Professor Trevor Leong
University of Melbourne
12 May 2022

Professor Trevor Leong is a Consultant Radiation Oncologist and past Director of Radiation Oncology at Peter MacCallum Cancer Centre and University of Melbourne. He received the David Cooper Clinical Trials and Cohort Studies Award for his work leading a randomised phase II/III trial of preoperative chemoradiotherapy versus preoperative chemotherapy for resectable gastric cancer.

Worldwide, an estimated one million new cases of gastric cancer are diagnosed each year (including 2,000 in Australia), and it is the second most common cause of cancer related death. 

For decades, surgery was the only curative treatment option available for patients with operable gastric cancer. However, the five-year survival rates with surgery alone are dismal. 

In the early 2000s, there were several important advances adding chemotherapy and radiotherapy to surgery that resulted in improved cure rates for these patients. 

Currently there are two global standards of care for patients undergoing surgery for gastric cancer; one that uses chemotherapy alone and one that uses both chemotherapy and radiotherapy. Choosing between these two quite different treatment strategies represents a common problem for oncologists and their patients. Opinions remain divided regarding the relative efficacy of these two treatment options and clinical practice varies not only between countries, but also between institutions within the same country.

TOPGEAR is a randomised phase III trial led by the Australasian Gastro-Intestinal Trials Group (AGITG) that is trying to answer one of the most important questions in gastrointestinal oncology worldwide. It aims to determine the best combination of chemotherapy, radiotherapy and surgery to improve cure rates for patients with gastric cancer. Opening to patient recruitment in 2009, we initially established the Australian sites before moving to develop international recruitment in 2013. Having established over 70 sites in Europe, North America, New Zealand and Australia, this trial has involved the collaborative efforts of the European Organisation for Research and Treatment of Cancer (EORTC), the largest clinical trials group in Europe, and the Canadian Cancer Trials Group (CCTG). This collaboration has propelled TOPGEAR to international recognition and will allow this Australian-led trial to set the standard of care and improve treatment outcomes on a global-scale.

Professor Trevor Leong received his award from the daughters of Professor David Cooper, Ilana Cooper and Bec Cooper. (Photo: Pew Pew Studio)

This international collaboration didn’t come easy. We campaigned at CCTG and EORTC meetings for several years, and had to gain endorsement from multiple committees. The number of steps we had to take for international approval over several years was a major effort, but I think the endorsement we received illustrates the importance of this trial across the different regions.

It has been a long journey for our team and we were initially met with uncertainty from the different stakeholders, needing cooperation of all three cancer treatment disciplines (surgeons, radiation oncologists and medical oncologists) to get the trial off the ground and convince the groups of the importance of the end goal. There were sceptics at the beginning, but you have to be persistent. 

This is one of the largest and most significant oncology trials to be led from Australia, and it is a credit to the AGITG for backing the trial throughout the various stages. Even before the trial results become available, I think that TOPGEAR has already provided benefits for patients with gastric cancer by fostering multidisciplinary management, and raising standards for the delivery of surgery and radiation therapy. 

I recently spoke with a prominent Canadian surgeon who has been invited to deliver a talk at the International Gastric Cancer Congress in the US outlining recent advances in gastric cancer treatment in Canada. On reflection, she believes that one of the highlights of gastric cancer treatment in Canada over the past 10 years has been participation in the TOPGEAR trial because “it has brought all the cancer disciplines together, as well as centres from across the country that do not usually collaborate”.

In May 2021, TOPGEAR reached its patient accrual target having successfully enrolled 574 patients from 15 countries around the globe. This is the trial’s third NHMRC grant and I think this is reflective of the fact that the trial is truly interdisciplinary and international, and its outcome will be of global significance. It is also an academic trial, which asks a fundamental question in oncology that cannot be addressed by Pharmaceutical industry sponsorship. For this reason, I am extremely grateful to the NHMRC for funding the trial since its inception. This latest NHMRC Clinical Trials and Cohort Studies grant will allow us to complete patient follow up, undertake and complete analyses, and disseminate the trial results.

I would like to thank everyone involved in TOPGEAR for their tireless efforts over the duration of this trial. TOPGEAR has involved hundreds of people across the globe and completing patient recruitment is a significant achievement that we all should be proud of. Progressing into the final stages, we look forward to sharing the results of the trial, which aim to set the global standard of care for patients with operable gastric cancer and improve treatment outcomes and cure rates.