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ANALYSIS European Society for Medical Oncology Buoyed by advances in genomics, and speeded up by technology afforded by bioinformatics, progress in cancer research has come on apace within recent decades. We speak to an array of key figures from ESMO, who highlight the important work they are doing to continue this encouraging trend INTERVIEW CONTRIBUTORS: David Kerr, ESMO President; Martine Piccart, ESMO President-Elect; ESMO Executive Board Members: Rolf Stahel, Paolo Casali, Razvan Popescu, Fortunato Ciardiello; Lewis Rowett, Annals of Oncology Executive Editor; Keith McGregor, ESMO Senior Director Could you provide an outline of ESMO’s overarching mission? societies. DK: ESMO is committed to the advancement of medical oncology for one simple reason: we ESMO members believe that such advancement will actually improve patient care and patient outcomes. ESMO also sponsors and promotes research, through fellowships and training grants; it disseminates education and information through conferences and publications; and it promotes communication and collaboration, not only among its members, but by reaching out to sister organisations and specialties and to the world at large. Improving the quality of prevention, diagnosis, treatment, supportive and palliative care is an impressive mission. What approaches are you employing to promote a multidisciplinary approach to cancer treatment and care? How does ESMO decide what the most effective treatments available are? In what ways is ESMO committed to advancing the specialty of medical oncology? MP: ESMO represents a community of members sharing a common discipline and curriculum and a responsibility in the fight against cancer. This implies providing real ‘deliverables’, which include: • Contributing to the reduction of inequalities in cancer outcomes across Europe by harmonising training, increasing the attractiveness of medical oncology as a profession, facilitating exchanges of oncologists in training, expanding opportunities for clinical and translational research fellowships at top cancer centres, increasing interactions with policy makers and the European Medicines Agency (EMA) to facilitate access to effective innovative diagnostic tests and therapies • Providing medical oncologists with high-quality, user-friendly tools to help them cope with the rapidly growing body of knowledge about new cancer pathways, targets and drugs, and to update their skills in treating a variety of malignancies, including rare tumours • Collaborating with national groups and sister societies to build evidence-based guidelines and expert recommendations on difficult issues, to improve the quality of cancer care and, in consideration of today’s remarkable heterogeneity in the process of treatment decisionmaking, make the ‘journey’ of cancer patients crossing EU borders less distressing • Making clinical research less bureaucratic and more readily accessible to patients and doctors (even outside academic centres), keeping existing, high-quality research networks in Europe alive and competitive worldwide This will require extensive efforts to map existing facilities across Europe, and therefore closer collaboration with national cancer 134 INTERNATIONAL INNOVATION RS: Cancer is a highly complex disease; more precisely, a wide range of diseases. A steady increase in the knowledge of its biology, better treatment approaches and new, more complex techniques have brought major changes in the management of cancer patients. The old paradigm of medical treatment reserved for advanced disease is now changing: there is a trend towards shifting the use of some effective drugs from more advanced settings to earlier stages of the disease, when chances for better treatment results and prevention of cancer recurrence are more realistic. Medical oncologists must treat cancer patients as a whole being, not only an organ affected by the disease, and therefore ESMO as a society cannot approach cancer issues in fragments. Because cancer is a complex disease, it has to be tackled as such, with complex methods, including a multidisciplinary approach. Despite being named the European Society for Medical Oncology, ESMO strongly believes in multidisciplinarity. In almost every aspect, ESMO ensures that also other cancer specialists play their important role: the ESMO Faculty, for example, is a group of over 300 members with special recognised expertise in identified fields of oncology who contribute by presenting at major meetings, developing educational programmes and reviewing reference material which guides doctors in treating patients. In line with the mission of providing the highest standards of cancer treatment and care, with the Clinical Practice Guidelines, ESMO offers evidence-based recommendations for optimal multidisciplinary diagnosis, staging, treatment and follow-up of most cancer types and clinical situations, aimed to help oncologists choose the best treatment available and guarantee the best quality care to their patients. One of ESMO’s aims is to facilitate equal access to optimal cancer care to all cancer patients. How much of a problem is equal access? PC: One major ESMO goal is to decrease inequalities in cancer care. While there are many determinants of such inequalities, one example is variable reimbursement models of new therapies across the EU, which is particularly alarming in a time of economic crisis and rising healthcare costs. ANALYSIS Key ESMO figures (clockwise from top left): Martine Piccart, Rolf Stahel, Paolo Casali, David Kerr, Razvan Popescu, Fortunato Ciardiello, Lewis Rowett, Keith Mcgregor The free movement of medical oncologists recently made possible after the EU recognition of medical oncology will also contribute to the harmonisation of how medical oncology is practiced in the clinical setting, spreading best practice and improving the quality of cancer care for the benefit of patients. an example: this multi-partner initiative is led by ESMO and involves medical specialists, research groups, patient advocates and the pharmaceutical industry working together to improve the methodology of clinical trials for rare cancers, with the ultimate goal of accelerating the development of drugs for rare cancer patients. What plans have you got to improve and increase liaisons with other oncology specialities, national societies, cancer leagues, patient groups and, where appropriate, the pharmaceutical industry? Through the ESMO Cancer Patient Working Group, medical oncologists work side-by-side with patient organisations on projects they feel meet patient’s needs. By providing educational information (eg. Guides for Patients) and networking platforms, ESMO is able to make the information available to patients in a language they can understand, empowering them with knowledge about their disease. RP: Through our activities, we unite key oncology stakeholders who share our goals and objectives. Enhancing our relationships with European and national oncology societies, as well as cooperative research groups, consolidates and strengthens our European network and reinforces our united efforts. For example, the ESMO National Representative and Membership Committee represents the needs of our members and acts as a liaison with individual national communities to get a thorough understanding of local issues. ESMO constantly consults and collaborates with other oncology stakeholders, in the context of a multidisciplinary approach to cancer care, but also to improve initiatives that would never be achieved if carried out individually. The European Action Against Rare Cancers is To what extent do you disseminate ‘good science’? LR: ESMO disseminates and sponsors ‘good science’ through a variety of channels: fellowships, educational and e-learning programmes, events – including the biennial ESMO Congress – and the Society’s official journal Annals of Oncology. Annals covers the broad spectrum of cancer research with an emphasis on practice-changing clinical research. In recent years Annals has published updates of the European Code Against Cancer, important consensus documents, epidemiologic estimates of European cancer incidence and mortality and significant clinical research in practically every tumour area. WWW.RESEARCHMEDIA.EU 135 ANALYSIS KM: Another major ESMO initiative to disseminate good science is the new scientific resource portal OncologyPRO: this first-in-class, unique online portal enables oncologists to easily access a rich source of reference information including most oncology journals, clinical trials information, biomarker and drug databases, oncology news, congress reports, webcasts, CME (Continuing Medical Education) resources, clinical practice guidelines and practice tools. What relevance does your work have for the major problems faced by the developing world? DK: Cancer is a major problem faced by developing countries: in contrast to a few decades ago, the majority of the global cancer burden now occurs in medium- and low-income countries. It has been estimated that by 2030 we could expect 26.4 million cancer cases worldwide, and 17.1 million cancer deaths annually. The WHO believes that regions with a large proportion of low- or medium-income countries will be most affected, and will bear some 70 per cent of that burden. But this isn’t a problem for the future, this is happening now. ESMO and its members have invaluable knowledge, expertise and experience which can and must be brought to bear on this issue. By working together, using science to inform our decisions, and considering the needs of all cancer patients, be they in developed or developing countries, we have the possibility to shape all our futures for the better. Do you think that cancer research has progressed substantially in recent years? How do you anticipate research and therapeutic treatments developing in the future? FC: Cancer research has seen extraordinary progress over the past 30 years. We have acquired considerable knowledge of the mechanisms responsible for cancer development and progression at a very precise molecular level. For most cancer types we know which key genes and proteins are involved in carcinogenesis and are able to use this information to classify different tumours in terms of prognosis and, even more importantly, the best therapeutic approach. In the past 15 years, new anticancer drugs, defined as molecular targeted agents, have been developed and in several cases have changed the clinical practice – for example, in breast, colorectal, and lung cancers, and in some haematological malignancies. The knowledge about cancer cell mechanisms at the molecular level has also allowed for a better and more selective use of these novel drugs in patients whose cancer largely depends on the molecular targets, which lies at the foundation of the next challenge in the clinical management of cancer patients: the true personalisation of therapies. With such a wide range of contributing factors and diversity of forms, do you think the much needed ‘cure for cancer’ will ever be found? DK: We need to move beyond the concept of a ‘cure’; there are cancers for which we have highly effective therapies, and there are still diseases for which we need more effective therapies. But we already know so much of what we can and what we should do to save millions of lives: tobacco control is an obvious example; better food preparation to eliminate communicable disease-related cancers, and adequate sun protection to reduce melanoma are other examples. Many of us have great expectations for the HPV vaccines in cervical and other HPV-related cancers. If we can raise the outcomes of all patients to the level of the best outcomes then we can similarly improve the lives of millions. We can do that through education and training, making information on best practice available to all, and by changing the ways we deliver care to optimise results. We don’t just need new drugs, we need new knowledge on how best to use the drugs we already have, socalled individualised medicine based on greater genetic understanding of cancer and how the drugs work. 136 INTERNATIONAL INNOVATION MP: I don’t believe in the eradication of cancer, but I do believe in a world where cancer is more preventable than today – in view of upcoming improved technologies to identify high-risk individuals; where cancer is more treatable than today – with earlier diagnosis and improved biomarkers of treatment success or failure; and where cancer becomes more manageable for patients – thanks to better chronic therapies with fewer side-effects. We need long-standing efforts and a revolution in research: less fragmented initiatives, more biomarker datasharing, and stronger public-private partnerships are some essential changes we need if we want to see radical progress in the fight against cancer by 2020. www.esmo.org