European Multidisciplinary Conference in Thoracic Oncology (EMCTO 2011) 24—26th February 2011, Lugano

State of play in thoracic oncology

Professor Rolf Stahel – University Hospital of Zurich, Switzerland

I’m lucky to have Professor Rolf Stahel, you’ve made the long journey from Zurich here to Lugano, Rolf, and you have a very important position here at the European Multidisciplinary Conference in Thoracic Oncology because you are President of the European Thoracic Oncology Platform. I want to ask you about ETOP as it’s called, but first of all what about this meeting? You’re getting some of the top cancer professionals here all together, what’s the benefit of it?

Well this meeting is a tremendous opportunity for the top academic physicians from different specialities to come together to interact in a respectful way, to ask each other and last night at dinner they told me, it’s amazing how much I learn from your profession each time. Very often we meet among our peers, which is at times boring because we know what they expect, what they say, but here to meet with people from other professions but having the same goal – to improve the outcome of lung cancer – is just a tremendous opportunity.

Much is being made these days of the word multidisciplinary and the need to cross-fertilise. Just what, in practical terms, can you get from that sort of cross-fertilisation?

It’s the only way to advise your patient with the best treatment opportunities. When I started in the field of oncology things were moving in a linear fashion – patients would go to surgery and then they would be released, there would be a relapse, there would be the radiotherapies taking care and then eventually there would be metastatic disease and the patient would be in some treatment centre in medical oncology. There was not much interaction between the colleagues, but we’d say, OK, he didn’t take care so the patient comes to us. Now we see the patients together, at least for those circumstances where we need to meet with the patient more than one specialty. We discuss every clinical situation together on a board and it’s such a different thing to get different thoughts in. What has happened over the last two years, which was new to the multidisciplinarity, is now the inclusion of the pathologist who has a key role in helping us to decide what would be the treatment opportunity.

Individualising therapy is a high ideal, to what extent do you think is it now a real possibility?

Well it is in a way, I think there are two ways that come to it. Because individualising or personalising treatment means you have to be able to select between treatment options; if there would be only one option, there’s no individualisation. So it has emerged that now several treatment options for similar situations are available. Then, of course, if you think OK an option is systemic treatment, which systemic treatment? And here the pathology comes in because we know now that what we term the lung cancer, or non-small cell lung cancer, up to five or six years ago is a multitude of very different molecularly driven diseases. And based on the example of EGFR mutation and of ALK fusion gene and many other things that are coming now, we are very convinced that within a few years we will tailor the treatment according to the mutation status of the tumour of the patient.

Now could you tell me about your relatively new baby, the European Thoracic Oncology Platform?

Well, I think it’s an answer to the current needs because the advances in the past, and still an important tool to advances nowadays, are big randomised studies where average patients are treated with regimen A versus something added to it. That was fine but now when you see we think a certain subgroup of lung cancer is a hazard, 2% of all, it’s not so easy to study the groups. You need a catchment area to identify the patients, you need sites which have molecular capacity, so it’s a very different story. We think we may be able to have advances just on a study on 50 patients if they’re identified right. So that needs a whole new infrastructure on how to deal with clinical research and ETOP, and particularly our project which is called Lungscape, is one answer to this need.

So Lungscape is looking at biomarkers, molecular markers?

Lungscape will provide a platform for the TOP centres in Europe; it will be a virtual databank of clinical data, TNM staging, digitalised pathology and molecular data. The first step on a set of at least 1,500 operated patients up to three years ago, so with a clinical follow-up, and we will have, eventually, all those patients’ tumours will be tested with the important molecular markers. So they will give a molecular landscape of what is happening in Europe in the way of lung cancer topics.

So you’ve got something like a virtual bio-bank to give you this landscape, what kind of benefits will come from that?

It’s tremendous. The thing is, when a few of us with this idea started… it’s very hard to say when the idea started but it started, let’s say, in May last year. We had a translational research meeting here in Lugano supported by the San Salvatore Foundation, which is in Lugano, and we really said, “This is the opportunity.” Think about there is a set of centres which have the capacity to do the molecular testing and a new idea comes in from basic research. The centres are there, immediately you could see what is the frequency of a certain mutation and we will have a structure which will say, OK, we can identify rapidly even low frequency mutations and we will have a structure to do the clinical studies on those patients. Plus, for example TNM staging, so far the data has been mostly on patients who were entering clinical trials but to have a registry of patients that don’t have to be in a clinical trial, just the patients that are operated in the different centres, we have all the data and we have biological data so we think we can add to the TNM the biological part, TNMB as I call it. So the opportunities are tremendous and there is a lot of excitement within the community about it.

Indeed, some of the presentations here in Lugano are predicting that there could be big differences in response rates and sizeable improvements in survival without any sacrificing of quality of life. How much do you think we can look forward to this level of optimism?

I’m usually very sceptical but here, I think, this is what we are looking for, the whole community.

So what should doctors be doing right now about all of this?

First doctors should keep abreast; it will take a while but we all have to realise that what we called one disease, like lung cancer or non-small cell lung cancer, will break down into a multitude of diseases; that there will be an increasing need of competent centres that will help doctors in the molecular diagnosis, that will help in guidance and suggestion of what might be the best treatment. So it needs a new type of networking to provide the best for your patient.

Now you’re the keynote lecture speaker, so what, in a few words, is the keynote of this meeting here in Lugano?

The keynote is working together in a respectful way; communicate and strive to the same goal. And this community is now formed and this will provide the basis for the future.

Rolf, it’s great to see you and please carry on doing the good work and we’ll all be very interested to follow it.

Thank you.