Arriving in Australia in 2003 for a one year working holiday stint after finishing his medical studies and junior medical officer training in the United Kingdom, Dr Rishi Kotecha didn’t predict he would go on to oversee the treatment of every child and adolescent with leukaemia in Western Australia.
One year turned into another, then another, and after making the decision to complete his postgraduate studies in Australia and build his career here, he unintentionally discovered paediatric oncology as his preferred speciality.
“I was working at Princess Margaret Hospital and during my training I was rostered to the paediatric oncology unit, which I found to be very heart wrenching and I thought, ‘this is not for me’. Then I got rostered to do it again and I started to see the patients that I'd seen the first time that were actually cured from their treatment.
“It was incredibly heart-warming to hear them tell me that I had had a massive impact on their life and that they'd remember me for forever. Even 18 years later, a lot of them still keep in touch, sending me photos and emails.”
The paediatric leukaemia specialist wears many hats in his quest to improve treatment for cancer patients. In addition to his statewide supervisory role as the clinical lead for all young Western Australian patients with blood cancers, he is a Consultant Paediatric Oncologist and Clinical Haematologist at Perth’s Children’s Hospital and an Associate Professor in Curtin Medical School at Curtin University. He is also a member of the Children’s Oncology Group and the international BFM Study Group, which are responsible for the design and implementation of clinical trials for children with leukaemia worldwide.
Dr Kotecha is driven by a need to know more, which is fortunate for those under his care, and has seen him relentlessly pursue ways to improve treatment for children and adolescents with leukaemia.
While working full time at the hospital, Dr Kotecha undertook his PhD. It was a period of intense work, which saw him splitting his time between his patients and his laboratory-based research, clocking up more than 100 hours a week.
“I used to wake up really early in the morning, go to the lab and set my experiments up, start clinic around 8.30, and at lunchtime I'd run back over to the lab again for about an hour, then go back to the clinic in the afternoons, and then in the evenings, analyse all the results from the lab. It was crazy, but you know, it's something I was passionate about.”
Dr Kotecha established the Leukaemia Translational Research Laboratory, which sits within the Telethon Kids Cancer Centre at the Telethon Kids Institute and says a lot of patients want to contribute back by donating their tumour samples to the research. Those samples are then used to generate models of leukaemia in the laboratory and test new drugs that aren't currently being used to treat patients.
Dr Kotecha is focused on improving outcomes for infants with acute lymphoblastic leukaemia (ALL).
Read more: Combinational therapeutics in high-risk infant acute lymphoblastic leukaemia.
“The Kids' Cancer Project has generously funded me in the past to look at the outcomes for babies with acute lymphoblastic leukaemia diagnosed before their first birthday.”
Last century, a diagnosis of ALL was associated with pallative care. Current survival rates have improved to exceed 90 percent in standard-risk patients. Unfortunately, infants diagnosed at less than one year of age remain an exception to this success.
“About 80 percent of those babies have a genetic rearrangement in their leukaemia cells that makes it very aggressive - their survival is less than 40 percent.”
Dr Kotecha aims to change these statistics, splitting his focus between patient care and clinical research. His research, funded by The Kids’ Cancer Project, has informed the release of a new paper that looks at the effects of a drug designed for babies with this aggressive form of leukaemia.
“This paper is important because it actually showed that this particular drug didn't provide any additional benefit to patients. It tells clinicians that this is probably not a drug that we should be testing or using in this patient population. It prevents more harm from being done.”
This research work is only made possible from sourcing funding from organisations, such as The Kids’ Cancer Project, and Dr Kotecha says it has been invaluable in helping him develop his research laboratory.
Read more: Paediatric oncologist on a mission.
“When I started it was very small, we’ve been able to expand the scope of our projects and work that we're doing through the support of this type of funding.”
With the help of donations to charities like The Kids’ Cancer Project, he hopes his work will go onto have real world impacts for those going through childhood cancer.
“We aim to establish a full circle. We get the sample from the patient, it comes to the lab bench where we are able to test novel treatments and we then plan for efficacious treatments to be translated back to the bedside again, to actually improve outcomes for patients.”
