The EORTC is all about science and progress in cancer care
Over 50 years ago, visionary leaders in cancer medicine realized that advancement of patient management requires solid understanding of the disease and biology, vigorous testing of novel treatments, and interdisciplinary collaboration and exchange beyond state boundaries. This remains true today, and is even more important as we move into an era of personalized medicine.
Platforms for molecular testing are needed to profile each patient’s tumor. Novel tools and imaging methods allow for adequate and early evaluation of the treatment effect. The European Organisation for Research and Treatment of Cancer (EORTC) is well positioned to provide the needed network and infrastructure to advance science and new treatments. The EORTC Headquarters staff is eager to contribute and help, and we sincerely thank them here for their continued commitment.
Oncology has grown from small sub-disciplines of internal medicine, radiation therapy or surgery, respectively, to a large specialty of its own. The tremendous increase in knowledge, understanding, and treatment has led to organ-based specialization as is reflected in the EORTC Groups structure. As we move forward, interdisciplinarity, the integration of pharmacology, molecular biology, tumor immunology, and imaging, as well as transversal problem solving beyond organ-based medicine, are gaining increasing importance.
The complexity of biology, the interaction of tumor and its stroma, and a plethora of agents to be tested are challenges and opportunities to rational trial design and conduct. We now understand that there may be common pathways leading to tumor proliferation. Novel treatment strategies are oriented towards the specific molecular aberrations. Molecular tumor characterization is becoming routine also in daily practice. The input of well-trained biologists is needed in order to understand the requirements and limitations of clinical decision making. Clinicians, for their part, need to understand the limitations of molecular techniques, the importance of quality assurance, test reliability, specificity, and sensitivity.
The regulatory environment has changed over the past decade. What was meant to lead to harmonization allowing for rapid translation from the bench to the clinic has resulted in heavy administrative requirements. Patient information sheets resemble the fine print of complex legal language and do not contribute to a true informed consent. What was meant as protection of patients’ rights and interests and enhanced patient safety results in confusion for the patients in an already difficult period their lives. Obstruction to novel and promising treatments is the consequence. Constructive lobbying, in particular also by the EORTC, directed towards an explanation of the limitations of the current directive has not gone unheard, and a revised proposal of the clinical trials directive is in circulation.
The economic downturn limits the available financial resources for cancer research and the care of cancer patients. The best response to scarce resources is to collaborate and share competences. The EORTC has a long-standing partnership with industry adhering to strict standards of trial quality and academic independence. This partnership has led to a number of practice-changing trials. The quality of EORTC investigators has been confirmed by repeated inspections by national competent authorities, and EORTC trial results have allowed for registration of several new drugs or indications. The complexity of clinical trials, as well as the expansion into countries outside the EORTC network, requires new models of collaboration. Examples of new and fruitful collaboration are on its way, a win-win situation for industry and academia; the ultimate winners are our patients.
Novel sources of funding are needed. The EORTC is a partner in seven EU projects. The partnership with Walgreens Boots Alliance and the EORTC Cancer Research Fund is recognition of the value that the EORTC brings to cancer research. This partnership has enabled the initiation of a unique biobank and molecular tumor characterization platform in colorectal cancers. Unique is not only the partnership, but also the close linking of a tissue platform with clinical trials and thus homogenous treatment and outcome data. Those of you who have participated in these activities can testify to the dedication and commitment of the leadership and the employees of Walgreens Boots Alliance. We thank the EORTC Cancer Research Fund and Walgreens Boots Alliance for this visionary initiative.
Patient and patient advocacy groups are becoming increasingly involved in both individual and politico-scientific decisions of cancer care. We need to learn to listen to patients’ representatives, and they will need to understand the difference between an individualized decision and trials designed to provide care for an entire group of patients.
Opening up of groups – transversal and international collaboration
New models of interaction and exchange among academics are needed. Certain treatments and treatment modalities may be applicable across several tumor types. The importance of transversal platforms and continuous interaction and collaboration are of utmost importance. Boundaries, be it disciplines, specialties, or state, must be overcome. International collaboration (also beyond Europe) and outreach is required.
A better understanding of the disease and understanding why our interventions fail or succeed is an obligation. Nevertheless, with the excuse of patients’ interests and legal considerations, access to biological material is often being hindered; tissue collection and exchange are made particularly difficult. Some institutions do not allow the sharing of material despite a patient’s explicit authorization, regulators do not allow tissue to cross state borders, and even we as investigators sometimes prefer to store tumor tissues for future use (?) in our basements. Ethical considerations are often brought forward, while in actuality ethics warrants that we learn a maximum from each patient in order to minimize the number of times we make the same mistakes.
With these thoughts we look forward to a continued and fruitful collaboration and thank you for your trust and friendship.