UCT’s cancer response – a multipronged approach

World Cancer Day, which is commemorated globally on 4 February, aims to raise attention and inspire action for a cancer-free future. According to Professor Jennifer Moodley, the director of the Cancer Research Initiative at the University of Cape Town’s (UCT) Faculty of Health Sciences (FHS), the burden of cancer is rising worldwide, especially in low- and middle-income countries like South Africa.

“The rising burden [of cancer] relates to the growing and ageing population, life circumstances and ways of living, and ongoing infections such as the human papillomavirus (HPV) and hepatitis,” said Professor Moodley.

UCT’s collective response to cancer is complex and multifaceted, bringing together experts from various fields. A few of them give insights below into how their work is contributing towards creating a cancer-free future.

Saif Khan

Emerging researcher Saif Khan is a PhD candidate under the supervision of Professor Sharon Prince in the Department of Human Biology at the FHS. He heads the Postgraduate Cancer Research Initiative Group (PGCRI), among other leadership positions.

HPV is the main causative agent of cervical cancer, and Khan seeks to determine if the oncoprotein TBX3 interacts with HPV oncoproteins, E6 and E7, to drive this cancer. He has established that TBX3 contributes to cervical cancer cell proliferation and migration. Through his research focus, which is to unravel the molecular basis of cervical cancer initiation and progression, Khan aims to find affordable and effective treatment options and has adopted a high-throughput drug repurposing screen to identify commercially available drugs that are able to disrupt the HPV E6/E7/TBX3 axis.

“Cervical cancer … remains a leading cause of death among women in low- and middle-income countries.”

“While great strides have been made to prevent and treat cervical cancer, it remains a leading cause of death among women in low- and middle-income countries. The main treatment options for cervical cancer are associated with a poor prognosis, drug resistance and horrendous side effects, as they target both cancer and normal cells. Therefore, affordable and cancer-specific treatment options are urgently needed,” said Khan.

Repurposing drugs that target the HPV E6/E7/TBX3 axis will significantly reduce the side effects associated with current therapies. In addition, drug repurposing allows for the discovery of potentially more affordable, safer and effective commercially available drugs that can quickly be brought into the treatment regimen against this deadly disease.

Associate Professor Delva Shamley

Associate Professor Delva Shamley is the director of the Clinical Research Centre (CRC) and the head of the Division of Clinical Anatomy and Biological Anthropology in the Department of Human Biology at the FHS.

Between 25% and 50% of breast cancer survivors experience upper limb pain, dysfunction and lymphoedema due to the medical treatment they receive to combat the cancer, which results in survivors living with chronic musculoskeletal conditions. These effects, which can impact quality of life and the ability to return to work, may develop up to eight years after treatment. The effects are well documented, and their management is an integral component of cancer survivorship plans internationally, but not in South Africa.

The local plan is being developed by Associate Professor Shamley.

“Our research programme has two key aims. Firstly, it’s to identify genetic predisposition for developing complications after treatment. Secondly, it’s to develop an integrated care pathway that is both effective and sustainable in our public health environment,” Shamley explained.

Survivorship plans include recommendations that exercise has been shown to significantly improve upper limb function, reduce fatigue and enhance general quality of life. As the numbers of survivors increase annually, the need to address their lives as cancer survivors is critical.

Dr Rene Krause

Dr Rene Krause is a senior lecturer in palliative medicine at UCT, and her work is linked with Groote Schuur Hospital. She is also part of the Association of Palliative Care Practitioners of South Africa and the African Palliative Care Association.

Dr Krause’s area of focus is on the integration of palliative care into academic teaching hospitals, which includes teaching, service delivery and quality improvement, as well as guideline development and advocacy.

“Palliative care focuses on improving quality of life of patients with cancer by means of a biopsychosocial and spiritual approach. This is not only for the patient but also for the family. Palliative care is a patient-centred approach that has proven to prolong both the life and the quality of life of patients with incurable cancers,” said Krause.

Neelakshi Mungra

Neelakshi Mungra is a PhD candidate in the Medical Biotechnology and Immunotherapy Research Unit (MB&I). Hosted at the Institute of Infectious Disease and Molecular Medicine (IDM) at the FHS, the lab is one of the first of its kind on the continent.

Spearheaded by Professor Stefan Barth, holder of the South African Research Chairs Initiative (SARChI) Chair in Cancer Biotechnology, MB&I specialises in the development of modular antibody technologies aimed at facilitating precision medicine by differential diagnosis and immunotherapy.

In collaboration with Professor Roger Hunter from UCT’s Department of Chemistry, Mungra’s research combines the use of highly toxic synthetic labels which, when coupled with disease-specific antibodies, result in an intelligent system that specifically targets and kills tumour cells.

“Achieving next generation immunotherapies where only cancer cells are eliminated, with minimal collateral damage to normal cells, continues to remain an important unmet need in oncology,” said Mungra.

“By coupling antibodies to fluorescent substrates and using these as an optical imaging system, some of my team’s recent research has uncovered the first step towards a better understanding of the disease-specific cell surface profiles of South African breast cancer patient biopsies.”

With this information becoming increasingly available, the field of targeted drug development can be expedited and tailored according to surface marker-specific patient groups best responding to specific immunotherapy or precision medicine. This is especially apparent in the management of a daunting disease like breast cancer.

Professor Alan Davidson

Professor Alan Davidson is the head of Haematology/Oncology at the Red Cross War Memorial Children’s Hospital and a professor of paediatrics at UCT. He is also the director of postgraduate education in UCT’s Department of Paediatrics and Child Health at the FHS.

Professor Davidson is the principal investigator of UCT’s paediatric cancer database, a platform intended to explore epidemiology and outcomes of all children under 15 diagnosed at the Red Cross War Memorial Children’s Hospital and Groote Schuur Hospital. The aim of the platform is to become a research-ready resource for the multidisciplinary team.

“The unit’s research work has contributed to improving the treatment of children with cancer and building cancer advocacy in both South Africa and sub-Saharan Africa. Apart from benchmarking outcomes in a variety of cancers, we have shown the efficacy of standard treatment protocols in children with HIV/AIDS, the utility of multidisciplinary care in paediatric brain tumours, and the fact that cost-effective regimens can still be very effective,” Davidson said.

“The research has helped us in our work with the International Society of Paediatric Oncology’s Developing Countries (SIOP-PODC) committee, the South African Children’s Cancer Study Group, the South African Paediatric Brain Tumour Workshop and the Society for Neuro-Oncology’s sub-Saharan Africa branch. In this way we try to fulfil the university’s Afrocentric mandate.”

His team has co-authored many of SIOP-PODC’s adapted treatment regimens.

Davidson added: “As in every other aspect of paediatric oncology, research and innovation is a team sport.”

Professor Jennifer Moodley

In addition to her role as the director of the Cancer Research Initiative at the FHS, Professor Jennifer Moodley is also a public health medicine physician.

Professor Moodley’s research focus and approach, informed by her work as a clinician in rural and urban healthcare settings, are on understanding pathways and addressing barriers to early cancer diagnosis and treatment using qualitative and quantitative methods. Breast and cervical cancer are leading cancers on the continent and much of her research relates to these. This includes research on health service challenges in the prevention and diagnosis of both cancers; formative and cost-effectiveness research on implementation of an HPV vaccination programme; and research on HIV and cervical cancer.

“We must work with and strengthen our healthcare system to facilitate early diagnosis and appropriate management of those diagnosed.”

Moodley’s work brings together the many excellent academics who collaboratively pursue innovative, effective and relevant approaches to the prevention, diagnosis and treatment of cancer. She also works with key stakeholders, including policy makers, non-governmental organisations and healthcare providers, through partnerships that inform research questions and facilitate translation of research into public policy and benefit.

“We need to increase awareness of ways to prevent cancer, for example through vaccination, exercise and measures against cigarette smoking. Further, most cancers are diagnosed at a late stage when the outcome is much worse … We must work with and strengthen our healthcare system to facilitate early diagnosis and appropriate management of those diagnosed. In addition, we need to also address survivorship and palliative care,” she said.

“Researchers have a responsibility to communicate findings to the public. We need to partner with communities and civil society to position cancer as a public health priority.

“Addressing cancer requires teamwork.”