Brain Matter: Dr Andrew Dodgshun
“I always wanted to be a doctor. I always wanted to work with children,” says paediatric oncologist, Dr Andrew Dodgshun. “It’s what I’m meant to do.”
Today, Dr Dodgshun, the 2011 winner of the gold medal for the highest overall performance in the Royal Australasian College of Physicians Fellowship (FRACP) exams in paediatrics, continues to work at the Canterbury District Health Board. He is still at the bedside of his child patients with brain cancer, still supporting the families, and now able to provide more accurate diagnosis, prognosis and better treatment regimes, including minimising the number of chemotherapy sessions, as a result of his breakthrough research findings to reclassify paediatric glioma.
Funded by Cancer Research Trust New Zealand, Dr Dodgshun, undertook a landmark study at the Children's Cancer Centre, Royal Children's Hospital, Melbourne on paediatric glioma. His aim was to develop a tool that combined epigenetics (the biological mechanisms that switch genes on and off) and clinical information to determine the best treatment for children with glioma. He wanted to move on from the binary classification of high grade and low grade tumours which was based on how they look under the microscope.
“It was amazing how many useful findings were uncovered,” he said. “Having a year to dedicate to research was a springboard to do what I am doing now: having the confidence to put research into clinical practice to safely reduce the chemotherapy regime for low grade glioma and also reduce costs to the public health system.”
Paediatric glioma is the most common group of brain tumours in children. It comprises a large number of different tumours and it had been difficult to determine individualised treatments for many patients. Cutting edge molecular techniques have revealed new information about these tumours that had not been known before. The difficulty had been how to bring these new technologies in the clinic room to decide treatment.
“My hypothesis was that by integrating traditional risk factors and molecular data I could come up with a more personalised model of risk,” Dr Dodgshun said.
He built a comprehensive database of all gliomas seen and treated in the Royal Children’s Hospital over an 18-year period. Using clinical details, outcome data, scans, pathology and the molecular data he was able to define risk groups based on outcome.
“I was able to define ten glioma groups over five risk categories from very low risk (no further treatment needed, 95 percent chance of long-term survival) to very high risk (no opportunity for cure, palliative care recommended).”
One of the unexpected findings was that children who underwent a less intensive chemotherapy treatment for low grade glioma had the same outcomes with fewer side effects as those with more intensive treatment. The less intensive regimen is now considered standard in New Zealand and Australia paediatric oncology centres.
“My gut feeling was that that data on survival rates from a reduced chemotherapy regime would not be as good as it was. The research proved me wrong,” he said. “I’m loving that I can now say with certainty what the best course of treatment is for this group of children – and provide accurate information about the outcome to the families. In cases of incurable tumours, I also don’t want to give false hope. I feel very privileged to do what I do and want to give my best. I owe it to the children and their families.”
The next step along this line of research is a new study which is already underway at both Starship and Christchurch Hospitals in collaboration with the German Cancer Research Centre using epigenetics to improve diagnostic accuracy. Dr Dodgshun is also involved in a collaboration with SickKids Hospital in Toronto on epigenetic testing of a rare type of glioma.
“I am grateful that I can make a difference in a small way,” he said. “I am primarily a clinician and like it that way and am able to continue with meaningful and intellectually challenging research as a part of my clinical role.
“But I have a lot of other things in my life that are enriching and satisfying like spending time with family and friends, playing bass in the church band and planting native trees at our section. Being able to do these things makes me a better oncologist for families who need me to be at my best when they are at their most vulnerable.”
In 2014, Cancer Research Trust NZ awarded Dr Dodgshun the Murray Jackson Clinical Fellowship to develop a tool for risk profiling and accurate prognostication in paediatric glioma integrating clinical features with epigenetics. The project looked to combine clinical information with information from these new techniques to decide exactly how all this information fits together to form the best treatment for children with glioma.