Tissue Banks Why Bother

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Tissue Banks Why Bother?!?

• Dr Nik Zeps
• Radiation Oncology
• Sir Charles Gairdner Hospital

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Why do tissue banking?
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Tissue Bank-history

• Done by interested individuals
• Unregulated
• None or poor consent
• No SOPs
• None or poor databases
• Wide variation in storage conditions
• Poor assessment of use
• Quality?

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Australia

• Discovered in 1688 by William Dampier
• Not colonised until 1788-Capt James Cook
• WA not until 1829
• 9 Australian Parliaments (6 states, 2 territories
  and 1 federal)
• Popn
• 1914-3 million
• 2004- 20 million

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• Carries out
• Consent
• Collection
• Processing
• Storage
• Data linkage (WAGER)

• AOCS (ovarian)-1000 (147)
• RADAR (prostate) -200
• IAB (Prostate)-150
• TARGIT (Breast)-150
• Cancer Fatigue 100
• Locally Advanced BC
• Colorectal cancer -general
• Breast Cancer-general
• TMAs (3000)

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Consent form
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Management
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Project Driven Collection

• Australian Ovarian Cancer Study
• TARGIT TARGeted Intraoperative radioTherapy for
  Early Breast Cancer
• RADAR trial investigating the effect on PSA and
  survival of patients with localized prostate
  cancer by using different durations of androgen
  deprivation combined with radiation treatment
• TGFb-1 and MMPs
• gh2ax
• IL12
• Locally Advanced Breast Cancer-neoadjuvant
• PhD project on apoptosis and metabolism
• Colorectal
• methylation

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TMAs

• Colorectal TMA 17 blocks representing 1050 cases
• Burnham San Diego, Alabama (Grizzle), Erasmus
  Rotterdam, NUH singapore
• Ovarian cancer 3 blocks representing 221 cases
• Med solutions
• Breast Cancer 5 blocks representing 600 cases
• Westmead, Flinders, WAIMR
• Gastric Cancer 2 blocks representing 120 cases
• Peter Mac, NUH singapore
• Han Qian Feng, Anne-Marie Shearwood, Zhao Wen
  Ying, Nik Zeps, David Joseph, Barry Iacopetta,
  Arun Dharmarajan (2005) sFRP-4 and ß-catenin in
  Colorectal Carcinoma. Cancer Lett. 2006 Jan
  8231(1)129-37.
• Chai M, Zeps N, Joseph D, Goldblatt J, Harvey J,
  Charles A, Iacopetta B (2004) Loss of expression
  of hMLH1 and hMSH2 mismatch repair enzymes in a
  population-based series of colorectal cancers.
  Clinical Gastroenterology and Hepatology 2004
  Nov2(11)1017-25

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What issues remain?

• Uncertainty
• Cooperation of Stakeholders
• Demand
• Do researchers know what is possible?
• Trust
• Regulation
• Money

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Proposal Routine Pathology run tissue banking

• Pros
• All samples routinely come through them
• Are SOP driven
• Trained staff
• Appropriate facilities
• Legislated to keep samples for QA
• Cons
• Performance management means no money for
  biobanking
• Research not part of the new culture
• No consent
• Academic pathology demise

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Pathwest Research Services

• Prospective bio-specimen collection
• Specialised processing of samples
• Storage services of bio-specimens
• Ethics services/consultation
• Management of and Access to Associated health
  information

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Workflows
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Patient identification
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Consent

• Treating Dr obtains a consent to contact
• Tissue Bank staff obtain consent
• opt out consent
• All pts for elective surgery have tissue banked
  unless state no
• Blood or health information still require opt
  in consent
• Likely to be required for time to come

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Interim plan

• Collect only for Projects
• Full cost recovery
• Community owned
• Benefit sharing
• Transparent Governance
• New approaches to consent and community engagement

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Other WA initiatives

• WA DNA Bank
• To operate out of Pathwest
• Incorporate all existing DNA banks
• WARTN, Busselton, CVD, Diabetes, mesothelioma,
  melanoma, Joondalup Health Survey, Raine, Sleep
  apnoea, AMD
• WA Genetic Epidemiology Resource
• All existing clinical databases
• WA Data Linkage Project

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The Future

• Specimen collection under routine path services
• Standardise consent, SOPs etc
• Integrate with all other specimen/health info
  groups in Perth
• Promote cooperation amongst researchers
• Engage with community to maximise outcomes.