Cliona Kirwan’s main focus of research is the symbiotic relationship between cancer and clotting. It is well recognised that cancer patients are at increased risk of deep vein thrombosis (clots in the legs) and pulmonary embolism (clots in the lung). Cancer seems to promote clotting. Cancer patients, especially those with more advanced disease, have increased levels of clotting molecules in their blood. However it is now known that this is a two-way process. The clotting system is also helping cancer grow and spread. Cliona is exploring ways to treat cancer through targeting the clotting system.
Cliona’s PhD was entitled ‘The Role of Procoagulants in Cancer and Chemotherapy Induced Venous Thromboembolism. This was a prospective cohort study of patients receiving chemotherapy for advanced and early breast cancer. She investigated alterations in circulating levels of procoagulant molecules expressed by cancer cells (tissue factor; tumour necrosis factor; vascular endothelial growth factor by ELISA, thrombospondin by radio-immunoassay and cancer procoagulant by an indirect chromogenic assay). This was compared to markers of angiogenesis (VCAM), hypercoagulability (D-dimer, thrombin-antithrombin, prothrombin fragments 1+2, plasminogen activator inhibitor), development of venous thromboembolism, response to treatment and death.
As part of her post-doctoral research, she is chief Investigator of the CHAMPion (Cancer-induced Hypercoagulability as A Marker of Prognosis) Study, a 540-patient multicentre study, adopted by the NCRN (database number 8685), investigating clotting in early breast and colorectal cancer patients. She is also Principal Investigator on ‘Post-radiotherapy Perfusion’, a cohort study assessing the role of near-infrared spectroscopy in assessing long term breast radiotherapy damage and co-Investigator on the Northwest Research Collaborative (http://nwresearch.org/) PPAC (Packing of Perianal Abscess Cavities) feasibility study and planned RCT study.
AS part of her NIHR Clinician Scientist Award, entitled ‘The Thrombin Pathway in Breast Cancer Dissemination: a potential biomarker and novel therapeutic target’, she is chief investigator on the T-POETIC multicenter study (UKCRN database number 12314), the TuFCLot study (investigating circulating tumour cells in breast cancer), and the TIP Trial, due to commence soon. In addition she has laboratory studies exploring the role of clotting on cancer stem cells and the tumour microenvironment.