ASCO 2011 Annual Meeting, 3—7 June 2011, Chicago

2011 Gianni Bonadonna Breast Cancer Award and ASCO breast highlights

Professor Luca Gianni (Istituto Nazionale Tumori, Milan, Italy)

Luca Gianni, all the way from Milano, prize winner of the Gianni Bonadonna prize, this is just fantastic news, congratulations.

Thank you.

I really am so pleased for you and pleased for Milan and I expect that Professor Bonadonna is pretty pleased too. Tell me what it means to you.

Well Gianni, a mentor, a friend and a person who conveyed to all collaborators the spirit of going ahead, never look behind except for getting new ideas for the next steps. That has been always his legacy and, as you can imagine, I am particularly pleased and proud to have received an award in his name and I had the honour of telling him personally and so he was particularly moved by that.

And he was pleased? I bet he was. So Luca, why did you get the award? Come on, tell me all.

One very important person in my institution told me, if you deserved it, that is a good thing; if you didn’t, that is your problem. So I don’t know really why, I think that it is mostly because we continue to adhere to the concepts Gianni Bonadonna put together - new ideas, quality of data and mentorship for new guys. In a way I interpreted this apparently well enough to be considered.

I think, as an unbiased observer, I would say that you carried the standard on after the awful thing that happened to Gianni Bonadonna and I think that you’ve done a great job. I think that you are probably one of the strictest academic minds applying themselves to the business of drug discovery and drug development and that’s obviously a thought shared with a lot of other people because you were given this award. So tell me, I know you’re a bit modest to discuss this, tell me about what your group are doing now. You’ve just moved to San Raffaele Hospital, which is a big general hospital in Milano, how’s that going?

It is going well; it is one of the largest general hospitals in Italy and is also a very good university hospital with a great academic component and an independent research institute. So these are the three things that make the challenge of creating a new cancer centre very possible and this is the bat that I am playing now.

Are you involved in all three areas? You’re teaching there? I know you love teaching.

I’m not a teacher, I tutor young fellows.

You do PhD students.

Yes, and I run a lab. Basically what we are doing now is we already set up a phase I unit that was my original job, as you know, and we are creating a very strong group in breast cancer, along with a major effort in establishing other diseases that already are very frequent in San Raffaele.

And you’ve got terrific imaging at San Raffaele too, haven’t you?

Absolutely, the imaging and bio-imaging at San Raffaele are top notch in terms of facilities, in terms of machinery, most importantly in terms of people who are joining or who have already joined the institute.

So you’ve been walking around here carrying your medal, or whatever you get, what have you seen in the ASCO meeting 2011, Luca?

I have observed the continuous trend shifting towards tailoring the interpretation of disease, no longer according to site or anatomy but according to molecular features and characteristics going along with a major effort of drug discovery and new drug definitions. This is a fantastic opportunity but is also a challenging one. I think that, in spite of all that we preach on tailoring treatments to new targets, we are still not so close to the ideal situation.

We still have a lot of off target effects, which is unexpected.

Yes, we have a lot of off target effects, a lot of unexpected toxicities and the results, although very pleasant, they are not a solution necessarily. They are just the start of a solution, most like.

Now when you move institutes, you have down time but by 2012 ASCO what are you going to be bringing to the meeting, do you think? What’s going to be maturing?

The major investment that we are doing now is to interpret the data of all the biobanks that we have been collecting over the years with neoadjuvant trials. The purpose of this is to try and see whether we can establish a new biomarker and now the ability to predict benefit of therapy. This would be an incredible turnaround because if we succeed in that type of approach, and by molecular dissection of the disease, breast cancer, we are getting closer than we have ever been. We will have the possibility of linking response at surgery with long term benefit and eventually do without long and pragmatic adjuvant trials, which is addressing one key point. We have too many drugs and if we only think in breast cancer but in any other disease type of all the possible permutations, just for new drugs not for new and old drugs. The task of developing them is just impossible so we have to find new clinical trial tools and validate the new clinical trial tools.

Expensive technology?

The technology is as expensive as it goes and that means that up to a few years ago just running the genome sequence of a tumour would take an enormous amount of money and time. Now we are getting very close to spending around $1000 per genome and it would not take more than a couple of weeks to get it. I expect that with the pace of the technological advancement it would become soon the time when a genome can be analysed, I would say, almost in real time. Now the problem will be what we will do with all that information.

That’s going to require some very clever computer technology, mathematical algorithms, informatics…

It will require a major departure from the way we approach medicine and medical problems.

And these kinds of people are not growing on trees and I expect, I hope, I trust that you are growing them in your medical school in San Raffaele.

What I ask of many of my young fellows is to have a full immersion of at least a few months with biostatisticians. They have to learn the language of biostatisticians to make biostatisticians understand what is relevant for a clinician and merge the two languages because otherwise it will be impossible to proceed.

Luca Gianni, award-winner of the 2011 Gianni Bonadonna Award, congratulations and thank you very, very much indeed for giving us time to talk.

Thank you.