitamin D and calcium supplements will be recommended. ** Risedronate 35 mg po once per week. 20 ANZ BCTG Annual Report 2008-2009 ANZ 0501 Later adjuvant Aromatase inhibitor Therapy for postmenopausal women with Endocrine-Responsive breast cancer (LATER) A randomised double-blind trial in postmenopausal women who have completed five years of adjuvant endocrine therapy for early, hormone-sensitive breast cancer more than one year previous and who are disease-free at study entry. Many women who were diagnosed with and received standard treatment for breast cancer several years ago are concerned about their ongoing risk of breast cancer returning. Until now, the management of ongoing risk has been linked to surveillance by annual clinical review and mammography. The LATER trial addresses the important question of whether additional treatment with the aromatase inhibitor letrozole, commenced much later, for example from six to 15 years after the initial diagnosis of breast cancer, could reduce the risk of breast cancer returning in this large and high risk group of women. LATER is a very high priority trial to both improve outcomes for women and gain a better understanding of the biology of breast cancer. The ANZ BCTG has enrolled 36 women to the LATER trial (31 March 2009). The LATER trial is supported by a NHMRC Project Grant (2008-2012). Lead International Group: ANZ BCTG ANZ BCTG Study Co-Chairs: Prof John F Forbes (Calvary Mater Newcastle) Assoc Prof Michael Green (Royal Melbourne Hospital) First ANZ BCTG Participant Enrolled: 16 May 2007 Patient Population Postmenopausal Stratification Institution ER and/or PgR+ early BC AET for 5 years AET completed ≥ 12 months* Disease-free BC AET: LET: PLAC: Node status: N+/N-/UNK AET: TAM/AI/Other R A N D O M I S A T I O N LET for 5 years PLAC for 5 years adjuvant endocrine therapy letrozole 2.5 mg daily po placebo daily po * Study entry will be ≥ 6 years after diagnosis of primary breast cancer. ANZ BCTG Annual Report 2008-2009 21 Pre-operative Systemic Therapy Trials Traditionally, chemotherapy and endocrine treatments (systemic therapy) have been given once a patient has undergone surgery for breast cancer. However, more recently, interest has arisen in administering these therapies before surgery (known as pre-operative systemic therapy or neoadjuvant therapy). Pre-operative therapy can substantially reduce the size of a primary breast tumour to allow for breast conserving surgery and surgical resection of previously inoperable tumours. Other potential benefits of pre-operative therapy include the ability to gain systemic control of micrometastatic disease and to assess the sensitivity of an individual tumour to chemotherapy drugs that might be used for post-operative treatment. Trials can also be designed to plan post-operative treatments which are based on tumour response and biological change. Women could avoid morbidity from ineffective systemic therapy and important biological information relevant to pathways, targets and resistance to therapies may come only from this approach. The administration of pre-operative therapy requires the support of the entire oncology team as they must work together to deliver treatments for selected patients in this setting. Surgeons in particular should be informed about potential pre-operative research initiatives as they are the gatekeepers for the treatment of early breast cancer. ANZ 0502 (NeoGem) A phase II trial evaluating the efficacy and safety of epirubicin and cyclophosphamide (EC) followed by docetaxel with gemcitabine (DG) (+ trastuzumab if HER2-positive) as neoadjuvant chemotherapy for women with large operable, or locally advanced, breast carcinoma. Larger breast cancers are usually associated with a poorer prognosis and a higher risk that the disease has spread beyond the breast. Standard treatment for this type of breast cancer involves extensive surgery such as a mastectomy and also the removal of lymph nodes from the armpit. A course of chemotherapy (adjuvant chemotherapy) will usually follow to eliminate any small tumour cells that may remain undetected. The NeoGem trial has been developed by researchers of the ANZ BCTG and investigates the benefit of giving chemotherapy prior to surgery (pre-operative systemic therapy). Study treatment includes an initial course of standard chemotherapy (epirubicin and cyclophosphamide) followed by a course of newer chemotherapy drugs for breast cancer (docetaxel and gemcitabine). Women diagnosed with a type of breast cancer known as HER2-positive also receive trastuzumab (Herceptin®). It is hoped that with this treatment the size of the tumour will be reduced, allowing any remaining tumour to be removed by breast conserving surgery. Small samples of tumour tissue and blood are collected before and after chemotherapy. This type of research may identify treatments that are more effective for different types of breast cancer, leading to treatments tailored to the needs of individual patients. This trial will have its interim safety and efficacy analyses in 2009. It will provide a unique tissue resource for translational research, and a NHMRC Project Grant has been submitted for some of this work in collaboration with the Kolling Institute at the University of Sydney. This trial also has a sentinel node substudy. The ANZ BCTG has enrolled 77 participants to this trial (31 March 2009). The NeoGem trial is supported by a NHMRC Project Grant (2007-2009). 22 ANZ BCTG Annual Report 2008-2009 Lead International Group: ANZ BCTG ANZ BCTG Study Chair: Dr Nicole McCarthy (Royal Brisbane and Women’s Hospital) Prof Bruce Mann (Royal Melbourne Hospital) – Sentinel Node Substudy First ANZ BCTG Participant Enrolled: 30 August 2006 Patient Population Operable unilateral primary breast cancer clinically T2 ≥ 3 cm only, T3-4,N0-1,M0, diagnosed by core biopsy HER2+ or HER2Age ≥ 18 years No prior chemotherapy or hormonal therapy for invasive malignancy R E G I S T R A T I O N S HER2- DG x 4 R G EC x 4 E HER2+ DGT x 4 R Y EC (4 cycles) E: epirubicin C: cyclophosphamide 90 mg/m2 600 mg/m2 DG (4 cycles) D: docetaxel G: gemcitabine 75 mg/m2 day 1 1000 mg/m2 days 1 & 8 DGT (cycle 1) T: trastuzumab D: docetaxel G: gemcitabine T: trastuzumab 4 mg/kg 75 mg/m2 1000 mg/m2 2 mg/kg DGT (cycle 2 to 4) D: docetaxel 75 mg/m2 G: gemcitabine 1000 mg/m2 T: trastuzumab 2 mg/kg T: trastuzumab 6 mg/kg U T to 1 year day 1 day 1 day 1 day 2 day 2 & 8 day 8 & 15 day 1 day 1 & 8 day 1, 8 & 15 day 22 of last cycle then every 3 weeks (up to a total of one year of therapy) Tissue collection (tumour biopsies and serum): Pretreatment: EC x 2: DG or DGT: Definitive surgery: 5 core biopsies (3 FFPE and 2 cores of frozen tissue); frozen serum sample. after completing 2 cycles: 2 core biopsies (1 FFPE, 1 frozen fresh tissue); frozen serum sample. before first dose DG/DGT: frozen serum sample. 4 mm punch biopsy of residual tumour / areas of fibrotic stroma (frozen fresh tissue); a minimum of 10 FFPE blocks, including a sample from the axillary nodes, if possible; and frozen serum sample. ANZ BCTG Annual Report 2008-2009 23 Surgical Trials The aim of surgery for breast cancer is to obtain maximum benefit with minimum morbidity and optimal cosmesis (the appearance of the breast after surgery). This has been a long term challenge for breast surgeons given that adequate tumour resection has a direct correlation to long term survival. Until recently, the standard surgical treatment for breast cancer was to remove the breast or cancerous lump from the breast, and also to remove the lymph nodes under the arm (axillary dissection) in order to test these nodes for the presence of breast cancer cells. The development of new surgical techniques has refined this process and today a procedure called sentinel node biopsy is used. This technique determines whether breast cancer cells have spread to the lymph nodes under the arm by only removing the ‘sentinel’ node (the node that the cancer usually spreads to first). If a surgeon finds that the sentinel node has no cancer cells the removal of additional axillary lymph nodes can be avoided. The sentinel node biopsy procedure reduces the number of breast cancer patients who need to have an axillary dissection and also the potential side effects of having this surgery including lymphoedema. The advent of sentinel node biopsy has resulted in opportunities for further research. In particular, it has been noted that although a sentinel node sometimes does not contain clear evidence of metastatic spread of the cancer, it does contain tiny clumps of abnormal cells seen only under the microscope. These cells are called “micrometastases” and their size is less than 0.2 mm. Their significance to breast cancer outcomes is not known. Hence there can be a dilemma for the treating surgeon and the woman, as to whether the finding of micrometastases should mean that additional axillary lymph nodes should be removed, with a potential negative impact on quality of life, or whether they can be ignored. IBCSG 23-01 A randomised trial of axillary dissection versus no axillary dissection for patients with clinically node-negative breast cancer and micrometastases in the sentinel node. This international clinical trial will determine if the extent of axillary surgery can be reduced for women with good prognosis early breast cancer who have only small clumps of cancer cells, called micrometastases, found in the sentinel lymph nodes. It may be that the long term prognosis for patients when there are micrometastases in sentinel nodes is the same as when no cancer cells are found. If the prognosis is the same, it may be possible to avoid removal of all the axillary nodes in these patients. All patients taking part in this trial receive additional standard therapy following surgery to further reduce the growth of any remaining cancer cells. This trial studies factors such as the rate of breast cancer recurrence (return of the cancer), and short and longer term complications of surgery. IBCSG 23-01 is of considerable importance in terms of improving outcomes for women with breast cancer and also in understanding breast biology. The ANZ BCTG has enrolled 25 of the 730 patients participating in this trial internationally (31 March 2009). 24 ANZ BCTG Annual Report 2008-2009 Lead International Group: International Breast Cancer Study Group (IBCSG) ANZ BCTG Study Co-Chairs: Assoc Prof Ian Campbell (Waikato Hospital, NZ) Prof John Collins (Royal Melbourne Hospital) First ANZ BCTG Participant Enrolled: 2 March 2006 Patient Population Breast carcinoma ( ≤ 5 cm macroscopic) Clinically node-negative One or more micrometastatic sentinel lymph nodes (≤ 2 mm; no extracapsular extension) Stratification Institution Menopausal status Preoperative SNB under local anaesthesia (Y/N) SNB * Pathological exam Primary BC surgery Pathological exam of primary tumour R E G I S T R & A T I O N R A N D O M I S A T I O N A Ax B no Ax * Confirmation that the primary tumour is macroscopically ≤ 5 cm, one or more micrometastatic (≤ 2 mm) sentinel node(s), with no extracapsular extension by pathological examination. Adjuvant treatment: patients will be eligible for enrolment in protocols of the IBCSG. (Section 5.4 of protocol) Ax: axillary lymph node dissection SNB: sentinel node biopsy Systemic Therapy Trials Breast cancer may spread from the breast to other parts of the body through the lymphatic system and blood vessels. This can lead to subsequent recurrence of breast cancer as a secondary cancer in another organ (known as advanced or metastatic breast cancer). The use of systemic drug therapies after surgery, for example chemotherapy, has been proven to reduce the risk of breast cancer recurrence and has saved many lives over the past 30 years. Changes in adjuvant therapy over recent years, due to the greater use of aromatase inhibitors, taxanes, other systemic therapies and trastuzumab, means that fewer women are relapsing, however, those who do relapse clearly require different, more targeted types of treatment. Current systemic therapy trials therefore aim to refine drug treatments in particular subgroups of women who remain at higher risk of recurrence despite standard treatments. This includes women whose cancers do not express hormone receptors (ER/PR-negative), or over express HER2 receptors (HER2-positive); or women who are very young. ANZ BCTG Annual Report 2008-2009 25 IBCSG 22-00 Low-dose cytotoxics as “anti-angiogenesis treatment” following adjuvant induction chemotherapy for patients with ER-negative and PgR-negative breast cancer. Several chemotherapy drugs have been shown to reduce the formation of new blood vessels (angiogenesis), which stops tumour cells from growing quickly or spreading to different parts of the body. However it is not yet known which drug combination or duration is the most effective option following surgery for breast cancer. It is possible that using lower doses of chemotherapy drugs for a longer period may be more effective, patients may experience fewer side effects, and there may be an increased benefit due to the longer treatment time. This study will determine if low-dose chemotherapy with oral cyclophosphamide and methotrexate, given for 12 months following three to six months of standard chemotherapy, delays breast cancer recurrence more effectively than short term standard chemotherapy alone for women with breast cancer that is not hormone-responsive. In IBCSG 22-00, breast cancer patients are evenly divided between two groups. One group will receive chemotherapy drugs every three to four weeks, for up to six cycles. The other group receives the same treatment as the first group, followed by low-dose chemotherapy in tablet form, taken one or two times per day, twice a week for one year. The ANZ BCTG has enrolled 56 of the 793 patients participating in this trial internationally (31 March 2009). Lead International Group: International Breast Cancer Study Group (IBCSG) ANZ BCTG Study Chair: Prof John F Forbes (Calvary Mater Newcastle) First ANZ BCTG Participant Enrolled: 12 August 2003 Stratification S U R G E R Institution Menopausal status (pre vs post) Induction chemotherapy (AC/EC x 4 vs other regimens) Y R A N D O M I S A T I O N * Approved induction chemotherapy regimens C: cyclophosphamide 50 mg/day orally M: methotrexate 2.5 mg/twice a day orally Before induction chemotherapy begins or any time prior to day 56** of the last cycle of induction induction chemotherapy* B induction chemotherapy* followed by CM x 12 months continuously for 1 year (365 days) days 1 and 2 of every week for 1 year (52 weeks) ** Amendment 3: November 2005 - extended the timing of randomisation 26 ANZ BCTG Annual Report 2008-2009 A IBCSG 24-02 / BIG 2-02 Suppression of Ovarian Function Trial (SOFT) A phase III trial evaluating the role of ovarian function suppression and the role of exemestane as adjuvant therapies for premenopausal women with endocrine-responsive breast cancer. Young, premenopausal women with breast cancer may have a poorer long term prognosis despite receiving chemotherapy. The hormone oestrogen, which is produced by the ovaries, can encourage the growth of cancer cells in patients with hormone-responsive breast cancer. If normal ovarian activity is stopped (ovarian function suppression), the production and action of oestrogen is decreased and hormone-responsive breast cancers cannot grow as quickly. Chemotherapy, hormone treatments (such as tamoxifen or an aromatase inhibitor) and stopping ovarian activity (by using the drug triptorelin, surgery, or radiation therapy) may all reduce the risk of breast cancer returning in young women with hormone-responsive breast cancer. However, it is unclear how best to combine these treatments or whether all three are necessary. SOFT is for young, premenopausal women with hormone-responsive breast cancer, who in many cases will have received adjuvant chemotherapy prior to study entry and who still have functioning ovaries. This trial will determine if exemestane or tamoxifen is the better hormone treatment for these women, and also whether turning off ovarian activity for five years further reduces relapse rates. The ANZ BCTG has enrolled 189 of the 2,276 patients participating in this trial internationally (31 March 2009). The SOFT trial is supported by a NHMRC Project Grant (2008-2010). Lead International Group: International Breast Cancer Study Group (IBCSG) ANZ BCTG Study Chair: Dr Prue Francis (Peter MacCallum Cancer Centre) First ANZ BCTG Participant Enrolled: 17 March 2005 ANZ 0701 (Co-SOFT) A substudy to the SOFT trial which evaluates the cognitive function of premenopausal women with endocrine-responsive breast cancer participating in SOFT. Potentially curative treatment for breast cancer might, in some women, have an adverse effect on their subsequent cognitive function. It is known that oestrogen has an important role in brain function. Standard treatments for hormone-responsive breast cancer (such as tamoxifen and exemestane) work by interfering with the action of oestrogen and therefore, may have an effect on brain functions such as memory and thinking. The ANZ BCTG has taken the international lead in developing the substudy Co-SOFT which uses computerised card memory games and questionnaires to monitor changes in brain function before, during and after breast cancer treatment for patients taking part in the parent SOFT trial. The ANZ BCTG has enrolled five of the 16 patients participating in this trial internationally (31 March 2009). The Co-SOFT substudy is supported by a NHMRC Project Grant (2007-2011). ANZ BCTG Annual Report 2008-2009 27 Lead International Group: ANZ BCTG ANZ BCTG Study Chair: Assoc Prof Kelly-Anne Phillips (Peter MacCallum Cancer Centre) First ANZ BCTG Participant Enrolled: 7 November 2007 Patient Population Stratification Institution R Premenopausal women with histologically proven hormone receptor-positive breast cancer G ER ≥ 10% and/or PgR ≥ 10% E Number of positive nodes (0;1 or more) No CT stratum (randomise after surgery)* S U R Y CT stratum (randomise within 8 months after completing chemotherapy)* Prior CT (Y/N) Intended method of OFS (GnRH analogue for 5 years; surgical oophorectomy; ovarian irradiation) * R A N D O M I S A T I O N Years TAM x 5 yrs OFS + TAM x 5 yrs OFS + EXE x 5 yrs 0 1 2 3 4 5 6 Cognitive Function Assessments CT: chemotherapy ≥ 2 months duration if anthracycline included; ≥ 4 months duration if no anthracycline is included TAM: tamoxifen 20 mg daily po for 5 years EXE: exemestane 25 mg daily po for 5 years OFS: ovarian function suppression - triptorelin: 3.75 mg injection every 28 days for 5 years or surgical oophorectomy or ovarian irradiation * Patients may have received tamoxifen or aromatase inhibitor prior to randomisation. Patients must remain premenopausal after chemotherapy. 28 ANZ BCTG Annual Report 2008-2009 IBCSG 25-02 / BIG 3-02 Tamoxifen and EXemestane Trial (TEXT) A phase III trial evaluating the role of exemestane plus GnRH analogue as adjuvant therapy for premenopausal women with endocrine-responsive breast cancer. This trial compares tamoxifen with the aromatase inhibitor, exemestane, in women who also have ovarian function suppression using the drug triptorelin. Women receive triptorelin plus tamoxifen or triptorelin plus exemestane. Tamoxifen and exemestane are two different types of drugs which limit the effects of oestrogen on cancer cell growth. Tamoxifen works by stopping oestrogen from fuelling cancer cells, while exemestane works by preventing the production of oestrogen. Research has shown that exemestane works better in postmenopausal women because their ovaries are no longer producing oestrogen. TEXT will determine if stopping ovarian activity in premenopausal women (ie reducing oestrogen production) will allow exemestane to work in the same way as it does for postmenopausal women. This trial is designed for patients who should receive ovarian function suppression from the start of their adjuvant breast cancer treatment. The ANZ BCTG has enrolled 191 of the 2,050 patients participating in this trial internationally (31 March 2009). The TEXT trial is supported by a NHMRC Project Grant (2008-2010). Lead International Group: International Breast Cancer Study Group (IBCSG) ANZ BCTG Study Chair: Dr Prue Francis (Peter MacCallum Cancer Centre) First ANZ BCTG Participant Enrolled: 15 September 2006 S U R G E R Y Patient Population Stratification Premenopausal women with histologically proven hormone receptor-positive breast cancer Institution ER ≥ 10% and/or PgR ≥ 10% Candidates to begin GnRH analogue from the start of adjuvant therapy CT: chemotherapy TAM: tamoxifen EXE: exemestane Triptorelin CT (Y/N) Number of positive nodes (0; 1 or more) * R A N D O M I S A T I O N Triptorelin x 5 yrs + TAM x 5 yrs ( ±CT) Triptorelin x 5 yrs + EXE x 5 yrs ( ±CT) if used, should begin at the same time as Triptorelin. ≥ 2 months duration if anthracycline is included; ≥ 4 months if no anthracycline is included 20 mg daily po for 5 years** 25 mg daily po for 5 years** 3.75 mg IM injection every 28 days for 5 years, to begin from the start of the adjuvant therapy. * Randomisation prior to receiving any adjuvant systemic therapy. ** Tamoxifen or exemestane should start after adjuvant chemotherapy has been completed or at least 6-8 weeks after the initiation of triptorelin, whichever is later. ANZ BCTG Annual Report 2008-2009 29 IBCSG 27-02 / BIG 1-02 / NSABP Trial B-37 A randomised clinical trial of adjuvant chemotherapy for radically resected loco-regional relapse of breast cancer: Chemotherapy versus Observation. Standard breast cancer treatment may involve surgery followed by a combination of radiotherapy, chemotherapy and/or hormone therapy (a drug which stops the body’s natural hormones from feeding the cancer). Despite these treatments the cancer may return to the same area (the breast, surgical scar, chest wall, or armpit) for a small number of patients. If the breast cancer returns to the same area, it is not clear if further chemotherapy will provide any additional benefit. Given the impact of chemotherapy on quality of life, it is important to understand how effective the addition of chemotherapy is at preventing the tumour from returning a second time or spreading to other areas of the body. This trial aims to answer this question. All patients receive the standard treatment (surgery and/or radiotherapy and/or hormone therapy). In addition, one half of patients also receive chemotherapy. The ANZ BCTG has enrolled two of the 147 patients participating in this trial internationally (31 March 2009). Lead International Group: International Breast Cancer Study Group (IBCSG) ANZ BCTG Study Chair: Assoc Prof Fran Boyle (Mater Sydney) First ANZ BCTG Participant Enrolled: 12 April 2006 Patient Population First loco-regional relapse invasive breast cancer Surgical resection ± RT No distant metastases Suitable for 3-6 months CT Stratification S U R G E R Y Endocrine therapy: CT: chemotherapy: RT: radiotherapy: 30 ANZ BCTG Annual Report 2008-2009 Prior CT (Y/N) ER+ and/or PgR+ Location of recurrence (breast vs Mx scar/ chest wall vs regional lymph nodes) R A N D O M I S A T I O N A B observation (± RT) ER+ and/or PgR+: endocrine therapy HER2+: trastuzumab (optional) CT (± RT) ER+ and/or PgR+: endocrine therapy HER2+: trastuzumab (optional) mandatory for ER and/or PgR receptor-positive recurrent tumours. at discretion of investigator. Must be at least 3 cycles and should start within 4 weeks of randomisation and within 16 weeks of resection of loco-regional recurrence. recommended for patients who have not received prior adjuvant RT. Patients with microscopically involved margins of resection must receive RT of ≥ 40 Gy. Patients randomised to CT should receive RT before, during or at the completion of CT. For all patients, RT must begin within 9 months of surgery. IBCSG 34-05 / SWOG S0230 Prevention Of Early Menopause Study (POEMS) A phase III trial of LHRH analogue administration during chemotherapy to reduce ovarian failure following standard adjuvant chemotherapy in early stage, hormone receptor-negative breast cancer. One in four breast cancer patients are premenopausal and chemotherapy treatment is given to these patients to destroy any remaining cancer cells after surgery, and to prevent these cells from growing and spreading to other parts of the body. Unfortunately the most common long term side effect of this treatment is early menopause. In addition to avoiding early occurrence of menopausal symptoms (hot flushes, mood changes, early bone changes and heart disease), many patients in this group also wish to prevent infertility as a result of treatment. The international trial POEMS is evaluating whether the LHRH analogue goserelin, which temporarily suppresses ovarian function, can prevent permanent ovarian failure after chemotherapy in premenopausal women with endocrine non-responsive breast cancer. In the POEMS trial, premenopausal women with breast cancer receive standard chemotherapy with or without goserelin. Menopausal symptoms are monitored and menopausal status is assessed by menstrual reporting and blood tests during the study. If goserelin proves to be effective, this will be a major step forward in reducing one of the most significant long term side effects of chemotherapy for premenopausal women with breast cancer. The ANZ BCTG has enrolled 36 of the 169 patients participating in this trial internationally (31 March 2009). Lead International Group: The Southwest Oncology Group (SWOG) and International Breast Cancer Study Group (IBCSG) ANZ BCTG Study Chair: Assoc Prof Kelly-Anne Phillips (Peter MacCallum Cancer Centre) First ANZ BCTG Participant Enrolled: 29 September 2006 Patient Population Stratification Premenopausal ≥ 18 < 50 years Age: < 40 vs 40-49 Stage I, II or IIIA breast cancer (neo)adjuvant chemotherapy regimen: 4 cycles vs 6-8 cycles anthracycline based regimen vs 6-8 cycles non-anthracycline based regimen ER- and PR- Radiotherapy: Goserelin: R A N D O M I S A T I O N Arm 1 standard (neo)adjuvant chemotherapy containing cyclophosphamide Arm 2 goserelin + standard (neo)adjuvant chemotherapy containing cyclophosphamide radiation therapy may be given to breast/chest wall/lymph node groups while on protocol treatment at clinician's discretion. 3.6 mg sc every 4 weeks - begins one week prior to first chemotherapy treatment and continues until the last chemotherapy treatment. ANZ BCTG Annual Report 2008-2009 31 IBCSG 35-07 / BIG 1-07 Study Of Letrozole Extension (SOLE) A phase III trial evaluating the role of continuous letrozole versus intermittent letrozole following four to six years of prior adjuvant endocrine therapy for postmenopausal women with hormone receptor-positive, node-positive early stage breast cancer. After initial treatment for hormone-responsive breast cancer, standard long term treatment usually includes at least five years of hormone treatment. For postmenopausal women, hormone treatment usually consists of an aromatase inhibitor such as letrozole. Half of all the recurrences in these women occur between five and 15 years after their initial diagnosis, when the five years of hormone treatment has been completed. Research has shown that extending hormone treatment beyond the usual five years may prevent or delay breast cancer recurrence and may prolong survival, but the best treatment plan and length of treatment is still unclear. Results from some smaller studies indicate that short breaks from letrozole treatment may make letrozole-resistant breast cancer cells more vulnerable to letrozole treatment when the treatment is restarted. The international trial SOLE, is evaluating whether having three-month treatment-free periods, during five years of extended letrozole treatment, will further prevent or delay breast cancer from returning. This trial is being opened progressively at ANZ BCTG participating institutions and the number enrolled is expected to increase over the next 12 months. The ANZ BCTG has enrolled five of the 425 patients participating in this trial internationally (31 March 2009). Lead International Group: International Breast Cancer Study Group (IBCSG) ANZ BCTG Study Chair: Dr Jacquie Chirgwin (Box Hill and Maroondah Hospitals) First ANZ BCTG Participant Enrolled: 19 February 2009 Patient Population Stratification Postmenopausal Institution ER and/or PgR+ early BC 4-6 years of prior AET therapy Node-positive at initial diagnosis Prior AET (AI(s) SERM(s)): AI alone, SERM alone, both SERM and AI * R A N D O M I S A T I O N LET continuously x 5 yrs Intermittent LET 9m 0 9m 12 9m 24 9m 36 12 m 48 60 * Within 12 months of the last dose of prior endocrine therapy LET: letrozole 2.5 mg daily po for 5 years of adjuvant therapy Intermittent LET: 2.5 mg daily po for the first 9 months of years 1 through 4, followed by 12 months in year 5 AET: adjuvant endocrine therapy Patients must have had proper local treatment including surgery with or without radiotherapy for primary breast cancer with no known clinical residual loco-regional disease. 32 ANZ BCTG Annual Report 2008-2009 ANZ 0702 / BIG 2-06 / N063D / EGF106708 Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation study (ALTTO) A randomised, multi-centre, open-label phase III study of adjuvant lapatinib, trastuzumab, their sequence and their combination, in patients with HER2/ErbB2-positive primary breast cancer. Many breast cancer cells have growth receptor molecules on their surface. Growth receptors are similar to antennae which protrude from the cell and allow specific molecules to attach to the cell and influence the cell’s growth. One particular type of growth receptor is known as HER2. Patients with this type of breast cancer have a greater risk of the cancer returning after their initial treatment. The current standard treatment for HER2-positive breast cancer is the drug trastuzumab which is given in combination with other adjuvant treatments. However, close to half the women with HER2-positive breast cancer treated with trastuzumab may still have a recurrence of their disease some years later, so new and more effective therapies need to be investigated. Lapatinib is a new oral HER2 blocking drug which has been shown to slow or stop the growth of HER2-positive breast cancer which has spread to other parts of the body (advanced breast cancer). Lapatinib has also been effective when trastuzumab has not worked and in treating breast cancer that has spread to the brain. The ALTTO trial will extend our knowledge of optimal HER2 therapy in women with HER2-positive breast cancer, by comparing treatment with trastuzumab alone to lapatinib alone, or combinations of trastuzumab with lapatinib. All patients will receive treatment for 12 months. Some patients may also receive chemotherapy with a taxane for the first 12 weeks of treatment if their oncologist thinks this is indicated. For the first time we have a truly global trial as it involves collaboration with research groups from North America, Europe and the ANZ BCTG all working together. This is the first such collaboration for an adjuvant study and it will help to provide reliable results at the earliest opportunity. ALTTO is the single most important trial being conducted for women with HER2-positive breast cancer. If treatment with lapatinib alone, or in combination with trastuzumab is more effective than trastuzumab alone, the outcome for these women will be improved. A substudy investigating women’s preferences for the different modalities of therapy is under development. The ANZ BCTG has enrolled 97 of the 4,681 patients participating in this trial internationally (31 March 2009). ANZ BCTG Annual Report 2008-2009 33 Lead International Group: Breast International Group (BIG) ANZ BCTG Study Chair: Assoc Prof Fran Boyle (Mater Sydney) ANZ BCTG Study Co-Chair: Dr Marion Kuper-Hommel (Waikato Hospital, NZ) First ANZ BCTG Participant Enrolled: 15 April 2008 Patient Population S U R G E R Y Stratification Completely excised HER2positive invasive breast cancer (Neo)adjuvant anthracyclinebased chemotherapy completed (≥ 4 cycles) Hormone receptor status known CT timing ER and/or PgR positive vs negative Lymph nodes not assessed (neoadjuvant chemotherapy) vs 1-3 vs ≥ 4 positive Design 1** CT completed Design 2 concurrent paclitaxel or docetaxel (12 weeks) R A N D O M I S A T I O N trastuzumab x 52 weeks lapatinib x 52 weeks trastuzumab x 12 weeks wash out x6 weeks lapatinib x 34 weeks lapatinib + trastuzumab x 52 weeks Total treatment duration: 52 weeks Design 1: all CT completed prior to randomisation Design 2: concurrent paclitaxel 80 mg/m² IV weekly (12 weeks) or docetaxel 75 mg/m² IV every 3 weeks (12 weeks) Trastuzumab only 6 mg/kg IV* every 3 weeks trastuzumab 2 mg/kg IV† weekly for 12 weeks, then 6 mg/kg IV every 3 weeks for 40 weeks Lapatinib only 1500 mg po daily 1500 mg po daily Sequential trastuzumab 2 mg/kg IV† weekly for 12 weeks → 6 week washout → lapatinib 1500 mg po daily for 34 weeks trastuzumab 2 mg/kg IV† weekly for 12 weeks → 6 week washout → lapatinib 1500 mg po daily for 34 weeks Combination lapatinib 1000 mg po daily + trastuzumab 6 mg/kg IV* every 3 weeks lapatinib 750 mg po daily + trastuzumab 2 mg/kg IV† weekly for 12 weeks, then lapatinib 1000 mg po daily + trastuzumab 6 mg/kg IV every 3 weeks for 40 weeks * 8 mg/kg IV loading dose † 4 mg/kg IV loading dose Treatment to commence within 14 days of randomisation. Radiotherapy permitted concomitantly with biologic therapy in all treatment arms (both designs), if indicated. ** Design 1 (no concurrent taxane) closed to screening on 15 March 2009 34 ANZ BCTG Annual Report 2008-2009 Consumer Advisory Panel Report The ANZ BCTG has led the way in forming partnerships with women whose lives have been affected by breast cancer and in acknowledging their valuable contributions to research and the breast cancer cause. In 1999, the Board of Directors established a Consumer Advisory Panel (CAP) to provide a consumer perspective to the ANZ BCTG research program, particularly in the area of Patient Information and Consent materials. Today, all clinical trial protocols and relevant research documents are reviewed by the CAP using guidelines developed jointly by the CAP and the ANZ BCTG. CAP members represent the interests of all women with breast cancer, and in particular, those women who have, or who are currently participating in an ANZ BCTG clinical trial. CAP members met four times over the reporting period to discuss and plan activities. Clinical Trials Activities Consumer input to clinical trial protocols has proven to be very beneficial, helping to develop improved patient materials providing more clarity and understanding for potential new clinical trial participants. Strategies are in place which encourage discussion and feedback between the CAP and researchers regarding each reviewed document. During the reporting period, CAP members reviewed three clinical trial protocols and provided feedback on Patient Information and Consent materials. The CAP also firmly believes in Quality of Life measures for appropriate clinical trials and together with the researchers of the ANZ BCTG, the CAP has helped to ensure these are an important component to the development of new clinical trials. Membership CAP members during the reporting period were: Professor Linda Reaby AM, Jennifer Bryce, Sheryl Fewster, Cheryl Grant, Sue Guthrie, Carol Whiteside and Leonie Young. Linda Reaby, Chair of CAP, took a leave of absence commencing November 2008. The Chair position has been shared by fellow CAP members Cheryl Grant and Leonie Young. CAP members are active in the following ANZ BCTG committees and external committees: ■■ Linda Reaby: Steering Committees of ANZ 0501 LATER, IBIS-II, ANZ 0502 (Neo-Gem); Scientific Advisory Committee. ■■ Jennifer Bryce: Scientific Advisory Committee, Local Therapy Sub-committee. ■■ Sheryl Fewster: Supportive Care Sub-committee. ■■ Cheryl Grant: Systemic Therapy Sub-committee; Patient representative for Australasia: ALTTO International Steering Committee; Associate Investigator on a grant application for a proposed study: PANZ-ALTTO Sub-study Investigation of Patient Preferences. ■■ eonie Young: Associate Investigator on a grant application for a proposed study - Physical Activity L and Breast Cancer Survivorship: A program of Research on Survival, Quality of Life and Associated Mechanisms – an international collaboration; and SNAC I and II Steering Committees. CAP members have helped the ANZ BCTG senior management to develop a CAP Terms of Reference (TOR) to act as a guiding document for all CAP activities. The TOR includes the purpose, guiding principles and role of CAP, along with information regarding membership, governance and resources. ANZ BCTG Annual Report 2008-2009 35 Advocacy Activities CAP activities extend beyond clinical trial protocol review, with its members actively involved in creating awareness and understanding of clinical trials via public speaking opportunities, presentations at conferences (both national and international), co-authoring of scientific papers and other publications, conduct of media interviews and consumer forums. Leonie Young represented the ANZ BCTG CAP at the NBCC International Clinical Trials Project LEAD in Paris in December 2008. The CAP assists with IMPACT - Improving Participation and Advocacy for Clinical Trials - which is a unique ANZ BCTG initiative to create a network of women who have been ANZ BCTG clinical trial participants. The CAP firmly believes that women who have experienced first-hand what it is like to participate on a clinical trial are well placed to promulgate the importance of clinical trials and the benefits for women. Thus, all components of the IMPACT Program are designed to ensure members are well equipped and able to advocate effectively for clinical trials research in their communities. A component to IMPACT is the IMPACT Advocate Program in which CAP members play a lead role in coordination and mentoring. This program is held in conjunction with the ANZ BCTG Annual Scientific Meeting and is an innovative way to provide a select group of consumers with a unique insight into the breast cancer clinical trials research process. In 2008, the program included advocates from New Zealand, New South Wales, the Australian Capital Territory and the Northern Territory. We are very grateful for the support of Associate Professor Ian Campbell, Dr Nicole McCarthy and Dr Jacquie Chirgwin who gave their time to lead the daily tutorial sessions. We were also particularly delighted to have a presentation by Margo Michaels, Director and Founder of the Education Network to Advance Cancer Clinical Trials. This is a United States organisation devoted to community centred approaches to cancer clinical trials education. Margo shared with us some of her approaches to expanding consumer influence in cancer clinical trials. The future The ANZ BCTG was one of the first clinical trials research groups to involve consumers in the planning and conduct of its research program. CAP members bring extensive and valuable connections with key breast cancer organisations and personal experience to their role, but each participates in the ANZ BCTG CAP as an independent consumer. CAP members bring the views of women to the table without constraint and provide a unique and important perspective to the research programs of the ANZ BCTG. The CAP is successful because its members have a mutual respect for each other’s beliefs and opinions. The ANZ BCTG and its CAP have fostered an attitude of collaboration built upon acceptance, sharing of information, and the desire to make a difference. This environment of collaboration and respect has been nurtured by researchers and consumers alike. It is fundamental to the ANZ BCTG’s goal of delivering benefits to women diagnosed with, or at risk of, breast cancer through the conduct of high quality clinical trials. Leonie Young Acting Chair Consumer Advisory Panel Cheryl Grant Acting Chair Consumer Advisory Panel 36 ANZ BCTG Annual Report 2008-2009 Fundraising and Education Report The generosity of the Australian community continues to support the important work of the ANZ BCTG via its fundraising and education department, the Breast Cancer Institute of Australia (BCIA). I am delighted to report that the BCIA has had its most successful fundraising year to date, raising $4.85 million from donations, corporate support and special events and projects. This increase has been achieved whilst also keeping our costs to fundraise at a minimum (26%). Income Expenditure Net Profit $4,856,949 (11% increase on previous year) $1,266,276 $3,590,673 (8.6% increase on previous year) ■■ Fundraising income does not include income from bequests ($55,000). Operational Improvements Over the past year, the BCIA has put into place several operational strategies to ensure the future growth and success of our fundraising activities. These have included a restructure of the Donations Processing Department, the employment of new staff and a reassignment of particular duties within current staff portfolios. Ongoing development of our website, specifically the online donation facility, has been a priority and an investment was made to purchase the software programming modules of our fundraising database. This has provided us with new opportunities to develop and enhance our database and to assist in decreasing the costs and response times associated with processing donations. Fundraising The “journey” our donors experience when they choose to support the BCIA is very important. Our intention is to build strong, engaging relationships over the long term and to ensure our donors receive the best possible attention and acknowledgment for their support, and the assurance that each donation is used wisely. To this end, our “donor journey” is continually being developed and refined as we respond to the individual needs of our donors. We are exploring new ways to contact donors, and we hope to learn more about those who support us by conducting special surveys over the coming 18 months. We have spent time consolidating our existing long term corporate relationships and working on new ways to enhance these relationships. We want to ensure these partnerships remain relevant and mutually beneficial. The wonderful generosity of Avon, its Sales Representatives and customers continues with the recent donation of $500,000. We are so grateful for their efforts on our behalf. ANZ BCTG Annual Report 2008-2009 37 So too, our partnership with the Commonwealth Bank continues to grow as we identify new ways of working together to promote our Australian Women’s Health Diary. The Bank, its staff and customers continue to support the diary very generously and the many unique opportunities the Bank provides to us to promote our research is very much appreciated. One of the highlights of the year has been the success of our 2009 Australian Women’s Health Diary which raised net $867,000 and achieved a 91% sales rate. We are delighted to have a loyal customer base which keeps on growing and extend our thanks to every person who purchased a diary. The team at The Australian Women’s Weekly remain committed to continually improving each new edition of the diary – no easy feat and yet always achieved! I am sincerely grateful to Jo Wiles, Deputy Editor of The Weekly, for her unfaltering commitment to this project. Education An important role of the BCIA is to facilitate knowledge and understanding of clinical trials research in the wider community. A recent highlight has been the expansion of the IMPACT Program to include women from New Zealand who have participated in an ANZ BCTG clinical trial. In addition, the facility to join IMPACT online via the BCIA website has proven successful with many women, particularly from New Zealand, joining IMPACT this way. In Summary Our fundraising and education successes over the past year have been very much a team effort. I am fortunate to work with very dedicated and motivated people who are committed to the cause and to their own professional development. I congratulate the BCIA staff on the results we have achieved this year and thank them for their efforts. Funds raised by the BCIA are crucial to ensuring ANZ BCTG researchers can pursue new research ideas at the earliest opportunity which in turn provides benefits to women who face this disease each day. Consumer advocacy activities are also important to create greater understanding and awareness of the clinical trials process and the benefits of this research for women. It is certainly a privilege and very humbling to experience first-hand the generosity of our community at large. Giving is for many a very personal experience and at times even more remarkable when you consider it is often at a time of extreme loss and heartbreak. My thanks extend to the many thousands of individual donors, community groups and clubs, small and large businesses, schools and well-known corporate identities. Please be assured your ongoing support for the ANZ BCTG research program is very much appreciated and highly valued. Julie Callaghan General Manager Breast Cancer Institute of Australia 38 ANZ BCTG Annual Report 2008-2009 Fundraising Achievements and Highlights Donations Engagement of our regular donors remains a high priority for the BCIA. New ways of communication with our donors and the timing of mail campaigns has together assisted in increasing income from donations by 6% from the previous financial year. Over the past five years, gross income from donations has increased by 48%. 2005 2006 2007 2008 2009 $1,920,787 $2,113,600 $2,267,499 $2,680,075 $2,844,488 Appeals Four appeals were conducted during the reporting period along with our special Certificate Mailing recognising the giving history of our donors. Two of these appeals included our bi-annual newsletter (Editions 20 and 21) which keeps our donors up to date with research progress and reports on fundraising activities. The newsletter is also available via our website. Regular Giving Program Membership of our Regular Giving Program has grown with many donors now committing to a regular, monthly donation. Regular giving to the BCIA helps to ensure continuity of our research programs and enables us to plan ahead to take advantage of new research opportunities. It also significantly decreases our administrative costs and for many of our donors it makes giving “easy”. New donors It is important to continually attract and secure new long term donors to our research programs. The 2008 Mother’s Day Research Appeal achieved enormous growth thanks to the support of the advertising agency Lowe and the media company Universal McCann. More than 3,400 people made a donation in lieu of a gift for Mother’s Day and each received a special Mother’s Day Card to give to their mother or someone special which acknowledged their donation. This campaign generated record income and acquired many new donors to the BCIA. ANZ BCTG Annual Report 2008-2009 39 Our National Breast Cancer Awareness Month Mail Campaign conducted in October 2008 featured the story of Sheryl Fewster, a breast cancer survivor and member of our Consumer Advisory Panel. Many thousands of people throughout Australia responded to Sheryl’s personal story of her strong family history of breast cancer and subsequent diagnosis. Sheryl Fewster with her family. Bequests Bequests are a very important source of funding for the BCIA. Through our Bequest Program we provide regular information and advice to existing donors, potential new bequestors, solicitors and other relevant legal publications. During the reporting period two bequests were received and we gratefully acknowledge the following: ■■ Estate of the late Stanley Spencer Docker ■■ Estate of the late Thelma May Towell In Memoriam Giving a gift when a friend or family member dies is a meaningful and lasting way of commemorating their life and supporting breast cancer research. The BCIA received many In Memoriam donations during the past financial year. Our In Memoriam literature and donation envelopes were also sent upon request to relatives and Funeral Homes throughout the year. We sincerely acknowledge donations made in memory of: Ms Beryl Abberton Ms Janis Broalridje Ms Ellen Cook Ms Constance Adams Ms Pam Broalridje Ms Marie Cookson Mrs Alla Andrivon Ms Olive Burchell Mrs Gina Cooper Mrs Kim Avard Ms Brenda Camisa Ms Joan Cord-Udy Ms June Bailey Mr Stephen Carlson Mrs Shelly Louise Cox Mrs Janice Banff Mrs Jan Cassar Ms Dulcie Craig Mrs Sharyn Barclay Ms Nagammal Chetty Ms Palma Cressotti Mrs Taita Beaven Mrs Helen Chu (nee Little) Mrs Arecia D’Albret Mrs Helen Bendall Mrs Carole Clark Mr Clem Davies Ms Judy Birt Ms Kendelle Clark Dawn and Ruby Ms Margaret Black Mrs Irene Clarke Ms Elizabeth Dawson Mrs Veronica Blignaut Mrs Cathy Clifford Mrs Joan Dixon Mrs Alicia Boyle Ms Betty Cohen Mrs Joanne Duff Mrs Rena Breddin Mrs Amelia Cook Ms Jean Helen Earkins 40 ANZ BCTG Annual Report 2008-2009 Ms Corinne Rose Elyard Mrs Lucia Loren Mrs Shirley Sale Ms Janis Evans Mrs Angela Ludowici Mrs Carol Sbiza Ms Pam Evans Mrs Margaret Seger Ms Maggie Fairweather Mrs Alison Rosemary MacDonald Ms Pam Farmer Mrs June Magan Ms Barbara Fisher Ms Marion Mann Mrs Laureen Smith (nee Gabbett) Mrs Michelle Fowler Ms Merle Matson Mrs Lorna Somers Mrs Valda Franklin Mrs Katie Mattner Mrs Glenda Stewart Mrs Jennifer Gabbett Ms Kerryn McCann Ms Jennifer Stone Ms Sally Gillies Ms Mary McFarlane Mrs Clare Stone Mrs Andy Grant Mrs Jane McGrath Mrs Bessie Janet Stracey Mrs Anne-Marie Groves Mrs Anna McIlwain Ms Rosemary Sutherland Mrs Francesca Gwyther Mrs Marian McKerrigan Mrs Valerie Tepper Ms Georgina Hart Ms June Megan Ms Debbie Thompson Mrs Jean Hawkins Ms Susan Meredith Mrs Ingrid Todd Ms Petra Henn Mrs Merrilyn Minter Mrs Sue Todner Ms Brenda Hertogs Mrs Virginia Money Ms Ninette Trent Mrs Marion Hilleard Miss Ruth Morgan Ms Julie Turner Mrs Marlie Holding Mrs Paula Murphy Mrs Linda Ward Ms Roslyn Hunter Mrs Patricia Natt Mrs Karyn Warren Mrs Kathryn Inglis Ms Jean Newton Mrs Connie Webb Mrs Jo Iveson Mrs Marilyn O’Brien Mrs Eve Wilcher Ms Elizabeth Johnston Ms Patricia Pandos Mrs Mary (Mollie) Wilks Mrs Joyce Johnstone (Evans) Ms Nora Gertrude Parker Ms Lyn Williams Mrs Violet Johnston Mrs Dawn Pearson Chris Wilmot Mrs Judy (Janice) Jones Mrs Marcia Gwendelyn Perrett Mr J H Wilson Mrs Kath Keeping Ms Margaret Peters Ms Kylie Jane Withers Mrs Joan Kennedy Ms Denise Peterson Ms Winnie Wong Mrs Margaret Ann Kentler Mr D Petsas Mrs Pam Woods Mr Sammy Keramas Mrs Violet Ethel Phillips Mrs Maureen Yates Mrs Lynne Kidred Ms Dorothy Porter Mr Peter Zachariassen Mrs Kylie Margaret King Mr Walter Price Mrs Lyn Zachariassen Mrs Dorothy Laughlin Mrs Gaye Prior Mr Barrie Laughnan Mrs Lynette Ravelli Mrs Jean Leeson Ms Shirley Lorraine Reed (Mills) Mrs Denise Lindsay Mrs Patricia Russell Mrs Jean Littlewood Ms Debbie Ryan Mrs Gaye Loesch Mrs Joan Salamy Ms Karen Shanks ANZ BCTG Annual Report 2008-2009 41 In Celebration Many committed donors conducted In Celebration events in lieu of gifts for special occasions throughout the past financial year. Our In Celebration packs were highly sought after as individuals chose to celebrate their birthdays, weddings and other special events in a truly “giving” way. We acknowledge the following donors for their generosity: Mrs Margaret Ashton 80th Birthday Mr and Mrs Brian Barnes Retirement Mrs Narelle Beattie Birthday Mr and Mrs Jack Bonotto 40th Wedding Anniversary Ms Carol Carmichael 60th Birthday Ms Jocelyn Chenu 60th Birthday Mrs Valerie Chick 75th Birthday Mrs Rosemary Coghlan 60th Birthday Mr Barry Crowe Birthday Mr and Mrs John Difford 50th Wedding Anniversary Ms Helen Donovan Birthday Mr Shane Duncan 50th Birthday Mrs Sue Flanigan Christmas Ms Emma Flynn Christmas Mrs Melissa Greaves Birthday Mrs Ethel Gregg Christmas Mrs Claire Grover 60th Birthday Ms Sheila Hargrave 70th Birthday Dr Lillian Hayes 60th Birthday Ms Lyn Hill 50th Birthday Ms Jocelyn Honour Christmas Mr and Mrs Scott and Kirsty Hutchinson Wedding Mrs Dorothy Kerr Birthday Mrs Beth King 60th Birthday Mrs Dorit Krawitz 70th Birthday Mr and Mrs Ron and Margaret Lawrence 50th Wedding Anniversary Mr Greig Lawrie 70th Birthday Mrs Kaye McGuffie 50th Birthday Mr and Mrs Steve and Sasha McHardy Wedding Mrs Christine McKenzie Birthday Mrs Marj McLeod Christmas Mr Darcy Melrose Hodgson Birthday Ms Cathy Miller Birthday 42 ANZ BCTG Annual Report 2008-2009 Mrs Karen Ng 60th Birthday Mrs Judy Opit 70th Birthday Mrs Helen Owens 60th Birthday Mr Russell Patrick 50th Birthday Mr and Mrs N Peace Golden Wedding Anniversary Mrs Marina Perera Christmas Mrs Dhineli Perera Christmas Ms Margaret Peters 50th Birthday Ms Liz Phillips 50th Birthday Miss Danielle Probyn 23rd Birthday Mr Jon Roberts Christmas Mrs Laurel Rowe Christmas Mrs Rose Simon 51st Birthday Mrs Nina Stillone Christmas Mrs Alana Sutcliffe Birthday Online Activity The BCIA website continues to provide information and opportunities to engage our donors and the wider community. We strive to ensure the information on our website is up to date and relevant so that visiting our site is an enjoyable and unique experience. Fundraising activity on the website during the past financial year is shown below. Merchandise purchases Registration for Avon race for research Donations received from existing donors Donations received from new donors ANZ BCTG Annual Report 2008-2009 43 Special Events and Projects Special events and projects are important activities for the BCIA. As well as generating essential income, many of our special events and projects provide a unique opportunity for the BCIA to promote the ANZ BCTG research program, often on a large scale and to many different audiences. Income from special events and projects has increased in the past financial year by 25%. We are pleased with this result which stems from increased activity in this area, along with higher revenue generated from some of our long term projects. Over the past five years, gross income from special events and projects has increased by 79%. 2005 2006 2007 2008 2009 $807,879 $877,193 $915,997 $1,154,075 $1,445,927 Australian Women’s Health Diary The Australian Women’s Health Diary is a unique project of the BCIA which first came to life in 1999. The intention was to create an ongoing source of funding for the ANZ BCTG research programs and to provide a useful and informative tool for women of all ages to assist in their general health and wellbeing. The fantastic response we receive each year to our diary from the community confirms that this diary continues to achieve these aims. We are committed to ensuring our diary continues to be relevant, informative and an essential item for both our existing, and potential new customers. The 2009 Australian Women’s Health Diary has been our most successful edition generating a net profit of $867,000, an increase of 22% on the 2008 edition. We have achieved a sales rate of 91% across all selling channels. This brings the total raised from the diary since the first edition in 1999 to net $5.1 million. This is a critical contribution to the success of our ongoing research programs. Special thanks go to our long term, committed sponsors - The Australian Women’s Weekly which produces the diary on our behalf, the Commonwealth Bank which also sells the diary to Bank staff and the general public, and Avon. We are also grateful for the personal support Chris Bath (pictured), Channel 7 news anchor, continues to give to our diary and research programs. 44 ANZ BCTG Annual Report 2008-2009 Celebrating 10 years In August 2008, we were fortunate to gather together many of those people and sponsors instrumental in the development and success of our diary over the past 10 years. A special dinner was held and those in attendance were given an inspiring update on our research progress and what has been achieved thanks to monies raised by our ongoing fundraising efforts, in particular from the diary. Representatives from our major sponsors and key individuals involved in producing the diary were presented with framed certificates showing all 10 covers of the diary. Anthony Dene, Avon; John Forbes, BCIA; Jo Wiles, The Australian Women’s Weekly; Adrianne Nixon, Lowe. Darlene Gill, Rosemary Bruce, Meegan Davies, Sharon Brown, Stephanie Osfield and Phil Napper who have all worked on the diary pictured with John Forbes. Deborah Thomas, The Australian Women’s Weekly; Dr Jacquie Chirgwin, ANZ BCTG Board Chairman; Poppy Fassos, Commonwealth Bank. ANZ BCTG Annual Report 2008-2009 45 Macquarie Links Golf Club, Sydney NSW Charlestown Golf Club, NSW. Tee Off for Breast Cancer Research This event continues to be well supported by golf clubs throughout Australia with 320 clubs participating in the 2008 event helping to raise a record $140,000. This represents a 33% increase in income from the 2007 event. Golf clubs nominate a day, or a number of days, in their event calendar to Tee Off for Breast Cancer Research. The format of the day is up to each club and many innovative ideas from clubs and their members this year contributed to the overall enjoyment and success of their events. Shortland Waters Golf Club, NSW Ladies at Easts Leisure and Golf Club NSW held a bromeliad auction and members of Mount Coolum Golf Club QLD got into the spirit of the event by offering a pink nail painting service to all golfers on the day. The creative flair of the ladies at Wauchope Golf Club NSW caused quite a stir in the golf community when the greens people found a bra and balloon “fence” on the first tee of their golf course! We congratulate the following clubs who were particularly successful in their 2008 events: Macquarie Links International Golf Club, NSW $10,240 Wynnum Golf Club, QLD $6,550 King Island Golf Club, TAS $6,233 The Vintage Golf Club, NSW $5,108 Sussex Inlet Golf Club, NSW $4,800 Richmond Golf Club, NSW $4,600 Alyangula Golf Club, NT $3,913 Hervey Bay Golf Club, QLD Mt Coolum Golf Club, QLD Hervey Bay Golf Club, QLD Mt Coolum golfers get into the spirit 46 ANZ BCTG Annual Report 2008-2009 Avon race for research Our 5km fun run and walk, Avon race for research, surpassed all expectations in 2008 attracting a record 3,380 entrants and raising a remarkable $94,000 for the BCIA. This represents a 42% increase in income and a 47% increase in participation from the 2007 event. Held on 26 October 2008 on the Newcastle Foreshore NSW, it was the most successful in the 12 year history of the race and brings the total monies raised from this event to $440,000. The online entry component proved to be very successful with a third of all entrants utilising this facility. A record number of entrants also registered for the Newcastle Permanent Sponsorship Challenge, which is a very important component to our event and contributes significantly to the overall monies raised. Using the My Sponsorship Challenge section of the website, entrants could email their sponsors requesting support and keep a track of their sponsorship tally. The introduction of timing chips was well received by all entrants and helped to streamline the registration process and time recording on the day. The technology the timing chips provided also contributed to a significant reduction in the cost and resources required to produce the post-race certificates acknowledging entrants’ participation, time and place within their chosen category. Over 120 wonderful volunteers gave their time on race day to assist in the organisation, and our thanks extend to our many sponsors who provided fantastic prizes, essential equipment and valuable promotional support. Avon generously provided a free Sunscreen and Lip Balm for every entrant who crossed the finish line. Our special thanks also go to our other major sponsors: Newcastle Permanent, The Herald, Radio Newcastle NXFM and Southern Cross Ten. ANZ BCTG Annual Report 2008-2009 47 Community Fundraising We are continually overwhelmed by the generosity and energy of the Australian community. The BCIA is fortunate to be regularly approached by individuals, community groups and clubs, schools and businesses to be the recipient of funds raised via special events they wish to conduct on our behalf. Our Fundraising Guidelines and Application Form is supplied and authorities issued to govern these important relationships. We are particularly grateful to the following who have raised essential funding for our research over the past year: ACE Radio Broadcasters, Horsham VIC Allianz Australia, Charlestown NSW Belcastro Hair, Northmead NSW Belmont Hospital STRAS Unit, Belmont NSW Bev Powell and Barb Withers, Wagga Wagga NSW Billie Bowen, Charters Towers QLD Black Lotus Yoga Studios, Enmore NSW BNC Netball Club, Merewether NSW Brunkerville Uniting Church, Brunkerville NSW Church of the Good Shepherd Handcraft Group, Kotara South NSW Dean Cook, Williamtown NSW Doug Wiskins and Joyce Workman, Pelaw Main NSW Grand Court of NSW Order of the Amaranth, Toukley NSW Gresford Women’s Bowling Club, East Gresford NSW Ivan Webster, Vermont VIC (pictured) Joanne Meehan, Castle Hill NSW Kay Wahlstedt, Cardiff NSW Leo’s Takeaway, Raymond Terrace NSW Maitland Embroiderers Incorporated, Maitland NSW Ivan Webster shaved his beard of 37 years to raise funds for the BCIA. 48 ANZ BCTG Annual Report 2008-2009 Maitland Patchwork Quilters The cheque presentation from the NSW Police Force Spokeswomen’s Network. Maitland Patchwork Quilters, Maitland NSW (pictured) Maureen Kelly, North Arm Cove NSW Milton College, North Sydney NSW Narla Village Aged Care Facility, Belmont North NSW New South Wales Police Force Spokeswomen’s Network, Parramatta NSW (pictured) North Shore Primary School, Geelong VIC Quorn Bowling Club, Quorn SA Palm Lakes Resort Social Club, Carindale QLD Patrons of the Sacred Heart Housie, Newcastle NSW Peta Allman, Roseville NSW Rachel Wadsworth, Goughs Bay VIC St Joseph’s Craft Group, North Mackay QLD St Phillip’s Christian College, Waratah NSW Sewing Bees, Salamander Bay NSW (pictured) Shoukash Jewellery, Granville NSW South of the River Hairdressing, Adamstown NSW Stockton Women’s Bowling Club, Stockton NSW Swansea Football Club, Swansea NSW (pictured) Swansea Workers Club, Swansea NSW Telstra Business Services, Southbank VIC The Trinity Connection, Summer Hill NSW Thompsons Australia, Hurstville NSW Trish Price, Palmwoods QLD Uproar Ladies Fashions, Belmont NSW Varley Country Club, Newdegate WA Woodlands Quilting Group, Wallsend NSW Sewing Bees Participants in the Swansea Football Club fundraiser. ANZ BCTG Annual Report 2008-2009 49 Corporate Support The BCIA is fortunate to receive ongoing support from a number of well-known corporate organisations. Our partnerships with these corporate organisations are successful and rewarding and each has been long term. This demonstrates the special ongoing commitment these corporate organisations share with us to save lives and bring health benefits to all Australians. Income from corporate organisations has increased by 4% from the previous year. This modest growth is reflective of our recent strategies to consolidate and build on our existing relationships. It is important to build corporate partnerships which are vibrant, successful and mutually beneficial to all involved. 2005 2006 2007 2008 2009 $561,400 $560,109 $553,466 $544,887 $566,534 ■■ This income does not include sponsorship received from the Commonwealth Bank for the Australian Women’s Health Diary. This is represented in the Special Events and Projects income. Avon We are delighted to have been in partnership with Avon Australia, its Sales Representatives and clients since 1996. Since this time, Avon has donated a remarkable $5.85 million to our research programs through the sale of Avon Pink Ribbon Products. Avon Sales Representatives do not make any profit from the sale of Pink Ribbon Products – all of the monies raised are donated to the breast cancer cause – and this makes them very special members of our research team. Avon Public Relations Manager, Ms Michaela Groves, presented Professor John Forbes, ANZ BCTG Director of Research, with a donation of $500,000 at the 2008 Avon race for research event (pictured below). These funds were raised by the sale of the Avon Pink Ribbon Key Ring and Charm Bracelet (pictured). Avon race for research, a 5km fun run/walk in Newcastle NSW, is sponsored by Avon and in 2008 more than 3,380 people received a free Avon Sunscreen and Lip Balm when they crossed the line. Avon also supports our efforts to foster and attract the best, new breast cancer researchers by sponsoring the Avon Travel Grant which provides opportunities for breast cancer researchers from 50 ANZ BCTG Annual Report 2008-2009 throughout Australia to attend the Annual Scientific Meeting (ASM) of the ANZ BCTG. Eleven grants were awarded in July 2008 to attend the ASM in Wellington, New Zealand and each recipient was very grateful for the opportunity to attend this important research forum. Avon is also a sponsor of our Australian Women’s Health Diary and in September 2008, Avon joined with the Commonwealth Bank to provide a special incentive to Bank staff to purchase the 2008 edition. For each Bank staff purchase, Avon provided a free mascara. The campaign was an overwhelming success. Commonwealth Bank The Commonwealth Bank has shared a special partnership with the BCIA since 1995 helping to raise $1.4 million for the ANZ BCTG research programs. The Commonwealth Bank sponsors the production of the Australian Women’s Health Diary and provides essential support in promoting the diary to its staff, customers and the general community. Bank staff support the diary and in 2008 purchased more than 6,500 of the 2009 edition, an increase of 1,000 from the previous year. These sales generated $52,000 and the Bank matched every purchase with an additional $1.00 donation, bringing the total raised by Bank staff to $59,000. Over the past 11 years, the combination of Bank staff sales and the Bank’s matching dollar program has generated $437,000 for our research programs. In 2007, the Bank sold the diary in selected branches nationally for the first time. Thanks to the Bank’s continued support, diaries were again available at selected Commonwealth Bank branches around Australia from October 2008 until January 2009. Bank branches sold over 5,460 copies of the 2009 edition, an increase of 44% on the previous year. During October 2008, Commonwealth Bank staff organised pink-themed events at branches throughout Australia, raising more than $5,400 from their efforts. As part of the 2009 Commonwealth Bank Cricket Series, the Hitting Cancer for Six initiative, now in its third year, saw the Bank donate $1,000 for every six hit by the Australian and South African players. The total amount raised was $45,000 and we were delighted to share this with the Prostate Cancer Foundation of Australia (PCFA). Pictured with Mike Hussey are Associate Professor Fran Boyle, ANZ BCTG Board Member and Mr Andrew Giles, CEO of the PCFA. ANZ BCTG Annual Report 2008-2009 51 The Australian Women’s Weekly The Australian Women’s Weekly has produced the Australian Women’s Health Diary on our behalf since the first edition in 1999. We are very fortunate to have a wonderful team led by Jo Wiles, Deputy Editor of The Weekly, helping to produce our diary. Many of the team, including Jo, have worked on every edition. Their expertise in writing, researching, editing, designing, promoting, producing and distributing the diary is the key to our diary’s great success. Other valued corporate sponsors include Mary Kay, Lowe, The Toner Recycler and Dateline Imports. Mary Kay Cosmetics has conducted the Warm Fuzzy Campaign since 1991. Mary Kay Directors and Consultants sell pink, fluffy Warm Fuzzies with antennae, big eyes and big feet for a gold coin donation. Mary Kay has raised over $394,000 from this initiative. Lowe is a valuable supporter of our research programs, having provided pro bono advertising advice for many of our fundraising campaigns for more than 10 years. Lowe helped to secure the support of Universal McCann for our 2008 Mother’s Day Campaign. The increased media exposure Universal McCann was able to obtain made this our most successful Mother’s Day Campaign to date. The Toner Recyler Pty Ltd specialises in the collection and distribution of empty printer and fax toner cartridges to the toner recycling industry. The BCIA receives $1.00 for every original toner cartridge collected that can be remanufactured. The Toner Recycler has donated $132,000 since 2002 from this initiative. Dateline Imports specialises in importing hair care and beauty products from around the world. In 2006, Dateline Imports launched a special range of Think Pink hair appliances and tweezers with $1.00 from the sale of each product donated to the BCIA. Dateline Imports has donated $11,287 since 2006 from this initiative. 52 ANZ BCTG Annual Report 2008-2009 Education Achievements and Highlights The BCIA plays an active role in facilitating consumer involvement in, and awareness of, the research programs of the ANZ BCTG. This includes facilitation of the Consumer Advisory Panel, management of the IMPACT Program, coordination of public consumer forums and the promotion of research results and other relevant information to the Australian and New Zealand public. Highlights for the reporting period are summarised below. IMPACT IMPACT - Improving Participation and Advocacy for Clinical Trials - is a program for women who have participated in a clinical trial conducted by the ANZ BCTG and acknowledges the contribution they have made to breast cancer prevention and cure. IMPACT aims to provide its members with reliable information so that they may become effective advocates for breast cancer clinical trials in the wider community. IMPACT membership has grown with women from New Zealand joining in 2008. This brings the membership to 1,700 women from all states and territories of Australia and New Zealand. Recruitment to the program is primarily via the IMPACT Recruitment Brochure which is provided to ANZ BCTG participating institutions to give to new clinical trial participants. Over 1,500 recruitment brochures were distributed to institutions throughout Australia and New Zealand in February 2009. The IMPACT Newsletter is produced specifically for IMPACT members to keep them informed of research progress. Editions 12 and 13 of the IMPACT newsletter were distributed to the membership in October 2008 and March 2009 respectively. An Information Session for new IMPACT members from New Zealand was held in Hamilton, New Zealand in June 2008. More than 50 women attended and they were acknowledged and thanked for their participation in the ANZ BCTG research program. It was also a wonderful opportunity to meet other women who have been through a similar experience and to hear about the latest in research progress. IMPACT Advocate Program The 3rd IMPACT Advocate Program was held in July 2008 in conjunction with the ANZ BCTG Annual Scientific Meeting (ASM) in Wellington, New Zealand. This program provides IMPACT members with the opportunity to attend the ASM where the latest worldwide research results and activities are discussed. 2008 IMPACT Advocate Graduates (l-r) Libby Burgess, Leslie Reilly, Penelope Creak, Bethel Holley, Raewyn Calvert. ANZ BCTG Annual Report 2008-2009 53 The aim of the IMPACT Advocate Program is to equip consumers with knowledge and understanding of the breast cancer clinical trials research process in order to promulgate its importance in the control of breast cancer. Five IMPACT members, including two from New Zealand, were accepted to this program in 2008 and found the experience very rewarding. Tutorial Sessions were conducted each day by ANZ BCTG researchers to help the Advocates to interpret and understand the scientific presentations. Leonie Young (left) and Linda Reaby (right) present Bethel Holley with a certificate acknowledging completion of the 2008 IMPACT Advocate Program. Associate Professor Ian Campbell leading discussion at an IMPACT Advocate Tutorial Session. Consumer Forums The ANZ BCTG conducts a public forum in conjunction with its Annual Scientific Meeting each year. In 2008, the ANZ BCTG joined with The Breast Cancer Aotearoa Coalition and the Cancer Society Wellington to present a special public forum for women in New Zealand. Over 100 women attended the forum on Saturday 5 July and learnt about the latest in research advances from international and local experts. Guest speakers included: ■■ Associate Professor Fran Boyle AM, Chair ANZ BCTG Scientific Advisory Committee ■■ Associate Professor Ian Campbell, Clinical Director, Breast Care Centre, Waikato Hospital, NZ ■■ Dr Carol Johnson, Radiation Oncologist, Wellington Blood and Cancer Centre, Wellington NZ ■■ s Margo Michaels, Executive Director and President, Education Network to Advance Cancer M Clinical Trials, Silver Spring US ■■ Professor Linda Reaby AM, Chair ANZ BCTG Consumer Advisory Panel Other Promotions The BCIA reported two research highlights to the Australian and New Zealand public during the reporting period. The first was a report on some of the excellent research presentations given at the ANZ BCTG ASM in Wellington New Zealand in July 2008. The second was a report on follow-up data for the international trial BIG 1-98 / IBCSG 18-98, which involved the largest number of women from Australia recruited to an international breast cancer treatment trial. The data was presented at the 31st San Antonio Breast Cancer Symposium in San Antonio, Texas US in December 2008. 54 ANZ BCTG Annual Report 2008-2009 Governance and Footprint The ANZ BCTG is a collaborative, national and international breast cancer clinical trials research group. It has both independent registered company status and academic status. The organisational structure of the ANZ BCTG reflects its corporate governance and operational areas of responsibility. All research conducted by the ANZ BCTG is carried out according to National and International Guidelines for Good Clinical Practice, the guidelines of the National Health and Medical Research Council (including the NHMRC Statement on Ethical Conduct in Research Involving Humans), the ethical approvals for our clinical trials, and applicable policies and regulations. The ANZ BCTG offices are located in Newcastle NSW Australia. Board of Directors (31 March 2009) Dr Jacquie Chirgwin Dr Chirgwin was elected Chair of the ANZ BCTG Board of Directors in 2005 and first became a member of the Board in 2003. She is also a member of the ANZ BCTG Scientific Advisory Committee and has had a long commitment to clinical research spanning some 20 years. Dr Chirgwin is a Medical Oncologist at Box Hill and Maroondah Hospitals in Victoria and has helped to establish breast cancer clinical trial departments in these hospitals along with the Breast Unit at Mercy Private Hospital in East Melbourne. She is a member of many national and international cancer research bodies. Professor Alan Coates AM Professor Coates is a founding member of the ANZ BCTG and has been a Board Director since 1991. He is Board Vice Chair and was the Chairman of the ANZ BCTG Scientific Advisory Committee for 13 years. He is Co-Chairman of the Scientific Committee of the International Breast Cancer Study Group which is based in Bern, Switzerland. Professor Coates served as the first Chief Executive Officer of The Cancer Council Australia from 1998 to 2006. Professor Coates has a long and distinguished international and national career in cancer research. He was awarded an AM in 2002 for services to medicine in the field of oncology, particularly breast cancer. Professor Stephen Ackland Professor Ackland was elected to the ANZ BCTG Board of Directors in 2007 and is a member of the ANZ BCTG Scientific Advisory Committee. He is a Medical Oncologist and Senior Staff Specialist in the Medical Oncology Department of the Calvary Mater Newcastle. Professor Ackland is a Director of the NSW Cancer Council, Editor of the Asia Pacific Journal of Clinical Oncology and is a member of many national and international cancer research bodies. ANZ BCTG Annual Report 2008-2009 55 Associate Professor Fran Boyle AM Associate Professor Boyle was elected to the ANZ BCTG Board of Directors in 2001 and is the Chair of the ANZ BCTG Scientific Advisory Committee. She is a Medical Oncologist and is Associate Professor of Medical Oncology at the University of Sydney, and Director of the Patricia Ritchie Centre for Cancer Care and Research at the Mater Hospital, Sydney. Associate Professor Boyle is also a Board Member of the National Breast and Ovarian Cancer Centre and of the Breast Cancer Network Australia. She has close links with health professionals across the spectrum of cancer care and with the undergraduate teaching program of the University of Sydney. Associate Professor Boyle was awarded an AM in 2008 for service to oncology as a researcher and clinician, particularly in the treatment of breast and brain cancers, to medical education, and as a contributor to professional organisations. Associate Professor Ian Campbell Associate Professor Campbell was elected to the ANZ BCTG Board of Directors in 2001 as the Board’s New Zealand Representative. He is a member of the ANZ BCTG Scientific Advisory Committee and Chair of the Local Therapy Sub-committee. He is a Surgeon and Associate Professor of Surgery with the Waikato Clinical School, University of Auckland. Associate Professor Campbell is the Clinical Director of the Breast Care Centre at Waikato Hospital in Hamilton; Chairman of the Waikato Breast Cancer Trust; and the NZ Representative on the Breast Section of the Royal Australasian College of Surgeons. He chaired the NZ Guidelines for Management of Early Breast Cancer (published August 2009) and serves on a number of breast cancer trial management or steering committees. He has a long standing commitment to cancer control and in particular to clinical research in breast cancer. Professor John Forbes Professor Forbes is a founding member of the ANZ BCTG and has been a Board Director since 1991. He is the Director of Research of the Group and a member of the ANZ BCTG Scientific Advisory Committee. Professor Forbes is also Professor of Surgical Oncology, University of Newcastle; Director, Department of Surgical Oncology, Calvary Mater Newcastle; and Medical Director, Breast Cancer Institute of Australia. He was the Group Coordinator of the ANZ BCTG Operations Office from inception to November 2007. He has had a lifetime commitment to the pursuit of quality in research through careful planning and conduct of clinical trials and is a member of many international trial steering committees, and other national and international clinical research bodies. * Retired from the Board in July 2008. 56 ANZ BCTG Annual Report 2008-2009 Associate Professor Anne Hamilton Associate Professor Hamilton was elected to the ANZ BCTG Board of Directors in 2005, and is a member of the ANZ BCTG Scientific Advisory Committee, and Chair of the Finance and Audit sub-Committee. She is a Senior Staff Specialist in Medical Oncology at the Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney and Clinical Associate Professor at the University of Sydney. Associate Professor Hamilton trained in Melbourne before furthering her training overseas in Brussels and New York. For the past 15 years she has focused her activities in the area of breast cancer, conducting a familial breast cancer risk management clinic and treating women with early and advanced disease. Associate Professor Geoff Lindeman Associate Professor Lindeman is a Clinician-Scientist elected to the ANZ BCTG Board of Directors in 2003 and is also a member of the ANZ BCTG Scientific Advisory Committee. He is a Medical Oncologist at the Royal Melbourne Hospital where he heads the RMH Familial Cancer Centre. Associate Professor Lindeman is Laboratory Head (NHMRC Senior Research Fellow) of the Victorian Breast Cancer Research Consortium Laboratory, Walter and Eliza Hall Institute of Medical Research, Melbourne and Clinical Director of the ACRF Centre for Therapeutic Target Discovery. He is a member of the kConFab Executive (a consortium studying hereditary breast cancer) and a committee member to the Victorian Cancer Biobank (a Tissue Bank for cancer research). Professor John Simes Professor Simes has been an ANZ BCTG Board Director since 1991. He is Director of the ANZ BCTG Statistical Centre located at the NHMRC Clinical Trials Centre and a member of the ANZ BCTG Scientific Advisory Committee. Professor Simes is a practising Medical Oncologist at the Royal Prince Alfred Hospital, Sydney and a Professor of Clinical Epidemiology in the School of Public Health at the University of Sydney. He is Director of the NHMRC Clinical Trials Centre (CTC), where he is responsible for the CTC’s overall research program, and is an NHMRC Senior Principal Research Fellow. He sits on many international committees planning clinical trials in cancer and cardiovascular disease and has research interests in clinical trial methods, quality of life assessment and integrating trial evidence for better decision making and individualised care. ANZ BCTG Annual Report 2008-2009 57 Scientific Advisory Committee (SAC) (31 March 2009) Assoc Prof Frances Boyle AM Chair Medical Oncologist Prof John F Forbes Vice Chair, ANZ BCTG Director of Research Surgical Oncologist Assoc Prof Ian Campbell Chair, SAC Local Therapy Sub-committee Surgical Oncologist Prof Madeleine King Co-Chair, SAC Supportive Care Sub-committee Psycho-Oncologist Dr Nicole McCarthy Chair, SAC Systemic Therapy Sub-committee Medical Oncologist Dr Robert Brown Pathologist Dr Jennifer Bryce ANZ BCTG Consumer Advisory Panel Dr Jacquie Chirgwin Medical Oncologist Assoc Prof Boon Chua Radiation Oncologist Prof Alan Coates AM Medical Oncologist Prof John Collins Surgical Oncologist Dr Prue Francis Medical Oncologist Prof Val Gebski ANZ BCTG Group Statistician Assoc Prof Michael Green Medical Oncologist Assoc Prof Anne Hamilton Medical Oncologist Assoc Prof Vernon Harvey Medical Oncologist Prof David Joseph Radiation Oncologist Prof Ron Kay Surgical Oncologist Assoc Prof Geoffrey Lindeman Medical Oncologist / Clinician-Scientist Mrs Dianne Lindsay ANZ BCTG Trials Coordination Department Dr Janine Lombard Medical Oncologist Prof Bruce Mann Surgical Oncologist Assoc Prof Kelly-Anne Phillips Medical Oncologist Prof Linda Reaby AM ANZ BCTG Consumer Advisory Panel Prof R John Simes Medical Oncologist / Statistician Assoc Prof Raymond Snyder Medical Oncologist Assoc Prof Martin Stockler Medical Oncologist Dr Anne Sullivan Medical Oncologist Prof Rob Sutherland Pathologist Dr Craig Underhill Medical Oncologist Dr Nicholas Wilcken Medical Oncologist 58 ANZ BCTG Annual Report 2008-2009 Independent Data Safety and Monitoring Committee Prof Gordon Clunie Chair Dr Colin Furnival Assoc Prof Matthew Law Prof Martin Tattersall Prof John Zalcberg Consumer Advisory Panel Members (31 March 2009) Professor Linda Reaby AM Chair (on leave from November 2008) ACT Cheryl Grant Acting Chair (November 2008 – March 2009) NSW Leonie Young Acting Chair (March 2009) Consumer Coordinator, IMPACT Program QLD Jennifer Bryce VIC Sheryl Fewster WA Sue Guthrie NZ Carol Whiteside NSW Staff Member Listing (for period 1 April 2008 to 31 March 2009) Heath Badger Treatment Trials Team Leader Lauren Boyes Treatment Trials Team Leader Dr James Bull Clinical Fellow Julie Callaghan BCIA General Manager Wendy Carmichael Chief Operating Officer Tamar Carpenter BCIA Donor Relations Officer Joanne Cranch BCIA Fundraising and Finance Officer Brooke Cross BCIA Special Projects Officer Haley Crotty Trial Coordinator Annette Dempsey Trial Coordinator Donna Douglass Clinical Trials Assistant Akiko Kato-Fong Senior Trials Coordinator ANZ BCTG Annual Report 2008-2009 59 Sharyn Frank Information Support Officer Helen Garner Personal Assistant to Professor John Forbes Kellie Gasson Administrative Officer Emma Goddard Trial Coordinator Rosemary Goodenough Trial Coordinator Leigh Hainsworth BCIA Special Projects Officer Belinda Hansen Senior Trials Coordinator Melanie Harrison Senior Trials Coordinator Sarah Heelis BCIA Gift Processing Officer Linda Hunter Recruitment and Promotions Officer Juliette Jameson Administration Assistant Judy Jobling Trial Coordinator Angela Johns Trial Coordinator Ingrid Laycock Trial Coordinator Jenny Leggett BCIA Public Relations Manager Dianne Lindsay Head of Trials Management Lauren Macnab Senior Trials Coordinator Kelly Martin BCIA Donor Development Manager Carlie Mavin Trial Coordinator Anthony Morrison Trial Coordinator Alison Newton Trial Coordinator Rose Nguyen Trial Coordinator Katie Oleksyn Trial Coordinator Lisa Paksec Ethics and Regulatory Affairs Officer Flonda Probert Senior Trials Coordinator Rebecca Ramm Quality Assurance Officer Hollie Ritchie Trial Coordinator Kristy Schmidt Senior Trials Coordinator Benno Schmidhauser Trial Coordinator Margaret Seccombe Recruitment Coordinator Christine Spiteri Business Administrator – Accounts Receivable Rochelle Thornton Prevention Trials Team Leader Jaclyn Wallace Senior Trials Coordinator Nicole Walsh Administration Officer Angie Ward Trial Coordinator Robyn Watkins Business Administrator – Human Resources Coralie Watson Trial Coordinator Julianne Webb Trial Coordinator Stacey Wilks Business Administrator – Accounts Payable Toni Worgan Business Administrator – Human Resources 60 ANZ BCTG Annual Report 2008-2009 Contact Information Trials Coordination Department Australian New Zealand Breast Cancer Trials Group Department of Surgical Oncology Calvary Mater Newcastle Locked Bag 7 Hunter Region Mail Centre NSW 2310 Australia Phone: +61 2 4985 0136 Fax: +61 2 4985 0141 Email: [email protected] Web: www.anzbctg.org Business Administration Department Australian New Zealand Breast Cancer Trials Group PO Box 283 The Junction NSW 2291 Australia Phone: +61 2 4925 5255 Fax: +61 2 4925 3068 Email: [email protected] [email protected] Web: www.anzbctg.org Fundraising and Education Department Breast Cancer Institute of Australia PO Box 283 The Junction NSW 2291 Australia Phone: +61 2 4925 3022 Fax: +61 2 4925 3068 Email: [email protected] [email protected] Web: www.bcia.org.au ANZ BCTG Annual Report 2008-2009 61 This page is intentionally blank. 62 ANZ BCTG Annual Report 2008-2009 Contributors, Members and Supporters International Collaborators Breast International Group (BIG) Belgium Breast European Adjuvant Studies Team (BrEAST) Belgium Cancer International Research Group (CIRG) France Cancer Trials Support Unit (CTSU) US Clinical Trial Service Unit (CTSU) UK Cancer Research UK (CRUK) UK International Breast Cancer Study Group (IBCSG) Switzerland and US National Institute of Canada, Clinical Trials Group (NCIC-CTG) Canada National Surgical Adjuvant Breast and Bowel Project (NSABP) US Swiss Group for Clinical Cancer Research (SAKK) Switzerland Southwest Oncology Group (SWOG) US Participating Institutions Australian Capital Territory The Canberra Hospital Capital city – Garran ACT New South Wales Armidale Hospital Regional – Armidale Bankstown – Lidcombe Hospital Capital city – Sydney – Bankstown The Breast Centre Regional – Gateshead Calvary Mater Newcastle City – Newcastle Coffs Harbour Health Campus Regional – Coffs Harbour Concord Repatriation and General Hospital Capital city – Sydney – Concord Lingard Private Hospital City – Newcastle Lismore Base Hospital Regional – Lismore Liverpool Hospital Capital city – Sydney – Liverpool Macarthur Cancer Therapy Centre Capital city – Sydney – Campbelltown Manning Rural Referral Hospital Regional – Taree The Mater Hospital Capital city – Sydney – North Sydney Nepean Cancer Care Centre Capital city – Sydney – Kingswood Port Macquarie Base Hospital Regional – Port Macquarie Prince of Wales Hospital Capital city – Sydney – Randwick Riverina Cancer Care Centre Regional – Wagga Wagga ANZ BCTG Annual Report 2008-2009 63 Royal Hospital for Women Capital city – Sydney – Randwick Royal North Shore Hospital Capital city – Sydney – St Leonards Royal Prince Alfred Hospital Capital city – Sydney – Camperdown Southern Highlands Cancer Centre Regional – Bowral St George Hospital Capital city – Sydney – Kogarah St Vincent’s Hospital Capital city – Sydney – Darlinghurst Sydney Adventist Hospital Capital city – Sydney – Wahroonga Sydney Haematology and Oncology Clinic Capital city – Sydney – Hornsby Tamworth Rural Referral Hospital Regional – Tamworth The Tweed Hospital Regional – Tweed Heads Westmead Hospital Capital city – Sydney – Westmead Queensland Mater Adult Hospital Capital city – Brisbane – South Brisbane Mater Private Medical Centre Capital city – Brisbane – South Brisbane Nambour Hospital Regional – Nambour Princess Alexandra Hospital Capital city – Brisbane – Woolloongabba Royal Brisbane and Women’s Hospital Capital city – Brisbane – Herston St Andrew’s Toowoomba Hospital Regional – Toowoomba Toowoomba Base Hospital Regional – Toowoomba Townsville General Hospital Regional – Townsville Wesley Medical Centre Capital city – Brisbane – Auchenflower South Australia Ashford Cancer Centre Capital city – Adelaide – Ashford Flinders Medical Centre Capital city – Adelaide – Bedford The Queen Elizabeth Hospital Capital city – Adelaide – Woodville Royal Adelaide Hospital Capital city – Adelaide St Andrew’s Medical Centre Capital city – Adelaide Tasmania North West Regional Hospital Regional – Burnie Launceston General Hospital Regional – Launceston Royal Hobart Hospital Capital city – Hobart Victoria The Alfred Hospital Capital city – Melbourne – Prahran Austin Health Capital city – Melbourne – Heidelberg 64 ANZ BCTG Annual Report 2008-2009 Ballarat Oncology and Haematology Services Regional – Wendouree The Bendigo Hospital Regional – Bendigo Border Medical Oncology Regional – Wodonga Box Hill Hospital Capital city – Melbourne – Box Hill Cabrini Hospital Capital city – Melbourne – Malvern Epworth Richmond Hospital Capital city – Melbourne – Richmond Frankston Hospital Regional – Frankston Frankston Private Regional – Frankston The Geelong Hospital Regional – Geelong Maroondah Hospital Capital city – Melbourne – Maroondah Mercy Private Hospital Breast Unit Capital city – Melbourne – East Melbourne Monash Breast Clinic Capital city – Melbourne – Clayton Monash Medical Centre Capital city – Melbourne – East Bentleigh Peter MacCallum Cancer Centre Capital city – Melbourne – East Melbourne The Royal Melbourne Hospital Capital city – Melbourne – Parkville St Vincent’s Hospital Capital city – Melbourne – Fitzroy Western Hospital Capital city – Melbourne – Footscray Western Australia Fremantle Hospital Regional – Fremantle Mount Hospital Capital city – Perth Royal Perth Hospital Capital city – Perth St John of God Hospital Regional – Bunbury St John of God Hospital Capital city – Perth – Subiaco Sir Charles Gairdner Hospital Capital city – Perth – Nedlands New Zealand Auckland City Hospital City – Auckland Christchurch Hospital Regional – Christchurch Dunedin Hospital Regional – Dunedin North Shore Hospital City – Auckland Palmerston North Hospital Regional – Palmerston North Waikato Hospital Regional – Hamilton Wellington Hospital Capital city – Wellington ANZ BCTG Annual Report 2008-2009 65 Group Members Breast Physicians Brennan, Meagan Westmead Hospital Chen, Juliana NSW Breast Cancer Institute Fox, Jane Monash Medical Centre Freese, Sonja North Shore Hospital Gilbert, Linda Godbolt, Patricia Humeniuk, Vlad Logan, David Newcastle Private Hospital Medical Suites Mann, Lynne Auburn Hospital Masters, Richard Box Hill Hospital Read, Katrina Sardelic, Frank Breastscreen North-West Snook, Kylie North Shore Medical Centre Spellman, Louise Waikato Hospital Stoney, David Private Practice Westmead NSW Westmead NSW East Bentleigh VIC Takapuna Auckland NEW ZEALAND Hamilton NEW ZEALAND Taringa QLD Henley Beach SA New Lambton HeightsNSW Auburn NSW Box Hill VIC Melbourne VIC Tamworth NSW St Leonards NSW Hamilton NEW ZEALAND Ringwood VIC Study Coordinators / Research Nurses Anderson, Robyn Sir Charles Gairdner Hospital Badger, Heath ANZ BCTG Barry, Helen St John of God Hospital Bowers, Jayne Wellington Blood and Cancer Centre Boyes, Lauren ANZ BCTG Bracken, Karen NHMRC Clinical Trials Centre Bradbury, Jo Alfred Hospital Brown, Anna North Shore Hospital Buchanan, Daisy Prince of Wales Hospital Cakir, Burcu NHMRC Clinical Trials Centre Cavanagh, Shelley Waikato Hospital Chamen, Margaret Tamworth Hospital Charlton, Julie Lingard Private Hospital Clark, Sharon The Tweed Hospital Cocks, Christine Nambour General Hospital Coulter, Kristine Cox, Lynette Sir Charles Gairdner Hospital Crotty, Haley ANZ BCTG Dafo, Melissa Calvary Mater Newcastle Dalley, Dale St Vincent’s Hospital Daly, Michelle North Coast Cancer Institute Dash, Denise Mater Hospital D’Aulerio, Giuliana Cancer Council Clinical Trials Dean, Sally Calvary Mater Newcastle Dempsey, Annette ANZ BCTG Dhillon, Haryana University of Sydney Dryden, Julie Box Hill Hospital Dwyer, Miriam Haematology and Oncology Clinics Of Australasia Edhouse, Pam Royal North Shore Hospital Ellis, Lisa Southern Highlands Cancer Centre Ficatas, Helen Box Hill Hospital Fong, Akiko ANZ BCTG French, Julie The Garvan Institute Giddins, Suzanne Box Hill Hospital Goikhman, Albert Peninsula Oncology Centre Goodenough, Rosemary ANZ BCTG 66 ANZ BCTG Annual Report 2008-2009 Nedlands Newcastle Bunbury Wellington South Newcastle Camperdown Melbourne Takapuna Auckland Randwick Camperdown Hamilton Tamworth Merewether Tweed Heads Nambour Wagga Wagga Nedlands Newcastle Waratah Darlinghurst Coffs Harbour North Sydney Nedlands Waratah Newcastle Sydney Box Hill Milton St Leonards Bowral Box Hill Newcastle Darlinghurst Box Hill Frankston Newcastle WA NSW WA NEW ZEALAND NSW NSW VIC NEW ZEALAND NSW NSW NEW ZEALAND NSW NSW NSW QLD NSW WA NSW NSW NSW NSW NSW WA NSW NSW NSW VIC QLD NSW NSW VIC NSW NSW VIC VIC NSW Grundy, Renae Hague, Wendy Hammer, Elizabeth Hansen, Belinda Harrower, Yvonne Healey, Danielle Hemmings, Rebecca Henderson, Kelly Hoogeveen, Gillian Hoque, Mafizul Houghton, Susan Howarth, Gabrielle Howell, Deb Humm, Gillian Hurford, Melanie Innes-Rowe, Judy Janik, Marie Jobling, Judith Johns, Angela Jolly, Lynne Jones, Jeremy Joppa, Barbara Kelly, Kris Kendall, Wendy Kilmurray, Janice Ko, Sarah Laycock, Ingrid Lim, Yen Peng Lindsay, Dianne Long, Sarah Low, Jaclyn Macnab, Lauren Maliepaard, Sharon Mavin, Carlie May, Jennifer McColl, Sonya McCourt, Junie Metcalfe, Debbie Morrison, Anthony Mueller, Helen Murray, Bronwyn Neave, Lorraine Newton, Alison Nguyen, Rose Oleksyn, Katie Oliver, Lesley Paksec, Lisa Pasanen, Leeanne Petersen, Jennifer Plenge, Patricia Pollard, Elizabeth Porten, Lauren Power, Ann-Marie Preston, Cecelia Probert, Flonda Rajandran, Hema Ramm, Rebecca Ranieri, Nadia Raschke, Nicole Royal Hobart Hospital NHMRC Clinical Trials Centre Royal Hobart Hospital ANZ BCTG Calvary Mater Newcastle Mercy Private Hospital Tamworth Hospital Waikato Hospital Royal Melbourne Hospital Bankstown-Lidcombe Hospital Alfred Hospital Sir Charles Gairdner Hospital Cancer Council Victoria Midcentral District Health Launceston Hospital Sir Charles Gairdner Hospital Sydney Breast Cancer Institute ANZ BCTG ANZ BCTG St Vincent’s Hospital Nepean Cancer Care Centre Auckland Hospital The Breast Centre Riverina Cancer Care Centre Trans Radiation Oncology Group Auckland Hospital ANZ BCTG Sydney Breast Cancer Institute ANZ BCTG King Edward Memorial Hospital ANZ BCTG ANZ BCTG Frankston Hospital ANZ BCTG Canberra Hospital Wesley Research Institute Nepean Cancer Care Centre Waikato Hospital ANZ BCTG NHMRC Clinical Trials Centre Royal Prince Alfred Hospital North Shore Hospital ANZ BCTG ANZ BCTG ANZ BCTG Royal Hobart Hospital ANZ BCTG St Vincent’s Hospital Cancer Council Victoria St Vincent’s Hospital Sir Charles Gairdner Hospital North Shore Hospital St Vincent’s Hospital Nambour General Hospital ANZ BCTG Sir Charles Gairdner Hospital ANZ BCTG St Vincent’s Hospital North Coast Cancer Institute Hobart Camperdown Hobart Newcastle Waratah East Melbourne Tamworth Hamilton Parkville Bankstown Melbourne Nedlands Carlton Palmerston North Launceston Nedlands Camperdown Newcastle Newcastle Darlinghurst Penrith Auckland Gateshead Wagga Wagga Newcastle Auckland Newcastle Camperdown Newcastle Subiaco Newcastle Newcastle Frankston Newcastle Woden Auchenflower Penrith Hamilton Newcastle Camperdown Camperdown Takapuna Auckland Newcastle Newcastle Newcastle Hobart Newcastle Fitzroy Carlton Darlinghurst Nedlands Takapuna Auckland Fitzroy Nambour Newcastle Nedlands Newcastle Fitzroy Port Macquarie TAS NSW TAS NSW NSW VIC NSW NEW ZEALAND VIC NSW VIC WA VIC NEW ZEALAND TAS WA NSW NSW NSW NSW NSW NEW ZEALAND NSW NSW NSW NEW ZEALAND NSW NSW NSW WA NSW NSW VIC NSW ACT QLD NSW NEW ZEALAND NSW NSW NSW NEW ZEALAND NSW NSW NSW TAS NSW VIC VIC NSW WA NEW ZEALAND VIC QLD NSW WA NSW VIC NSW ANZ BCTG Annual Report 2008-2009 67 Raymond, Bronwyn Royal North Shore Hospital Richards, Kate Peter MacCallum Cancer Centre Rine, Cheryl NCCI Port Macquarie Base Hospital Ritchie, Hollie ANZ BCTG Roberts, Pamela Armidale Hospital Scarlet, Jenni Waikato Hospital Scher, Barbara Cabrini Hospital Schmidt, Kristy ANZ BCTG Scott, Karen Alfred Hospital Shaw, Susan University of Tasmania Sheather, Kimberley Mater Hospital Sherman, Peter Royal Melbourne Hospital Silcock, Judith The Breast Centre Smith, Robin Alfred Hospital Smith, Joanne North Coast Cancer Institute Sporle, Jennifer Sproule, Victoria Calvary Mater Newcastle Stoneley, Adam Princess Alexandra Hospital Suffolk, Jennifer Princess Alexandra Hospital Teriana, Nory Royal Prince Alfred Hospital Thomas, Wendy Waikato Hospital Thompson, Kerin Auckland Regional Cancer and Blood Services Thornton, Rochelle ANZ BCTG Tipene, Marita Nepean Cancer Care Centre Trend, Stephanie Sir Charles Gairdner Hospital Wang, Xiaolu Liverpool Hospital Ward, Angie ANZ BCTG Watson, Coralie ANZ BCTG Webb, Julianne ANZ BCTG Wegener, Vicky Sydney West Cancer Trials Centre Wellington, Karen Bendigo Hospital Whatman, Anne Campbelltown Hospital Whitney, Suzanne Lismore Base Hospital Wilkinson, Lisa Western Hospital Wilks, Anne North West Regional Hospital Williams, Philippa NCCI Port Macquarie Base Hospital Winter, Rosemary NSW Breast Cancer Institute Withers, Emma St Vincents Hospital, Melbourne Wong, Shuet Oi Bankstown-Lidcombe Hospital Wood, Janice North Shore Hospital Woolett, Anne Geelong Hospital Wysman, Kirrilli St Vincent’s Hospital St Leonards East Melbourne Port Macquarie Newcastle Armidale Hamilton Malvern Newcastle Melbourne Launceston North Sydney Parkville Gateshead Melbourne Coffs Harbour Fitzroy Newcastle Woolloongabba Woolloongabba Camperdown Hamilton Auckland Newcastle Penrith Nedlands Liverpool Newcastle Newcastle Newcastle Westmead Bendigo Campbelltown Lismore Footscray Burnie Port Macquarie Westmead Fitzroy Bankstown Takapuna Auckland Geelong Fitzroy NSW VIC NSW NSW NSW NEW ZEALAND VIC NSW VIC TAS NSW VIC NSW VIC NSW VIC NSW QLD QLD NSW NEW ZEALAND NEW ZEALAND NSW NSW WA NSW NSW NSW NSW NSW VIC NSW NSW VIC TAS NSW NSW VIC NSW NEW ZEALAND VIC VIC Tweed Heads Waratah Brisbane Waratah Elizabeth Vale Campbelltown Palmerston North Gosford Bankstown Auckland North Sydney Parkville Perth Auchenflower NSW NSW QLD NSW SA NSW NEW ZEALAND NSW NSW NEW ZEALAND NSW VIC WA QLD Medical Oncologists Abdi, Ehtesham Abell, Fiona Abraham, Rick Ackland, Stephen Adams, Jacqui Adams, Diana Allen, Simon Aroney, Rodney Asghari, Ray Ashley, Amanda Baron-Hay, Sally Basser, Russell Bayliss, Evan Beadle, Geoffrey 68 ANZ BCTG Annual Report 2008-2009 The Tweed Hospital Calvary Mater Newcastle Brisbane Private Hospital Calvary Mater Newcastle Lyell McEwin Hospital Macarthur Cancer Therapy Centre Palmerston North Hospital Gosford Hospital Bankstown-Lidcombe Hospital Auckland Hospital Mater Hospital Royal Melbourne Hospital Royal Perth Hospital Wesley Medical Centre Beale, Philip Royal Prince Alfred Hospital Begbie, Stephen Port Macquarie Base Hospital Beith, Jane Royal Prince Alfred Hospital Bell, Richard Geelong Hospital Bell, David Royal North Shore Hospital Biddulph, Jane Auckland City Hospital Blum, Robert Bendigo Hospital Bonaventura, Antonino Calvary Mater Newcastle Bond, Rodney Ballarat Oncology and Haematology Services Boyce, Adam Lismore Base Hospital Boyle, Fran Mater Hospital Brigham, Brian Prince of Wales Hospital Briscoe, Karen Coffs Harbour Health Campus Buck, Martin Bunbury Hospital Bull, James ANZ BCTG Burns, Ivon St Vincent’s Hospital Byard, Ian Byrne, Michael Chan, Arlene Mount Hospital Chantrill, Lorraine Macarthur Cancer Therapy Centre Cheong, Kerry Alison Ashford Cancer Centre Chern, Boris Redcliffe Hospital Chipman, Mitchell Warringal Medical Centre Chirgwin, Jacquie Box Hill / Maroondah Hospital Clarke, Kerrie Border Medical Oncology Coates, Alan International Breast Cancer Study Group Colosimo, Maree Holy Spirit Northside Hospital Craft, Paul Canberra Hospital Cronk, Michelle Nambour General Hospital Dalley, David St Vincent’s Hospital Davis, Alison The Canberra Hospital Day, Fiona Peter MacCallum Cancer Centre De Boer, Richard Royal Melbourne Hospital / Western Hospital De Souza, Paul St George Hospital Della-Fiorentina, Stephen Campbelltown Hospital Dewar, Joanna Sir Charles Gairdner Hospital Durrant, Simon Royal Brisbane and Women’s Hospital Dzhelali, Marina Wellington Blood and Cancer Centre Edwards, James Wellington Blood and Cancer Centre Eek, Richard Liverpool Hospital Findlay, Michael Auckland Hospital Fitzharris, Bernie Christchurch Hospital Foo, Serene Austin Health Forgeson, Garry Palmerston North Hospital Forouzesh, Bahram Riverina Cancer Care Centre Francis, Prue Peter MacCallum Cancer Centre Friedlander, Michael Prince of Wales Hospital Gainford, Corona NHMRC Clinical Trials Centre Ganju, Vinod Frankston Hospital Goggin, Leigh Sir Charles Gairdner Hospital Goldrick, Amanda Liverpool Hospital Goldstein, David Prince of Wales Hospital Goss, Geraldine Maroondah Hospital Breast Clinic Green, Michael Royal Melbourne Hospital / Western Hospital Grimison, Peter NHMRC Clinical Trials Centre Grossi, Marisa Peter MacCallum Cancer Centre Grygiel, John St Vincent’s Hospital Hamilton, Kate Ballarat Health Services Hamilton, Anne Royal Prince Alfred Hospital Camperdown Port Macquarie Camperdown Geelong St Leonards Auckland Bendigo Waratah Wendouree Lismore North Sydney Randwick Coffs Harbour Bunbury Newcastle Fitzroy West Hobart Gidgegannup Perth Campbelltown Ashford Redcliffe Heidelberg Box Hill Wodonga Centennial Park Chermside Woden Nambour Darlinghurst Garran East Melbourne Parkville Kogarah Campbelltown Nedlands Herston Wellington South Wellington South Liverpool Auckland Christchurch Heidelberg Palmerston North Wagga Wagga East Melbourne Randwick Camperdown Frankston Nedlands Liverpool Randwick Ringwood East Parkville Camperdown East Melbourne Darlinghurst Ballarat Camperdown NSW NSW NSW VIC NSW NEW ZEALAND VIC NSW VIC NSW NSW NSW NSW WA NSW VIC TAS WA WA NSW SA QLD VIC VIC VIC NSW QLD ACT QLD NSW ACT VIC VIC NSW NSW WA QLD NEW ZEALAND NEW ZEALAND NSW NEW ZEALAND NEW ZEALAND VIC NEW ZEALAND NSW VIC NSW NSW VIC WA NSW NSW VIC VIC NSW VIC NSW VIC NSW ANZ BCTG Annual Report 2008-2009 69 Harnett, Paul Harris, Marion Harrup, Rosemary Harvey, Vernon Hawson, Geoffrey Haydon, Andrew Hill, Jane Hitchins, Robert Holmes, Romayne Hovey, Elizabeth Isaacs, Richard Jameson, Michael Jeffery, Mark Jennens, Ross Joshi, Rohit Joubert, Warren Kannourakis, George Karapetis, Christos Kefford, Richard Kennedy, Ian Kichenadasse, Ganessan Kiely, Belinda Kirsten, Fred Koczwara, Bogda Kotasek, Dusan Kuper-Hommel, Marion Lee, Chee Khoon Lewis, Craig Lindeman, Geoffrey Loi, Sherene Lombard, Janine Lowenthal, Ray Lynch, Jodi Mainwaring, Paul Malden, Trevor Marx, Gavin McCarthy, Nicole McCrystal, Michael McLachlan, Sue-Anne McLaren, Blair McLennan, Roger McNeil, Catriona Mileshkin, Linda Millward, Michael Mitchell, Gillian Moon, Sarah Moylan, Eugene Ng, Siobhan Nottage, Michelle Nowak, Anna Olver, Ian Patterson, Kevin Pavlakis, Nick Perez, David Phillips, Kelly-Anne Pittman, Ken Porter, David Potasz, Nicole Ransom, David 70 ANZ BCTG Annual Report 2008-2009 Westmead Hospital Westmead Monash Medical Centre East Bentleigh Royal Hobart Hospital Hobart Auckland Hospital Auckland Nambour General Hospital Nambour Alfred Hospital Melbourne Riverina Cancer Care Centre Wagga Wagga Pacific Private Clinic Southport Alfred Hospital Melbourne Prince of Wales Hospital Randwick Palmerston North Hospital Palmerston North Waikato Hospital Hamilton Christchurch Hospital Christchurch Mercy Private Hospital East Melbourne Royal Adelaide Hospital Adelaide Princess Alexandra Hospital Woolloongabba Ballarat Oncology and Haematology Services Wendouree Flinders Medical Centre Bedford Park Westmead Hospital Westmead Waikato Hospital Hamilton Flinders Medical Centre Bedford Park NHMRC Clinical Trials Centre Camperdown Bankstown-Lidcombe Hospital Bankstown Flinders Medical Centre Bedford Park Ashford Cancer Centre Ashford Waikato Hospital Hamilton NHMRC Clinical Trials Centre Camperdown Prince of Wales Hospital Randwick Royal Melbourne Hospital Parkville Breast International Group Calvary Mater Newcastle Waratah Royal Hobart Hospital Hobart St George Hospital Kogarah Haematology and Oncology Clinics of Australasia Pty Ltd South Brisbane St Andrew’s Medical Centre Adelaide Royal North Shore Hospital / Private Hornsby Royal Brisbane and Women’s Hospital Herston Auckland Hospital Auckland St Vincent’s Hospital Fitzroy Dunedin Hospital Dunedin Geelong Hospital Geelong Westmead Hospital Westmead Peter MacCallum Cancer Centre East Melbourne Sir Charles Gairdner Hospital Nedlands Peter MacCallum Cancer Centre East Melbourne Dunedin Hospital Dunedin Cork University Hospital Cork St John of God Hospital Subiaco Royal Brisbane and Women’s Hospital Herston Sir Charles Gairdner Hospital Nedlands The Cancer Council Australia Sydney Queen Elizabeth Hospital Woodville Armidale Hospital Armidale Dunedin Hospital Dunedin Peter MacCallum Cancer Centre East Melbourne Queen Elizabeth Hospital Woodville Auckland Hospital Auckland Frankston Hospital Frankston St John of God Hospital Subiaco NSW VIC TAS NEW ZEALAND QLD VIC NSW QLD VIC NSW NEW ZEALAND NEW ZEALAND NEW ZEALAND VIC SA QLD VIC SA NSW NEW ZEALAND SA NSW NSW SA SA NEW ZEALAND NSW NSW VIC BRUSSELS NSW TAS NSW QLD SA NSW QLD NEW ZEALAND VIC NEW ZEALAND VIC NSW VIC WA VIC NEW ZEALAND IRELAND WA QLD WA NSW SA NSW NEW ZEALAND VIC SA NEW ZEALAND VIC WA Redfern, Andrew Richardson, Gary Robinson, Bridget Rutovitz, Joseph Sabesan, Sabe Schwarz, Max Scott, Claire Segelov, Eva Selva-Nayagam, Sid Sewak, Sanjeev Shannon, Catherine Shannon, Jenny Simes, John Simpson, Andrew Snyder, Raymond Stewart, Josephine Stewart, John Stockler, Martin Strickland, Andrew Sullivan, Anne Tattersall, Martin Taylor, Anne Thompson, Paul Thomson, Jacquelyn Toner, Guy Tsoi, Daphne Underhill, Craig Van Hazel, Guy Vasey, Paul Walpole, Euan Ward, Robyn White, Shane White, Michelle Wilcken, Nicholas Wong, Karmen Woodward, Natasha Wyld, David Young, Rosemary Royal Perth Hospital Perth Cabrini Hospital Malvern Christchurch Hospital Christchurch Sydney Haematology and Oncology Clinics Hornsby Townsville Cancer Centre Douglas Alfred Hospital Melbourne Walter and Eliza Hall Institute Parkville St Vincent’s Hospital Darlinghurst Royal Adelaide Hospital Adelaide Geelong Hospital Geelong Mater Adult Hospital South Brisbane Nepean Cancer Care Centre Penrith NHMRC Clinical Trials Centre Camperdown Wellington Blood and Cancer Centre Wellington South St Vincent’s Hospital Fitzroy Austin Health Heidelberg Calvary Mater Newcastle Waratah Royal Prince Alfred Hospital Camperdown Monash Medical Centre East Bentleigh Royal Prince Alfred Hospital Camperdown Royal Prince Alfred Hospital Camperdown Royal Adelaide Hospital Adelaide Auckland Hospital Auckland Frankston Hospital Frankston Peter MacCallum Cancer Centre East Melbourne Sir Charles Gairdner Hospital Nedlands Border Medical Oncology Wodonga Sir Charles Gairdner Hospital Nedlands Wesley Medical Centre Auchenflower Princess Alexandra Hospital Woolloongabba St Vincent’s Hospital Darlinghurst Austin Health Heidelberg Monash Medical Centre East Bentleigh Westmead Hospital Westmead Gleneagles Medical Centre Princess Alexandra Hospital Woolloongabba Royal Brisbane and Women’s Hospital Herston Royal Hobart Hospital Hobart WA VIC NEW ZEALAND NSW QLD VIC VIC NSW SA VIC QLD NSW NSW NEW ZEALAND VIC VIC NSW NSW VIC NSW NSW SA NEW ZEALAND VIC VIC WA VIC WA QLD QLD NSW VIC VIC NSW SINGAPORE QLD QLD TAS Non Clinical Participants Bryce, Jennifer Callaghan, Julie Carmichael, Wendy Carpenter, Tamar Cranch, Joanne Douglass, Donna Fewster, Sheryl Forbes, Jenny Frank, Sharyn Garner, Helen Gasson, Kellie Grant, Cheryl Guthrie, Susan Hainsworth, Leigh Heelis, Sarah Hunter, Linda Jameson, Juliette Leggett, Jennifer ANZ BCTG Consumer Advisory Panel Breast Cancer Institute of Australia ANZ BCTG Breast Cancer Institute of Australia Breast Cancer Institute of Australia ANZ BCTG ANZ BCTG Consumer Advisory Panel Hunter Breast Screen ANZ BCTG ANZ BCTG ANZ BCTG ANZ BCTG Consumer Advisory Panel ANZ BCTG Consumer Advisory Panel Breast Cancer Institute of Australia Breast Cancer Institute of Australia ANZ BCTG ANZ BCTG Breast Cancer Institute of Australia Camberwell Newcastle Newcastle Newcastle Newcastle Newcastle South Perth Newcastle Newcastle Newcastle Newcastle Denistone Auckland Newcastle Newcastle Newcastle Newcastle Newcastle VIC NSW NSW NSW NSW NSW WA NSW NSW NSW NSW NSW NEW ZEALAND NSW NSW NSW NSW NSW ANZ BCTG Annual Report 2008-2009 71 Martin, Kelly Breast Cancer Institute of Australia Preece, Debbie Reaby, Linda ANZ BCTG Consumer Advisory Panel Seccombe, Margaret Spiteri, Christine ANZ BCTG Walker, Melanie Beleura Private Hospital Walsh, Nicole ANZ BCTG Watkins, Robyn ANZ BCTG Westland, Kristie Maroondah Hospital Breast Clinic Whiteside, Carol ANZ BCTG Consumer Advisory Panel Wilks, Stacey ANZ BCTG Worgan, Toni Young, Leonie ANZ BCTG Consumer Advisory Panel Newcastle Cardiff Heights Belconnen Valentine Newcastle Mornington Newcastle Newcastle Ringwood East Kotara South Newcastle Marylands Sunnybank NSW NSW ACT NSW NSW VIC NSW NSW VIC NSW NSW NSW QLD Waratah NSW Sydney Herston Sydney Sydney Sydney Fitzroy Parkville NSW QLD NSW NSW NSW VIC VIC Melbourne East Melbourne VIC VIC Westmead NSW Maroochydore QLD Collingwood Collingwood Takapuna Auckland Woolloongabba Herston Darlinghurst Auckland Darlinghurst East Bentleigh Darlinghurst VIC VIC NEW ZEALAND QLD QLD NSW NEW ZEALAND NSW VIC NSW Westmead Hamilton Christchurch NSW NEW ZEALAND NEW ZEALAND Nurse Counsellors Hussain, Carole Calvary Mater Newcastle Clinical Researchers Butow, Phyllis Eakin, Elizabeth Juraskova, Ilona King, Madeleine Smith, Allan Benaud Thompson, Erik Visvader, Jane University of Sydney Cancer Prevention Research Centre University of Sydney Psycho-Oncology Co-Operative Research Group University of Sydney University of Melbourne Walter and Eliza Hall Institute Endocrinologists Davis, Susan Stern, Cathryn Alfred Hospital Private Practice Geneticists Kirk, Judy Westmead Hospital Haematologists Kellner, Sybil Cotton Tree Specialist Centre Pathologists Brown, Robert Constable, Leonie Craik, Jan Francis, Glenn Lakhani, Sunil Millar, Ewan Miller, Mary O’Toole, Sandra Susil, Beatrice Sutherland, Robert Melbourne Pathology Melbourne Pathology North Shore Hospital Princess Alexandra Hospital University of Queensland Garvan Institute of Medical Research Auckland Hospital Garvan Institute of Medical Research Monash Medical Centre Garvan Institute of Medical Research Radiation Oncologists Ahern, Verity Angell, Ruth Atkinson, Christopher 72 ANZ BCTG Annual Report 2008-2009 Westmead Hospital Waikato Hospital Christchurch Hospital Benjamin, Chellaraj Bishop, Michelle Blakey, David Borg, Martin Bryant, Guy Burke, Marie-Frances Byram, David Carroll, Susan Chua, Boon Delaney, Geoff Drummond, Roslyn Francis, Michael Gauden, Stan Graham, Peter Harvey, Jennifer Ho, Annie Jacob, George Jeal, Peter Johnson, Carol Joseph, David Kenny, Lizbeth Lonergan, Denise Matthews, John Morgan, Graeme Peres, Helen Phillips, Claire Round, Glenys Stevens, Mark Taylor, Karen Wynne, Christopher Zissiadis, Yvonne Auckland Hospital Peter MacCallum Cancer Institute/Bendigo Hosp Frankston Radiation Adelaide Radiotherapy Centre Southern Zone Radiation Oncology Wesley Medical Centre Launceston Hospital Royal Prince Alfred Hospital Peter MacCallum Cancer Centre Liverpool Hospital Peter MacCallum Cancer Centre Geelong Hospital WP Holman Clinic St George Hospital Mater Queensland Radium Institute Sydney Adventist Hospital Canberra Hospital Riverina Cancer Care Centre Wellington Blood and Cancer Centre Sir Charles Gairdner Hospital Royal Brisbane and Women’s Hospital Campbelltown Hospital Auckland Hospital Royal North Shore Hospital East Coast Cancer Centre Peter MacCallum Cancer Centre Waikato Hospital Riverina Cancer Care Centre William Buckland Radiotherapy Centre Christchurch Hospital Royal Perth Hospital Auckland Bendigo Frankston Adelaide South Brisbane Auchenflower Launceston Camperdown East Melbourne Liverpool East Melbourne Geelong Launceston Kogarah South Brisbane Wahroonga Woden Wagga Wagga Wellington South Nedlands Herston Campbelltown Auckland St Leonards South Brisbane East Melbourne Hamilton Wagga Wagga Melbourne Christchurch Perth NEW ZEALAND VIC VIC SA QLD QLD TAS NSW VIC NSW VIC VIC TAS NSW QLD NSW ACT NSW NEW ZEALAND WA QLD NSW NEW ZEALAND NSW QLD VIC NEW ZEALAND NSW VIC NEW ZEALAND WA Warana Nambour West Otahuhu, Auckland Auckland QLD QLD NEW ZEALAND NEW ZEALAND Camperdown Newcastle North Ryde Camperdown NSW NSW NSW NSW Kwazulu Natal Camperdown Gateshead Hamilton Gateshead Hamilton Brisbane Strathfield Takapuna Auckland East Bentleigh Perth SOUTH AFRICA NSW NSW NEW ZEALAND NSW NEW ZEALAND QLD NSW NEW ZEALAND VIC WA Radiologists Paszkowski, Andrew Pfeiffer, Deborah Urry, Sally Whitlock, Jeremy Lakeview Imaging Breast Screen Queensland Nambour Service Middlemore Hospital Auckland Hospital Statistician/Computer Scientists Gebski, Val Green, Andrew Hudson, Malcolm Zannino, Diana NHMRC Clinical Trials Centre Newton Green Technologies Macquarie University NHMRC Clinical Trials Centre Breast Surgeons Cacala, Sharon Carmalt, Hugh Clark, David Creighton, Jane Douglas, Charles Ehrstrom, Marcus Fryar, Barry Gluch, Laurence Harman, Richard Hart, Stewart Ingram, David Greys Hospital Royal Prince Alfred Hospital The Breast Centre Waikato Hospital The Breast Centre Waikato Hospital Private Practice The Strathfield Breast Centre North Shore Hospital Monash Medical Centre Mount Hospital ANZ BCTG Annual Report 2008-2009 73 Juhasz, Eva North Shore Hospital Krishnan, Sandra NSW Breast Cancer Institute Lambley, Jason Mater Medical Centre Laura, Sharon Private Practice Law, Michael Mitcham Private Consulting Suites Littlejohn, David Private Practice Mak, Cindy Concord Hospital Moore, Katrina Royal North Shore Hospital O’Brien, Jane Peter MacCallum Cancer Centre O’Donoghue, Gerrard Royal Melbourne Hospital Pitcher, Meron Western Hospital Sacks, Nigel Lyell McEwin Hospital Scott, Belinda Breast Associates Speakman, David Peter MacCallum Cancer Centre Tasevski, Robert Royal Melbourne Hospital Thomson, David Prince of Wales Hospital Walsh, David Queen Elizabeth Hospital Whineray Kelly, Erica Takapuna Auckland Westmead Cleveland East Gosford Mitcham Wagga Wagga Concord St Leonards East Melbourne Parkville Footscray Elizabeth Vale Auckland East Melbourne Parkville Randwick Woodville Castor Bay NEW ZEALAND NSW QLD NSW VIC NSW NSW NSW VIC VIC VIC SA NEW ZEALAND VIC VIC NSW SA NEW ZEALAND Parkville VIC Torquay UNITED KINGDOM Adelaide SA Takapuna Auckland Nambour Cabramatta Westmead Waratah Camden Coffs Harbour Bankstown Campbelltown NEW ZEALAND QLD NSW NSW NSW NSW NSW NSW NSW Heidelberg Woolloongabba Melrose Park Bankstown Hamilton Heidelberg Bendigo Parkville Nambour Lismore Nambour Nambour Parkville Westmead VIC QLD SA NSW NEW ZEALAND VIC VIC VIC QLD NSW QLD QLD VIC NSW Clinical Fellow / Surgeon Skandarajah, Anita Royal Melbourne Hospital Consultant Surgeon Donnelly, Peter Torbay Hospital Endocrine Surgeon Malycha, Peter Royal Adelaide Hospital General Surgeons Gerred, Susan Grieve, David Lee, Richard Leong, Su-Lin Levy, Richard Lim, Edwin Ross, William Soon, Patsy Stewart, Katherine North Shore Hospital Nambour General Hospital Medical Centre NSW Breast Cancer Institute Melanoma Unit Private Practice Coffs Harbour Surgical Group Bankstown-Lidcombe Hospital Private Practice Surgical Oncologists Baker, Caroline Bennett, Ian Birrell, Stephen Bonar, Francis John (Tom) Campbell, Ian Castles, Lindsay Chambers, Kevin Collins, John Creighton, Lisa Curtin, Austin Darcy, Justin Donovan, Michael Efe, Narine Elder, Elisabeth 74 ANZ BCTG Annual Report 2008-2009 Austin Repatriation Medical Centre Princess Alexandra Hospital Jill Need Breast Cancer Trials Centre Bankstown-Lidcombe Hospital Waikato Hospital Austin Repatriation Medical Centre Bendigo Hospital Royal Melbourne Hospital Nambour General Hospital Lismore Base Hospital Nambour General Hospital Nambour General Hospital Royal Melbourne Hospital NSW Breast Cancer Institute Forbes, John Calvary Mater Newcastle Waratah Foster, Hamish Lismore Base Hospital Lismore French, James Westmead Hospital Westmead Furnival, Colin Wesley Medical Centre Auchenflower Gale, Timothy Alfred Hosp, Box Hill Hosp, Monash Med Centre Melbourne Gill, Peter Royal Adelaide Hospital Adelaide Gillett, David The Strathfield Breast Centre Strathfield Gregory, Peter Private Practice Brighton Hargreaves, Warren St Vincent’s Hospital Darlinghurst Hastrich, Diana Mount Hospital Perth Henderson, Michael Peter MacCallum Cancer Centre East Melbourne Hughes, Malcolm Private Practice Castle Hill Hughes, Thomas San Clinic Wahroonga Hyams, David Aptium Oncology Inc. Jones, Wayne Auckland Hospital Auckland Kay, Ron Auckland Kitchen, Paul St Vincent’s Hospital Fitzroy Kling, Neill St John of God Hospital Bunbury Mann, Bruce Royal Melbourne Hospital Parkville Millar, Robert Royal Melbourne Hospital Parkville Miller, Iain Private Practice Sale Miller, Julie Royal Melbourne Hospital Parkville Mitchell, Gregory Geelong Hospital Geelong Molland, Gail Castle Hill Day Surgery Castle Hill Moon, Dominic Westmead Hospital Westmead Murphy, Craig Royal Melbourne Hospital / Private Parkville Neil, Suzanne Monash Medical Centre East Bentleigh Ng, Alexander Auckland City Hospital Auckland Noushi, Farnoush NSW Cancer Institute Lindfield Oliver, David St John of God Hospital Murdoch Pyke, Christopher Mater Adult Hospital South Brisbane Rice, Mark Dubbo Base Hospital Dubbo Robertson, Robert Private Practice Christchurch Saunders, Christobel University of Western Australia Perth Serpell, Jonathan Frankston Oncology Group Frankston Shah, Aashit Liverpool Hospital Liverpool Simon, Robert Lismore Base Hospital Lismore Spillane, Andrew University of Sydney North Sydney Sywak, Mark Royal North Shore Hospital St Leonards Townend, David Lismore Base Hospital Lismore Ung, Owen Westmead Hospital Westmead Wetzig, Neil Wesley Medical Centre Auchenflower Wilkinson, Stephen Hobart Private Hospital Hobart NSW NSW NSW QLD VIC SA NSW VIC NSW WA VIC NSW NSW USA NEW ZEALAND NEW ZEALAND VIC WA VIC VIC VIC VIC VIC NSW NSW VIC VIC NEW ZEALAND NSW WA QLD NSW NEW ZEALAND WA VIC NSW NSW NSW NSW NSW NSW QLD TAS ANZ BCTG Annual Report 2008-2009 75 Funders and Supporters Cancer Australia Cancer Institute NSW Hunter Medical Research Institute National Breast Cancer Foundation National Health and Medical Research Council NSW Department of Health University of Newcastle Sponsors Corporate Sponsors Mary Kay The Toner Recycler Dateline Imports Lowe 2008 Avon race for research Sponsors (Major and Official) Avon Newcastle Permanent Southern Cross Ten The Herald Radio Newcastle NXFM NCP Printing Instant Access Cactus Creative Communications Curves 76 ANZ BCTG Annual Report 2008-2009 Volunteers 2008 Avon Race for Research Volunteers Mr Bob Adams Ms Jenny Dunne Mrs Margaret McNaughton Ms Kim Bauer Mrs Cate Dymond Mrs Simone Montgomery Ms Jennifer Beldham Mr Matthew Ferrie Mr Josh Mowbray Mrs Pam Bennett Mrs Jenny Forbes Mr Geoff Muldoon Mr Rob Bennett Ms Lyn Freeman Mr Matthew Nolan Ms Susan Bennett Mr Andy Gertchin Mr Chris Nottle Mr William Bennett Ms Teegan Goolmer Mr Steve Petrassie Ms Joanne Buckingham Mr Andrew Green Ms Debbie Preece Mr Kevin Burbridge Mr Paul Hawker Mr Chris Regent Ms Hannah Connor Mrs Gabrielle Hussain Mrs Gailene Rowe Mr Jim Cowburn Ms Bridie Ingham Mr John Scanlon Mr Paul Cranch Mrs Cathy Ingham Mrs Lyn Scanlon Ms Giselle Crawford Mr James Ingham Ms Becky Stokes Mr Peter Dall Mr Neil Ingham Mr Graham Walker Mr Derek Davelaar Ms Marian Jones Mrs Cathy Walmsley Mrs Carolyn Davies Mr Chris Leggett Ms Maria Walz Mr Trevor Davies Mr Paul Lindsay Ms Fiona Way Ms Marea Davoren Mr Andrew Martin Mrs Dianne West Mr John Donn Mr Anthony Martin Ms Jessica White Mrs Marilyn Donn Mrs Judith Mason Mr Gordon Whitehead * ANZ BCTG and BCIA staff were also volunteers at this event. ANZ BCTG Annual Report 2008-2009 77 This page is intentionally blank. 78 ANZ BCTG Annual Report 2008-2009 Financial Report The ANZ BCTG is a not-for-profit, collaborative, national and international breast cancer clinical trials research group. It is an independent registered company with academic affiliations. The ANZ BCTG is governed by a Board of Directors and its purpose is outlined in the Group’s Constitution. The Board of Directors established a Finance and Audit sub-Committee (FAC) to assist with its financial oversight responsibilities. This Board sub-Committee has a Terms of Reference and meets four times per year. Financial management of the ANZ BCTG has two main facets: ■■ management of ANZ BCTG finances and resources; ■■ management of competitive and other grant funds administered by other Institutions. Financial Management Because of its company status, the majority of the Group’s income is managed directly by the Group. The Chief Operating Officer undertakes day to day financial management of the Group according to the delegations vested in this position by the Board, and ensures the ANZ BCTG adheres to applicable Australian corporate, taxation and charity legislation. Sources of ANZ BCTG income: ■■ clinical trials income (pharmaceutical partnerships, international collaborative group partnerships, untied education grants); ■■ competitive grants awarded to the ANZ BCTG (Cancer Australia); ■■ fundraising income (donations, special events, corporate sponsorships, bequests); ■■ other income (ASM registrations and sponsorships, sundry). Areas of ANZ BCTG expenditure: ■■ clinical trials randomisation and statistical services; ■■ clinical trials central activation, coordination and monitoring activities; ■■ clinical trials data management reimbursement payments to participating institutions; ■■ ANZ BCTG Annual Scientific Meeting; ■■ fundraising expenses; ■■ staff member salaries; ■■ other recurrent monthly infrastructure costs and core business expenses. Financial Management of Competitive Grant Funds Administered by other Institutions The ANZ BCTG applies for and secures competitive grants. Competitive grant funding mechanisms include streams for both research and infrastructure funding, and can be sourced from many organisations including but not limited to: ■■ National Health and Medical Research Council (NHMRC) (government); ■■ Cancer Institute NSW (government); ■■ Cancer Councils (government/private); ■■ National Breast Cancer Foundation (private); ■■ Other Trusts and Foundations. ANZ BCTG Annual Report 2008-2009 79 Competitive grant funds are administered by a recognised ‘administering institution’ and it is the responsibility of the administering institution to financially and legally account for the grants it administers. The University of Newcastle is the ANZ BCTG’s usual administering institution and competitive grant funding administered by this or other institutions is not shown in the financial statements of the ANZ BCTG. During the reporting period the ANZ BCTG held the following competitive grants administered by other institutions: ■■ Six NHMRC project grants supporting the following trials: IBIS-I, IBIS-II, LATER, SOFT and TEXT, Co-SOFT and ANZ 0502; ■■ One Cancer Institute NSW infrastructure grant. The Group’s competitive grant holdings amounted to just over $2 million for the reporting period. Financial Statements The statements contained in this Financial Report are a summary of the audited accounts for the financial year ended 31 March 2009. Full audited financial statements are available by contacting the ANZ BCTG. Any ANZ BCTG surplus is committed to supporting current and future ANZ BCTG research projects. All ANZ BCTG payroll liabilities are annually expensed to the external suppliers which manage the ANZ BCTG’s payroll. Income Statement 2009 $ 2008 $ Revenues from ordinary activities 9,346,985 7,430,175 Clinical trials protocol and per patient expenses 1,799,161 1,557,214 Clinical trials program expenses 2,427,042 1,583,643 Donations and fundraising expenses 1,266,276 1,073,005 Scientific, committee and administrative meetings expenses 544,239 491,036 Other expenses 601,983 414,686 6,638,701 5,119,584 Net surplus from ordinary activities 2,708,284 2,310,601 Total changes in equity 2,708,284 2,310,601 80 ANZ BCTG Annual Report 2008-2009 Balance Sheet 2009 $ 2008 $ Cash assets 11,353,150 9,366,530 Receivables 2,017,814 1,051,052 240,700 333,146 13,611,664 10,750,728 Other financial assets 113,166 64,203 Property, plant and equipment 462,768 129,285 Total non-current assets 575,934 193,488 14,187,598 10,944,216 Payables 2,544,837 2,009,739 Total current liabilities 2,544,837 2,009,739 TOTAL LIABILITIES 2,544,837 2,009,739 11,642,761 8,934,477 Accumulated funds 11,642,761 8,934,477 TOTAL ACCUMULATED FUNDS 11,642,761 8,934,477 CURRENT ASSETS Other financial assets Total current assets NON-CURRENT ASSETS TOTAL ASSETS CURRENT LIABILITIES NET ASSETS ACCUMULATED FUNDS ANZ BCTG Annual Report 2008-2009 81 Summary Income and Expenditure Statement 2009 $ 2008 $ Clinical trials income 3,049,834 1,649,683 Donations and fundraising income 4,856,949 4,379,037 Annual Scientific Meeting income 287,543 195,532 Cancer Australia infrastructure grant 342,090 511,705 55,000 1,000 Bank interest 565,093 477,546 Other income 190,476 215,682 9,346,985 7,430,185 Clinical trials protocol and per patient expenses 1,799,161 1,557,214 Clinical trials program expenses 2,427,042 1,583,643 Donations and fundraising expenses 1,266,276 1,073,005 Scientific, committee and administrative meetings expenses 544,239 491,036 Other expenses 601,983 414,686 TOTAL EXPENSES 6,638,701 5,119,584 NET SURPLUS 2,708,284 2,310,601 INCOME Bequests TOTAL INCOME EXPENDITURE 82 ANZ BCTG Annual Report 2008-2009 Income Annual Scientific Meeting Clinical trials Donations and fundraising Bequests Cancer Australia infrastructure grant Bank interest Other Expenditure Clinical trials Donations and fundraising Scientific, committee and administrative meetings Other ANZ BCTG Annual Report 2008-2009 83 Cashflow Statement CASH FLOWS FROM OPERATING ACTIVITIES 2009 $ Inflow/ (Outflow) 2008 $ Inflow/ (Outflow) Receipts from customers, donors and external funding 8,128,497 7,430,751 565,093 477,546 (6,253,714) (5,083,980) 2,439,876 2,824,317 Purchase of property, plant and equipment (453,256) (62,700) Net cash by (used in) investing activities (453,256) (62,700) Net increase/(decrease) in cash held 1,986,620 2,761,617 Cash at the beginning of the year 9,366,530 6,604,913 11,353,150 9,366,530 2009 $ 2008 $ 2,844,488 2,680,075 797,452 726,602 2,047,036 1,953,473 Income 566,534 544,887 Expense 34,044 24,246 532,490 520,641 1,445,927 1,154,075 434,780 322,157 Net income 1,011,147 831,918 TOTAL INCOME 4,856,949 4,379,037 TOTAL EXPENDITURE 1,266,276 1,073,005 NET INCOME FROM FUNDRAISING 3,590,673 3,306,032 Interest received Payments to suppliers and employees Net cash provided by (used in) operating activities CASH FLOWS FROM INVESTING ACTIVITIES Cash at the end of the year BCIA Fundraising Income and Expenditure Statement DONATIONS Income Expense Net income CORPORATE SUPPORT Net income SPECIAL EVENTS AND PROJECTS Income Expense 84 ANZ BCTG Annual Report 2008-2009 Publications 01/01/2008 to 31/12/2008 696. ATAC Trialists’ Group. Effect of anastrozole and tamoxifen as adjuvant treatment for early-stage breast cancer: 100-month analysis of the ATAC trial. Lancet Oncol 2008; 9:45-53. 697. Bernhard J, Zahrieh D, Zhang JJ, Martinelli G, Basser R, Hürny C, Forbes JF, Aebi S, Yeo W, Thürlimann B, Green MD, Colleoni M, Gelber RD, Castiglione-Gertsch M, Price KN, Goldhirsch A, Coates AS, for the International Breast Cancer Study Group (IBCSG). Quality of life and qualityadjusted survival (Q-TWiST) in patients receiving dose-intensive or standard dose chemotherapy for high-risk primary breast cancer. Br J Cancer 2008; 98:25-33. 698. Crivellari D, Sun Z, Coates AS, Price KN, Thürlimann B, Mouridsen H, Mauriac L, Forbes JF, Paridaens R, Castiglione-Gertsch M, Gelber RD, Colleoni M, Láng I, Del Mastro L, Gladieff L, Rabaglio M, Smith I, Chirgwin J, Goldhirsch A. Letrozole compared with tamoxifen for elderly patients with endocrine-responsive early breast cancer in the BIG 1-98 trial: efficacy, treatment and adverse events. J Clin Oncol 2008; 26(12):1972-1979. 699. Crown JP, Burris III HA, Boyle F, Jones S, Koehler M, Newstat BO, Parikh R, Oliva C, Preston A, Byrne J, Chan S. Pooled analysis of diarrhea events in patients with cancer treated with lapatinib. Breast Cancer Res Treat 2008; 112:317-325. 700. Cuzick J, Sestak I, Cella D, Fallowfield L, on behalf of the ATAC Trialists’ Group. Treatmentemergent endocrine symptoms and the risk of breast cancer recurrence: a retrospective analysis of the ATAC trial. Lancet Oncol 2008; 9(12):1143-1148. 701. Dang CT, Lin NU, Lake D, Dickler MN, Modi S, Seidman AD, Steingart RM, Norton L, Winer EP, Hudis CA. Preliminary safety results of dose-dense (dd) doxorubicin and cyclophosphamide (AC) followed by weekly paclitaxel (P) with trastuzumab (T) and lapatinib (L) in HER2 overexpressed/ amplified breast cancer (BCA). ASCO 2008; 518. 702. de Azambuja E, McCaskill-Stevens W, Quinaux E, Buyse M, Crown J, Francis P, Gelber R, PiccartGebhart M. The effect of body mass index (BMI) on disease-free and overall survival in nodepositive breast cancer treated with docetaxel and doxorubicin-containing adjuvant chemotherapy: the experience of the BIG 02-98 trial. European Breast Cancer Conference 2008; Abstract 29. 703. Del Mastro L. The difficult decision-making process for using or not using adjuvant chemotherapy in premenopausal endocrine-responsive breast cancer patients. Ann Oncol 2008; 19:1213-1215. 704. Dowsett M, Allred C, Knox J, Quinn E, Salter J, Wale C, Cuzick J, Houghton J, Williams N, Mallon E, Bishop H, Ellis I, Larsimont D, Sasano H, Carder P, Cussac AL, Knox F, Speirs V, Forbes J, Buzdar A. Relationship between quantitative estrogen and progesterone receptor expression and human epidermal growth factor receptor 2 (HER-2) status with recurrence in arimidex, tamoxifen, alone or in combination trial. J Clin Oncol 2008; 26(7):1059-1065. 705. Eastell R, Adamas JE, Coleman RE, Howell A, Hannon RA, Cuzick J, Mackey JR, Beckmann MW, Clack G. Effect of anastrozole on bone mineral density: 5-year results from the anastrozole, tamoxifen, alone or in combination trial 18233230. J Clin Oncol 2008; 26(7):1051-1058. ANZ BCTG Annual Report 2008-2009 85 706. Fleming GF and Francis P. Commentary on: Survival after adjuvant oophorectomy and tamoxifen in operable breast cancer in premenopausal women. Breast Diseases: A Year Book Quarterly 2008; 19:278-279. 707. Francis P, Crown J, Di Leo A, Buyse M, Balil A, Andersson M, Nordenskjöld B, Lang I, Jakesz R, Vorobiof D, Gutiérrez J, van Hazel G, Dolci S, Jamin S, Bendahmane B, Gelber RD, Goldhirsch A, Castiglione-Gertsch M, Piccart-Gebhart M on behalf of the BIG 02-98 Collaborative Group. Adjuvant chemotherapy with sequential or concurrent anthracycline and docetaxel: Breast International Group 02-98 randomised trial. J Natl Cancer Inst 2008; 100:121-133. 708. Francis P. Surprised by Hope. J Clin Oncol 2008; 26(36):6001-6002. 709. Gao J, Warren R, Warren-Forward H, Forbes JF. Reproducibility of visual assessment of mammographic density. Breast Cancer Res Treat 2008; 180:121-127. 710. Gianni L, Cole BF, Panzini I, Snyder R, Holmberg SB, Byrne M, Crivellari D, Colleoni M, Aebi S, Simoncini E, Pagani O, Castiglione-Gertsch M, Price KN, Goldhirsch A, Coates AS, Ravaioli A. Anemia during adjuvant non-taxane chemotherapy for early breast cancer: incidence and risk factors from two trials of the International Breast Cancer Study Group. Support Care Cancer 2008; 16:67-74. 711. Goss PE, Ingle JN, Pater JL, Martino S, Robert NJ, Muss HB, Piccart MJ, Castiglione M, Shepherd LE, Pritchard KI, Livingston RB, Davidson NE, Norton L, Perez EA, Abrams JS, Cameron DA, Palmer MJ, Tu D. Late extended adjuvant treatment with letrozole improves outcome in women with early-stage breast cancer who complete 5 years of tamoxifen. J Clin Oncol 2008; 26(12):1948-1955. 712. Grimison PS, Coates AS, Forbes JF, Cuzick J, Furnival C, Craft PS, Snyder RD, Thornton R, Lindsay DF, Simes RJ. Tamoxifen for the prevention of breast cancer: importance of specific aspects of health-related quality of life (HRQL) to global health status in the ANZ BCTG substudy of IBIS-I (ANZ 92P1) COSA 2008; ABSZ2-VFS96-2PFJQ-CK839. 713. Gruber G, Cole BF, Castiglione-Gertsch M, Holmberg SB, Lindtner J, Golouh R, Collins J, Crivellari D, Thürlimann B, Simoncini E, Fey MF, Gelber RD, Coates AS, Price KN, Goldhirsch A, Viale G, Gusterson BA, for the International Breast Cancer Study Group. Extracapsular tumor spread and the risk of local, axillary and supraclavicular recurrence in node-positive, premenopausal patients with breast cancer. Ann Oncol 2008; 19:1393-1401. 714. Holmberg L, Iversen O-E, Rudenstam CM, Hammar M, Kumpulainen E, Jaskiewicz J, Jassem J, Dobaczewska D, Fjosne HE, Peralta O, Arriagada R, Holmqvist M, Maenpa J. Increased risk of recurrence after hormone replacement therapy in breast cancer survivors. J Natl Cancer Inst 2008; 100:475-482. 715. Ingle JN, Tu D, Pater JL, Muss HB, Martino S, Robert NJ, Piccart MJ, Castiglione M, Shepherd LE, Pritchard KI, Livingston RB, Davidson NE, Norton L, Perez EA, Abrams JS, Cameron DA, Palmer MJ, Goss PE. Intent-to-treat analysis of the placebo-controlled trial of letrozole for extended adjuvant therapy in early breast cancer: NCIC CTG MA.17. Ann Oncol 2008; 19:877-882. 716. Juraskova I, Butow P, Lopez A, Seccombe M, Coates A, Boyle F, McCarthy N, Reaby L, Forbes JF. Improving informed consent: pilot of a decision aid for women invited to participate in a breast cancer prevention trial (IBIS-II DCIS). Health Expectations 2008; 11:252-262. 86 ANZ BCTG Annual Report 2008-2009 717. Leyland-Jones BR, Ambrosone CB, Bartlett J, Ellis MJC, Enos RA, Raji A, Pins MR, Zujewski JA, Hewitt SM, Forbes JF, Abramovitz M, Braga S, Cardoso F, Harbeck N, Denkert C, Jewell SD. Recommendations for collection and handling of specimens from Group Breast Cancer Clinical Trials. J Clin Oncol 2008; 26(34):5638-5644. 718. Muss HB, Tu D, Ingle JN, Martino S, Robert NJ, Pater JL, Whelan TJ, Palmer MJ, Piccart MJ, Shepherd LE, Pritchard KI, He Z, Goss PE. Efficacy, toxicity, and quality of life in older women with early-stage breast cancer treated with letrozole or placebo after 5 years of tamoxifen: NCIC CTG Intergroup trial MA.17. J Clin Oncol 2008; 26(12):1956-1964. 719. Pestalozzi B, Zahrieh D, Mallon E, Gusterson BA, Price KN, Gelber RD, Holmberg SB, Lindtner J, Snyder R, Thürlimann B, Murray E, Viale G, Castiglione-Gertsch M, Coates AS, Goldhirsch A. Distinct clinical and prognostic features of infiltrating lobular carcinoma of the breast: Combined results of 15 International Breast Cancer Study Group Clinical Trials. J Clin Oncol 2008; 26(18):3006-3014. 720. Pestalozzi BC, Francis P, Quinaux E, Dolci S, Azambuja E, Gelber RD, Viale G, Balil A, Andersson M, Nordenskjöld B, Gnant M, Gutierrez J, Láng I, Crown JPA, Piccart-Gebhart M on behalf of the BIG 02-98 Collaborative Group. Is risk of central nervous system (CNS) relapse related to adjuvant taxane treatment in node-positive breast cancer? Results of the CNS substudy in the intergroup phase III BIG 02-98 trial. Ann Oncol 2008; 19:1837-1841. 721. Rasmussen, BB, Regan MM, Lykkesfeldt AE, Dell’Orto P, Del Curto B, Henriksen KL, Mastropasqua MG, Price KN, Méry E, Lacroix-Triki M, Braye S, Altermatt HJ, Gelber RD, Castiglione-Gertsch M, Goldhirsch A, Gusterson BA, Thürlimann B, Coates AS, Vaile G, for the BIG 1-98 Collaborative and International Breast Cancer Study Groups. Adjuvant letrozole versus tamoxifen according to centrally-assessed ERBB2 status for postmenopausal women with endocrine-responsive early breast cancer: supplementary results from the BIG 1-98 randomised trial. Lancet Oncol 2008; 9:23-28. 722. Ravaioli A, Monti F, Regan MM, Maffini F, Mastropasqua MG, Spataro V, Castiglione-Gertsch M, Panzini I, Gianni L, Goldhirsch A, Coates AS, Price KN, Gusterson BA, Viale G, for the International Breast Cancer Study Group. p27 and Skp2 immunoreactivity and its clinical significance with endocrine and chemo-endocrine treatments in node-negative early breast cancer. Ann Oncol 2008; 19:660-668. 723. Regan MM, Pagani O, Walley B, Torrisi R, Perez EA, Francis P, Fleming GF, Price KN, Thürlimann B, Maibach R, Castiglione-Gertsch M, Coates AS, Goldhirsch A, Gelber RD for the SOFT/TEXT/ PERCHE Steering Committee and the International Breast Cancer Study Group. Premenopausal endocrine-responsive early breast cancer: Who receives chemotherapy? Ann Oncol 2008; 19:1231-1241. 724. Sestak I, Cuzick J, Sapunar F, Eastell R, Forbes JF, Bianco AR, Buzdar AU, on behalf of the ATAC Trialists’ Group. Risk factors for joint symptoms in patients enrolled in the ATAC trial: retrospective, exploratory analysis. Lancet Oncol 2008; 9:866-872. 725. Sestak I, Forbes JF, Edward R, Howell A, Cuzick J. Timing and severity of prominent side effects of anastrozole and tamoxifen. Eur J Cancer Supplements 2008; 6(7):71, Poster 73. ANZ BCTG Annual Report 2008-2009 87 726. Untch M, Gelber RD, Jackisch C, Procter M, Baselga J, Bell R, Cameron D, Bari M, Smith I, Leyland-Jones B, de Azambuja E, Wermuth P, Khasanov R, Feng-yi F, Constantin C, Mayordomo JI, Su-CH, Yu SY, Lluch A, Senkus-Konefka E, Price C, Haslbauer F, Suarez Sahui T, Srimuninnimit V, Colleoni M, Coates AS, Piccart-Gebhart MJ, Goldhirsch A, for the HERA Study Team. Estimating the magnitude of trastuzumab effects within patient subgroups in the HERA Trial. Ann Oncol 2008; 19:1090-1096. 727. Viale G, Giobbie-Hurder A, Regan MM, Coates AS, Mastropasqua MG, Dell’Orto P, Maiorano E, MacGrogan G, Braye SG, Öhlschlegel C, Neven P, Orosz Z, Olsewski WP, Knox F, Thürlimann B, Price KN, Castiglione-Gertsch M, Gelber RD, Gusterson BA, Goldhirsch A. Prognostic and predictive value of centrally reviewed Ki-67 labeling index in postmenopausal women with endocrine-responsive breast cancer: results from Breast International Group Trial 1-98 comparing adjuvant tamoxifen with letrozole. J Clin Oncol 2008; 26(34):5569-5575. 728. Viale G, Regan MM, Maiorano E, Mastropasqua MG, Golouh R, Perin T, Brown RW, Kovács A, Pillay K, Öhlschlegel C, Braye S, Grigolato P, Rusca T, Gelber RD, Castiglione-Gertsch M, Price KN, Goldhirsch A, Gusterson BA, Coates AS. Chemoendocrine compared with endocrine adjuvant therapies for node-negative breast cancer: predictive value of centrally reviewed expression of estrogen and progesterone receptors - International Breast Cancer Study Group. J Clin Oncol 2008; 26(9):1404-1410. 729. Viale G, Regan MM, Mastropasqua MG, Maffini F, Maiorano E, Colleoni M, Price KN, Golouh R, Perin T, Brown RW, Kovács A, Pillay K, Öhlschlegel C, Gusterson BA, Castiglione-Gertsch M, Gelber RD, Goldhirsch A, Coates AS. Predictive value of tumor Ki-67 expression in two randomized trials of adjuvant chemoendocrine therapy for node-negative breast cancer. J Natl Cancer Inst 2008; 100:207-212. 730. Wapnir IL, Aebi S, Gelber S, Anderson SJ, Láng I, Robidoux A, Mamounas EP, Wolmark N. Progress on BIG 1-02/IBCSG 27-02/NSABP B-37, a prospective randomized trial evaluating chemotherapy after local therapy for isolated locoregional recurrences of breast cancer. Ann Surg Oncol 2008; 15(11):3227-3231. 731. Wapnir IL, Aebi S, Geyer CE, Zahrieh D, Gelber RD, Anderson SJ, Robidoux A, Bernhard J, Maibach R, Castiglione-Gertsch M, Coates AS, Piccart MJ, Clemons MJ, Costantino JP, Wolmark N. A randomized clinical trial of adjuvant chemotherapy for radically resected locoregional relapse of breast cancer: IBCSG 27-02, BIG 1-02, NSABP B-37. Clin Breast Cancer 2008; 8:287-292. 01/01/2009 to 31/03/2009 732. Bonetti M, Zahrieh D, Cole BF, Gelber RD. A small sample study of the STEPP approach to assessing treatment-covariate interactions in survival data. Statistics in Medicine 2009; 28:1255-1268. 733. Dowsett M, Cuzick J, Wales C, Forbes J, Mallon L, Salter J, Quinn E, Bugarini R, Baehner FL, Shak S and on behalf of the ATAC Trialists’ Group. Risk of distant recurrence using oncotype DX in postmenopausal primary breast cancer patients treated with anastrozole or tamoxifen: a TransATAC study. Cancer Research 2009; 69 (2 Supplement):53. 88 ANZ BCTG Annual Report 2008-2009 734. Dowsett M, Procter M, McCaskill-Stevens W, de Azambuja E, Dafni U, Rueschoff J, Jordan B, Dolci S, Abramovitz M, Stoss O, Viale G, Gelber RD, Piccart-Gebhart M, Leyland-Jones B. Disease-free survival according to degree of HER2 amplification for patients treated with adjuvant chemotherapy with or without 1 year of trastuzumab: The HERA Trial. J Clin Oncol 2009; 27(18):2962-2969. 735. Gianni L, Gelber S, Ravaioli A, Price KN, Panzini I, Fantini M, Castiglione-Gertsch M, Pagani O, Simoncini E, Gelber RD, Coates AS, Goldhirsch A. Second non-breast primary cancer following adjuvant therapy for early breast cancer: A report from the International Breast Cancer Study Group. Eur J Cancer 2009; 45:561-571. 736. Maiorano E, Regan MM, Viale G, Mastropasqua MG, Colleoni M, Castiglione-Gertsch M, Price KN, Gelber RD, Goldhirsch A, Coates AS. Prognostic and predictive impact of central necrosis and fibrosis in early breast cancer: Results from two International Breast Cancer Study Group randomized trials of chemoendocrine adjuvant therapy. Breast Cancer Res Treat 2009; Published online: 12 March 2009. 737. Mouridsen HT, Giobbie-Hurder A, Mauriac L, Paridaens R, Colleoni M, Thürlimann B, Forbes JF, Gelber RD, Wardley A, Smith I, Price KN, Coates A, Goldhirsch A and the International Breast Cancer Study Group. BIG 1-98: A randomized double-blind phase III study evaluating letrozole and tamoxifen given in sequence as adjuvant endocrine therapy for postmenopausal women with receptor-positive breast cancer. Cancer Research 2009; 69 (2 Supplement):13. 738. Pagani O, Gelber S, Simoncini E, Castiglione-Gertsch M, Price KN, Gelber RD, Holmberg SB, Crivellari D, Collins J, Lindtner J, Thürlimann B, Fey MF, Murray E, Forbes JF, Coates AS, Goldhirsch A for the International Breast Cancer Study Group. Is adjuvant chemotherapy of benefit for postmenopausal women who receive endocrine treatment for highly endocrineresponsive, node-positive breast cancer? International Breast Cancer Study Group Trials VII and 12-93. Breast Cancer Res Treat 2009; 116:491-500. 739. Ruhstaller T, von Moos R, Rufibach K, Ribi K, Glaus A, Spaeti B, Koeberle D, Mueller U, Hoefliger M, Hess D, Boehme C, Thürlimann B. Breast Cancer patients on endocrine therapy reveal more symptoms when self-reporting than in pivotal trials: an outcome research study. Oncology 2009; 76:142-148. 740. Sun Z, Goldhirsch A, Price KN, Colleoni M, Ravaioli A, Simoncini E, Campbell I, Gelber RD, Towler M. Bone Quality Test (BQT) scores of fingernails in postmenopausal patients treated with adjuvant letrozole or tamoxifen for early breast cancer. The Breast 2009; 18:84-88. 741. Thürlimann B, Price KN, Gelber RD, Holmberg SB, Crivellari D, Colleoni M, Collins J, Forbes JF, Castiglione-Gertsch M, Coates AS, Goldhirsch A. Is chemotherapy necessary for premenopausal women with lower-risk node-positive, endocrine-responsive breast cancer? 10-year update of International Breast Cancer Study Group Trial 11-93. Breast Cancer Res Treat 2009; 113:137-144. ANZ BCTG Annual Report 2008-2009 89 This page is intentionally blank. 90 ANZ BCTG Annual Report 2008-2009 Glossary of Terms ACCRUAL TARGET (RECRUITMENT TARGET): The number of participants planned to be enrolled in the trial. ADJUVANT THERAPY: Additional treatment used to improve the effects of surgical treatment. In cancer, adjuvant therapy may include chemotherapy, hormonal or radiation therapy after surgery, which is aimed at killing any remaining cancer cells. ADVANCED BREAST CANCER: Cancer that has spread from the original site in the breast (metastasised) to other organs or tissues in the body. Also known as secondary breast cancer or metastatic breast cancer. ANGIOGENIC: Blood vessel formation, which usually accompanies the growth of malignant tissue. ANTIANGIOGENIC MOLECULE: An orally delivered small-molecule formulation with antiangiogenic and anticancer activity. ANZ BCTG: Australian New Zealand Breast Cancer Trials Group. AROMATASE INHIBITORS (AI) (examples: anastrozole, exemestane and letrozole): A class of drugs used in the treatment of breast cancer in postmenopausal women. Some cancers require oestrogen to grow. Aromatase is an enzyme that synthesises oestrogen. Aromatase inhibitors block the synthesis of oestrogen. This lowers the oestrogen level, and slows the growth of cancers. AXILLA: The underarm or armpit. AXILLARY DISSECTION: Surgery to remove lymph nodes from the armpit. The procedure can be performed either at the same time as breast surgery or as a separate operation. AXILLARY LYMPH NODES: Lymph nodes in and near the armpit. BIG: Breast International Group. BIOPSY: The removal of a small sample of tissue or cells from the body to help diagnose a disease. BREAST CONSERVING SURGERY: Surgery to remove part of the breast. Also called a lumpectomy or a wide local excision. CHEMOTHERAPY (examples: cyclophosphamide, doxorubicin, docetaxel and capecitabine): The use of medications (drugs) that are toxic to cancer cells. These drugs kill the cells, or prevent or slow their growth. The standardised combination of such drugs in the treatment of cancer is referred to as a ‘treatment regimen’. CIRG: Cancer International Research Group. CLINICAL TRIAL: Research conducted with the patient’s consent which usually involves a comparison of two or more treatments or diagnostic methods. Clinical trials are conducted to gain a better understanding of the underlying disease process and/or methods to treat or prevent it. The clinical trial process includes Phase I, II, and III trials. CRUK: Cancer Research U.K. DUCTAL CARCINOMA IN SITU (DCIS): Abnormal cells in the breast ducts, which over time could develop into invasive breast cancer. DOUBLE-BLIND TRIAL: A clinical trial in which neither the participating individual nor the study staff knows which participants are receiving the experimental drug and which are receiving a placebo or another therapy. ELIGIBILITY CRITERIA: Participant eligibility criteria for clinical trials can range from general (age, type of cancer) to specific (prior treatment, tumour characteristics, blood cell counts, organ function). Eligibility criteria may also vary with the stage of the disease. GOOD CLINICAL PRACTICE (GCP): A standard for the design, conduct, performance, monitoring, auditing, recording, analyses, and reporting of clinical trials that provides assurance that the data and reported results are credible and accurate, and that the rights, integrity and confidentiality of trial subjects are protected. ANZ BCTG Annual Report 2008-2009 91 GRADE (TUMOUR GRADE): The degree of similarity of the cancer cells to normal cells. Grade is assessed by a pathologist. Grade 1 carcinoma is well differentiated and is associated with a better prognosis. Grade 2 carcinoma is moderately differentiated and is associated with an intermediate prognosis. Grade 3 carcinoma is poorly differentiated and is generally associated with a worse prognosis. HER2-POSITIVE (HER2-amplified): HER2 stands for Human Epidermal Growth Factor Receptor 2. In HER2-positive breast cancer, the cancer cells have an abnormally high number of HER2 genes per cell. When this happens, too much HER2 protein appears on the surface of these cancer cells. This is called HER2 protein over expression or amplified. Too much HER2 protein is thought to cause cancer cells to grow and divide more quickly. HORMONE (ENDOCRINE) TREATMENT: Hormone (endocrine) treatment is used to treat breast cancers that are hormone receptor-positive. These cancers have receptors for the hormones oestrogen and/or progesterone; they are called ER and/or PR-positive cancers. There are several different types of hormone treatments. Some are taken as tablets (tamoxifen or aromatase inhibitors) and some are treatments to turn off or remove the ovaries (injections, surgery and sometimes radiotherapy). HORMONE RECEPTORS: Proteins in a cell which bind to specific hormones. This stimulates the cell to act in a particular way. HORMONE REPLACEMENT THERAPY (HRT): Drug therapy that supplies the body with hormones that it is no longer able to produce; usually to relieve menopausal symptoms. HUMAN RESEARCH ETHICS COMMITTEE (HREC): The Human Research Ethics Committee’s function is to review proposed research in order to insure that the subject’s rights are protected and that risk of harm is minimised. IBCSG: International Breast Cancer Study Group. INDEPENDENT DATA SAFETY AND MONITORING COMMITTEE (IDSMC): An independent group of experts or adequately qualified individuals who monitor patient safety and treatment effectiveness data while a clinical trial is ongoing. INFORMED CONSENT: Informed consent is a process whereby a person gives consent based on a clear understanding of the facts, any implications and possible future consequences. In the case of a clinical trial, these facts, implications and consequences are conveyed in the Patient Information Sheet and any associated materials. LOCALLY ADVANCED BREAST CANCER: Is breast cancer that has one or more of the following features: ■■ May be large (typically bigger than 5 cm) ■■ May have spread to several lymph nodes in the armpit (axilla) or other areas near the breast ■■ May have spread to other tissues around the breast such as the skin, muscle or ribs LUMPECTOMY: Also called “Breast Conserving Surgery”. LYMPHOEDEMA: Swelling caused by a build-up of lymph fluid, as a result of lymph nodes being removed or not working properly. MAMMOGRAM: An x-ray of the breast. MASTECTOMY: The surgical removal of the whole breast. METASTATIC BREAST CANCER: Cancer that has spread from the original site in the breast to other organs or tissues in the body. Also known as secondary breast cancer or advanced breast cancer. MICROMETASTASES: Small cancer cells that have spread (metastases) beyond the primary tumour and can only be detected by microscopic evaluation. MONOCLONAL ANTIBODIES (examples: trastuzumab and bevacizumab): A treatment designed to specifically target a cell within the body, particularly cancer cells. Different cancer types can be targeted with different monoclonal antibodies. MORBIDITY: The relative incidence of a particular disease within a defined population. NEOADJUVANT: Treatment given to the cancer patient prior to surgery or further treatment. NODAL STATUS: Whether a breast cancer has spread (node-positive) or has not spread (node-negative) to lymph nodes in the armpit (axillary nodes). The number and site of positive axillary nodes can help predict the risk of cancer recurrence. 92 ANZ BCTG Annual Report 2008-2009 NSABP: National Surgical Adjuvant Breast and Bowel Project. OESTROGEN: The main female sex hormone produced mostly by the ovaries. OESTROGEN RECEPTOR (ER): A protein that may be present on certain cells to which oestrogen molecules can attach. The term “ER positive” refers to tumour cells that contain the oestrogen-receptor protein. These cells are generally sensitive to hormone therapy. ONCOLOGIST: A doctor who specialises in treating cancer. ONCOLOGY: A branch of medicine that deals with cancer. OPEN-LABEL TRIAL: A clinical trial in which doctors and participants know which drug or treatment is being administered. OSTEOPOROSIS: A disease characterised by low bone mass and deterioration of bone architecture, which increases the susceptibility to fractures. PARTICIPATING INSTITUTION: Any public or private hospital or facility where ANZ BCTG clinical trials are conducted. PATIENT INFORMATION SHEET: A document designed to provide patients with relevant information and facts relating to the proposed clinical trial in order for the patient to make an informed decision regarding their participation in the trial. PHASE II CLINICAL TRIAL: The second stage of the evaluation of a new drug in humans; these trials evaluate drug safety and preliminary efficacy (effectiveness) in a large number of participants (up to several hundred). PHASE III CLINICAL TRIAL: The most rigorous and extensive type of scientific clinical investigation of a new treatment. These trials are designed to determine the effectiveness of a treatment, often by comparing it to an existing standard therapy or a placebo, in a large number of participants (typically hundreds or thousands). A phase III trial is generally required before a drug would be approved by regulatory authorities for general use. PLACEBO: An inert tablet (such as a sugar pill), liquid or powder that has no active ingredient. In clinical trials, experimental treatments are often compared with a placebo to assess the treatment’s effectiveness. PREVENTION TRIAL: A trial aiming to find better ways to prevent breast cancer in healthy women. PRINCIPAL INVESTIGATOR (PI): The person responsible for overseeing all aspects of a clinical trial at an ANZ BCTG participating institution level; submitting the protocol for institutional review board approval; recruiting participants; obtaining informed consent; and collecting data. PROGESTERONE RECEPTOR (PR): A protein that may be present on certain cells to which progesterone molecules can attach. The term “PR-positive” refers to tumour cells that contain the progesterone receptor protein. These cells are generally sensitive to hormone therapy. PROTOCOL: A written, detailed action plan for a clinical trial. The protocol provides the background, specifies the objectives, and describes the design and organisation of the trial. QUALITY OF LIFE: An individual’s overall appraisal of their situation and subjective sense of well-being. RANDOMISATION: A method of preventing bias in research by ‘randomly’ assigning clinical trial participants to treatment groups. Randomisation ensures each treatment group has a similar range and number of patients, such that any differences between treatment groups at the end of the trial can be attributed to the trial treatments. RANDOMISED TRIAL: A study in which participants are randomly assigned to one of two or more treatment arms of a clinical trial. RADIOTHERAPY: The use of radiation, usually x-rays or gamma rays, to kill cancer cells or damage them so they cannot grow and multiply. RECURRENCE: The return of breast cancer after a period of remission. During a recurrence, breast cancer cells which have evaded treatment may reappear at the original site or in another part of the body. SELECTIVE ESTROGEN RECEPTOR MODULATOR (SERM) (examples: tamoxifen and raloxifen): A class of medication that acts on the oestrogen receptors of cells by blocking the effects of naturally produced oestrogen within the body. This form of treatment has been shown to be effective on hormonesensitive breast cancers. ANZ BCTG Annual Report 2008-2009 93 SENTINEL NODE: Is the hypothetical first lymph node or group of nodes reached by metastasising cancer cells from a primary tumour. SENTINEL NODE BIOPSY: Sampling of the sentinel lymph node into which the primary tumour is draining first to determine if a full lymph node exploration is needed. SIDE EFFECTS: Unwanted effects of a drug or treatment (e.g. nausea, headache, hair loss, etc). Side effects may be short or long term, ranging from minor inconveniences to serious adverse events. STANDARD TREATMENT (THERAPY): The current best treatment known for a particular disease or condition. STUDY CHAIR: An adequately qualified clinician assigned by the ANZ BCTG to provide clinical advice and guidance for the development and ongoing conduct of a clinical trial. STUDY COORDINATOR: A member of the research team at an ANZ BCTG participating institution who takes responsibility for non-clinical aspects associated with the conduct of a clinical trial. SWOG: SouthWest Oncology Group – US. SYSTEMIC ADJUVANT THERAPY: The use of chemotherapy, hormone therapy and/or targeted therapy or a combination of these, given after surgery to target the entire body to destroy any cancer cells that may have spread to distant body parts but are below the level of clinical detection. TOXICITY: Harmful side effects from an agent being tested. TREATMENT TRIALS: Treatment trials are designed to test the safety and effectiveness of new drugs, biological agents, techniques, or other interventions in people who have been diagnosed with cancer. These trials evaluate the new treatment against standard treatment, if there is one. TYROSINE KINASE INHIBITOR (example: lapatinib): A drug that interferes with cell communication and growth and which may prevent tumour growth. 94 ANZ BCTG Annual Report 2008-2009 Yes, I want to support breast cancer research… You can donate online at www.bcia.org.au, or complete your details below and send to the postal address shown or fax it to 02 4925 3068. Breast Cancer Institute of Australia Postal Address: PO Box 283, The Junction NSW 2291 Australia Please accept my monthly gift of $25 $35 $50 $70 $ using my credit card PLEASE PRINT CLEARLY Card No. Mr/Mrs/Dr/Ms/Miss Address Name of Cardholder Cardholder’s Signature Telephone Email State Postcode Expiry date / OR please accept my gift of $ Charge to my credit card above. My cheque or money order is enclosed. Thank you! Your gift is tax deductible. AR2008-2009 ANZ BCTG Annual Report 2008-2009 95 This page is intentionally blank. This page is intentionally blank.