Download European Society for Medical Oncology

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
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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.
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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.
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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