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Great minds
Pioneers in melanoma breakthrough saves lives
Melanoma treatment pioneers Professor Georgina Long AO and Professor Richard Scolyer AO have been named joint Australians of the Year 2024 for their revolutionary approach to treating melanoma using immunotherapy. Their enduring professional partnership has saved thousands of lives and continues to break new ground - including in treating Richard's own illness.
It hadn’t really occurred to Professor Richard Scolyer (MD ’06) or Professor Georgina Long (BSc ’93, PhD ’96, MBBS ’01) that they might be recognised as Australians of the Year. Sure, their research into melanoma was groundbreaking, but it was a packed field.
“You get to meet everyone who’s been a state recipient,” Richard says. “They’re great people – all deserving recipients.”
Nonetheless, all nominees had to submit an acceptance speech before the ceremony, and they were told they should practise presenting theirs. “We only had half an hour to practise,” Georgina says. “And at the end of it – Richard will tell you – we said, ‘Do we really need to do this again?’”
She laughs.
“We practised two or three times,” Richard says. “Then we said, ‘Oh, we’re not going to win it – let’s just go and get dressed for the event.’”
Then their names were called.
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The buzz surrounding the pair goes back to May 2023. Richard was in Krakow, Poland, delivering a series of lectures. His research has the kind of global profile that means he travels frequently for work. On this occasion, his wife, Katie, had accompanied him so they could hike in the Tatra Mountains once the conference wrapped.
Their Friday hike was fabulous. Richard has always been an active person. In his forties, he re-started triathlons to keep fit. “We were up very high, near the border of Slovakia. As you get higher, your brain swells,” Richard says. “The next day I felt very tired and sick, which is unusual for me. I had a seizure that ultimately ended up being the first presentation of my brain tumour.”
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It was a Sunday morning in Sydney when Georgina’s phone rang. Katie delivered the news. As a problem solver, Georgina immediately wanted images of Richard’s brain scans. “It’s a joke in my family – I’m called Miss Fix-it,” she says. “If I’m presented with the problem, I want to fix it. Richard is like that too. But I want to do it yesterday.”
Within 24 hours, Georgina had shared the scans with Associate Professor Brindha Shivalingam – a close colleague and brain surgeon who confirmed she was looking at glioblastoma, an aggressive brain cancer with poor patient outcomes. “I got off the phone with Brindha,” Georgina says. Her voice cracks a little and she takes an uncharacteristic pause. “It was that ‘I’m in a nightmare’ pit of your stomach feeling. I was just overwhelmed with grief, to be honest.”
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Georgina and Richard aren’t certain of the specifics of their introduction. Georgina thinks she must have dropped by to see Dr Kerry Crotty in the Pathology Department where Richard worked, while she was studying. Their paths continued to cross, but she can’t remember a moment when it all clicked into place.
From his perspective, Richard recalls telling Georgina that melanoma research opportunities were on the brink of expanding.
He was right.
Australia has some of the highest melanoma rates in the world, with a diagnosis every 30 minutes and a death every six hours, earning it the nickname ‘Australia’s national cancer’.
A decade ago, the death rate was one every five hours. Most patients with advanced melanoma survived around nine months. Typical treatments involved chemotherapy, which was basically ineffective, and surgery or radiotherapy to symptomatic areas.
“I think at that stage every major melanoma unit in the world had a surgeon at the head of it, because it was a surgical disease. There weren’t drugs that worked,” says Richard.
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In 2009, a large research grant brought Georgina and Richard together in the lab that they would eventually co-lead from the Charles Perkins Centre at the University of Sydney. They were conducting the first human trials of immunotherapy drugs designed to stimulate the body’s own immune system to fight melanoma.
And they worked.
It was what Georgina calls ‘a penicillin moment’. The five-year survival rate for patients with advanced melanoma jumped from five percent to 50 percent.
This success sparked another thought – what if the body could begin fighting the cancer prior to its removal? Called 'neoadjuvant immunotherapy’, drug combinations are administered before surgery, to prompt an immune response. After the cancer has been removed, more drugs are often administered to ensure the immune system is trained to continue fighting the cancer. This is called adjuvant immunotherapy.
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Richard and Georgina's medical breakthroughs have earned them international acclaim.
Progress in complex cancer research is slow. Though she had experienced this firsthand, Georgina was still confronted by the glioblastoma literature.
“Grief is funny. It’s sort of overwhelming and it takes up every brain cell, and then with time it just gets less and less,” she says. “I had a problem to solve, so I just started thinking. And then I started reading everything I could.”
Glioblastoma sends snake-like tendrils out through the brain. Damage to the delicate surrounding tissues during surgery can affect memory, mood and personality. Standard treatment involves removal of as much of the tumour as is safe, followed by radiation and chemotherapy. It has not changed since 2005, and Richard’s subtype is essentially incurable.
“That was incredibly disappointing for someone like me,” Georgina says.
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Like Richard, Georgina’s research has earned her a global profile and a large network of world-leading specialists. Her reading made her feel like she could see a way forward – the gaps in trials that, with persistence, could become a pathway to more effective treatment.
Melanoma in the brain responds to a combination of immunotherapy drugs administered as initial treatment when the patient is first diagnosed, but this logic has not been applied to glioblastoma.
“They’ve done all these trials of one immunotherapy drug in patients with recurrent glioblastoma, where it’s tested as a follow-up treatment to radiotherapy and chemotherapy, and said it doesn’t work,” Georgina explains. “And I’m just thinking, ‘No! We haven’t tested all the things we could possibly test, nor in the right way!’”
She got to work immediately, pushing questions out to her peers about alternative options, and asking their opinion on treatments that she had devised.
Katie had called with the news on Sunday. By Tuesday, Georgina had a bold new plan.
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You can’t do something on your own. You need a great team. You need to have courage, but also be courageous. Don’t just lean in – leap in, if you really want to make a difference.
Professor Richard Scolyer AO
“My life has turned upside-down,” Richard says matter-of-factly.
As a pathologist, he had spent his early career examining cancers through a microscope, and had seen the sneaky coils of glioblastoma up close.
His initial conversations with Georgina about new approaches to his own cancer made complete sense to him – treat it like they would the most aggressive melanoma. Use combinations of immunotherapy drugs prior to surgery, and follow up with further personalised immunotherapy treatment once the tumour had been removed. It didn’t feel like a difficult choice.The challenge lay in convincing other people.
“I was told I could die sooner or be left with permanent neurological side- effects that would ruin the rest of my life,” Richard recalls. “But working in this field for a long time, I’ve been part of the teams that have worked on these clinical trials. It’s me looking down the microscope at the results that have helped transform the management of the disease.”
Finding an extended medical team who were on board with the treatment plan was difficult. Richard and his wife wrote extensive letters stating that they understood the risks.
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In June 2023, Richard had an open craniotomy – a riskier-than-usual procedure – to formally diagnose the glioblastoma. This was followed by treatment with a trio of immunotherapy drugs, then, 12 days later, surgery to remove as much of the tumour as safely possible.
Though recovery has been taxing physically and emotionally for Richard, the results have been positive. Samples from the removed tumour showed a significant increase in activated immune cells, meaning the immunotherapy drug had crossed the blood–brain barrier. It’s an enormous breakthrough that could reshape the future of glioblastoma treatment – and indeed many other cancers.
“We’ve actually learned from Richard’s tumour – including things that could influence vaccine development – and are now applying it to melanoma,” Georgina says.
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Watching their Australian of the Year acceptance speech, it’s impossible to tell that Georgina and Richard took to the stage slightly under-rehearsed. They barely need notes to state their case – prevention is better than cure.
“Zero deaths from melanoma is possible – we need a targeted screening program, and more investment in research. This must be a national priority.” says Georgina, eyes firmly on the audience. The audience bursts into applause.
Speaking to them later, it’s obvious that they don’t see their research as something that ends with their breakthroughs.
“We were so surprised, and very honoured, to be named Australians of the
Year,” Georgina says. “But it is decades of work. Even before us – it represents decades of work in immunotherapy.”
Having dedicated and ultimately risked his life to push for better patient outcomes, Richard is unsurprisingly direct in his wishes for the future.
“You can’t do something on your own. You need a great team,” he says. “You need to have courage, but also be courageous. Don’t just lean in – leap in, if you really want to make a difference.”
Written by Alex Johnson for Sydney Alumni Magazine. Photography by Stefanie Zingsheim.
13 May 2024