Research tackles tragic lung cancer rates for Māori

University of Auckland senior lecturer Dr Laird Cameron is focused on reducing the inequitable lung cancer burden borne by Māori.

While working as a medical oncologist at Auckland Hospital and Canopy Cancer Care for the past eight years, Cameron has seen first-hand the disadvantage Māori face with lung cancer.

The incidence of lung cancer is significantly higher for Māori than non-Māori and when diagnosed, Māori have a 1.3 times higher mortality rate. More than 300 Māori die from lung cancer a year,

“All through my training and in my clinical career, I’ve seen examples of inequality, where Māori patients have not had the health service meet their needs.

“Equity is important to me – we need to focus resources on groups that are suffering poorer outcomes - and the evidence is clear that Māori are doing worse than other groups with lung cancer,” says Cameron.

Thanks to a $1.2 million grant from the Health Research Council, Cameron and his Te Rōpu Rangahau team are looking at ways to optimise immunotherapy for Māori with advanced non-small cell lung cancer.

“Lung cancer kills the most New Zealanders of any cancer and has done for decades.

“My motivation for this research has come from my role as an oncologist, where I’ve seen the need,” says Cameron, who represents New Zealand on the Thoracic Oncology Group Australasia.

Immunotherapy is a new treatment for cancer, which harnesses the body’s own immune system to attack cancer cells.

In 2023, Pharmac funded the immunotherapy drug, pembrolizumab, which targets and blocks the PD-1 protein on the surface of immune cells.

“My project aims to make sure the benefits of that new, better drug reach Māori, who currently have tragic cancer outcomes."

While smoking rates are higher among Māori, this does not entirely account for the lung cancer burden in this group, Cameron says.

“It’s to do with our model of health care delivery under-serving Māori at each step along the diagnosis and treatment pathway.

“Māori are less likely to receive surgery or anti-cancer medicines.”

The researchers will use questionnaires to assess the health and wellbeing of Māori receiving immunotherapy in Aotearoa for non-small lung cancers. The information gathered will be compared to international data for lung cancer patients who have undergone immunotherapy.

Te Whatu Ora Māori research manager Dr Helen Wihongi and University of Auckland doctoral candidate Te Hao Apaapa-Timu will lead several hui with Māori patients and their whanau to gather information about their experiences of lung cancer.

The researchers will build a database of patients who have been recommended for immunotherapy in Aotearoa since January 2023.

Data will be compared for Māori, Pacific, Asian and European New Zealanders. Rates of treatment, outcomes and the PDL-1 profile of patients will be collated.

When people have a biopsy for lung cancer, a PDL-1 test is carried out, to show whether there are high levels of the protein, because this is linked with higher success rates for pembrolizumab treatment.

“This study will show whether or not there are differences in patients having a high PDL-1 score depending on their ethnicity.

“We will also see who’s getting tested, who is making it to treatment, and who isn’t.

“We will measure survival in all patients recommended for immunotherapy.

We want to know whether we’re achieving the improvements in survival that trials suggest we can get with pembrolizumab.”

The idea for the research stems from a seeding grant provided by Te Aka Mātauranga Matepukupuku, Centre for Cancer Research at the University of Auckland in 2021.

From there, Te Rōpu Kawanatanga was established. This group of lung cancer patients and their whanau have identified research priorities and are providing governance over the current research.

In 2021, Te Rōpu Rangahau research team formed, including the University’s pathology professor Cristin Print, biological sciences professor Rod Dunbar, research fellow Dr Kimiora Henare, honorary research fellow Stella Williams-Terei, Auckland Hospital kaumatua Thomas Hauraki, oncologist Dr Gireesh Kumaran, University of Otago biostatistics professor Katrina Sharples, Wihongi, and Apaapa-Timu.

Cameron is involved in another pilot project, led by Wihongi, offering immunotherapy to Māori patients in Māori primary care settings, rather than hospitals.

“We hope our projects will provide solid information to get the structure of the cancer service to meet Māori needs,” he says.