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

Cancer prevention through education

Professor Angelo Paradiso – Istituto Tumori ‘Giovanni Paolo II’, Bari, Italy

Now you have been, like all of us, going round the helter skelter of ASCO. Anything grabbed you and said, this is something I’ve got to take care of?

Considering breast or generally speaking?.

Generally speaking, then breast.

Generally speaking, impressive results concerning melanoma treatment. You know that yesterday the phase III trials results were firstly presented concerning immunotherapy and anti-BRAF treatment. Impressive results, for the first time in that the very, very hard situation like melanoma we have an opportunity, this is the first point that I have to stress in this meeting. The second one is the complete approach to the patient. The palliation is becoming even more important, not as an approach to the patients only for the last time of their life but all along their experience with the disease. This is a very different approach also from the cultural point of view. There has been a lot of room and a lot of discussion about that all along the meeting, very impressive. Concerning breast, the discussion on triple negative becomes even more large and molecular fingerprint signatures are there just to implement it, to compliment the pathological information that we daily handle. So I would say that an holistic approach to the patients is perhaps the most important comment that I can make from this meeting, the patients in the middle. It is really important, believe me.

And quite a lot of sessions on older patients with cancer and how important they are; they are in fact the majority of our patients, and that cohort are going to grow and so we had better start looking at these things. And there have been complaints that elderly patients are not put into clinical trials, they have been physically excluded from those trials, so we have no evidence base. There is an assumption that the older patient will do differently, probably less well, and so people are not going into them, so that’s important too. Are there any new medicines in the breast cancer area, new randomised trials? Not a great deal.

Monoclonal antibodies, monoclonal antibodies against more than one target, so poly-target, more targets all together just as a target for monoclonal antibodies. So the approach is more than one target, more than one biological drug together, to implement and to discuss, a long, long and important discussion, about when to stop that treatment, at progression or not. The maintenance also after progression of the disease, as a complimentary result.

That’s a fascinating thought isn’t it?

Absolutely, but could you imagine what does it mean from the economical point of view, the management of such an approach. Just coming back to melanoma, or to upper gastrointestinal disease, there was a very interesting meeting session yesterday just discussing the economical impact of that, and the conclusions were that one year of longer survival we are available to spend more than €100,000 per one year of longer survival. This is the impact from the economical point of view and then you can imagine how this changed completely our approach to the problem.

And I expect that bevacizumab for one year after ovarian cancer, the treatment initially is also not going to be cheap. I have no ideas how much it is though.

Just along this comment, if I can Gordon, there is another important session today about how to treat patients in less favoured, less economical developed countries. It’s a very important approach, an innovative approach, in this ASCO meeting; an overall and comprehensive view to the problem of cancer, not only drugs, drugs and drugs.

Yes, Peter Boyle was telling us about the population explosion and the issues that we are going to have to face and we agreed that prevention was actually a much more realistic way to go to meet the needs and the threats from the low income countries. We also agreed, Peter and I, that education was the most important part of the prevention. And that brings us to your other job, which is the Education Working Party of the OECI which is the Organisation of European Cancer Institutes which represents 73 approximately, about to be 80, major cancer institutes right across Europe. What are the plans, Angelo; you are coming to the general assembly in Amsterdam shortly and how do you see this pretty key job?

For what concerns, education?

Yes.

For what concerns education, just along the aim of the OECI, what we are trying to develop within the OECI in the next future is to share tools for education and to develop communication among comprehensive cancer centres. If we speak about a common platform, a common voice, we have first of all to know what each other is doing, and to share tools, because education, this is an example how complex it is to manage and to have tools and to prepare and e-communication, e-learning etc. There are costs, there is organisation needed for that; not all the institutes can support and can have the essential organisation, so sharing of tools, common language, common programmes, from one side. On the other side the dream for OECI could be to have a platform of people, of professionalities, to move all around Europe, just to try to develop the concept of multidisciplinarity. Only the OECI, perhaps, has this opportunity in the European scenario to put together multidisciplinary expertise in a common clinical pathway; this is the peculiarity of OECI.

My view, as you well know, is that the cancer institutes are the lighthouse, the beacon, the flagship, and that they have a duty to spread the light, best practice, guidelines and research technology platforms. Do you believe that, that all of the institutes are in this lead position?

First, try to reinforce the empowerment of this platform of all the cancer institutes in Europe, and the platform is there, the European project. Just reporting the level of excellence of comprehensive cancer centres, so guidelines just after, and to spread it to become available, the education, but also the technology platform and clinical trials, clinical trials all over Europe, this is the topic. If I can make just one more comment, I would say that peculiar is the role of OECI with respect to these countries, European countries.

I agree.

They are largely represented in OECI but they don’t have, generally speaking, still now enough budget to permit enough organisation to have an organic approach to education, to have an organic approach to multidisciplinarity. OECI should be there, first of all, there to spread such an approach to oncology.

I strongly believe that it is the responsibility of ecancer.tv and cancer.eu to provide all these tools and make them accessible at no extra costs. You can look at the Eastern European institutes, many of them, as being developing countries and they have much to learn from those at the west end of Europe which are the blue chip institutes within the European platform. And whatever we do providing educational tools or any other tools, I think they have to be simple and cheap, preferably free. And that’s one of my visions for what we can achieve.

I completely agree with this vision and approaches such as that one of ecancer Medical Science. It’s the only one, I think, from high professionality and a simple way to approach the problem all over the world, I would say. If I can come back to the OECI General Assembly in Amsterdam, just one more comment if I can make, is that I would stress the organisation there of a meeting in which all the scientific societies involved in cancer will be all around the table just to discuss about common pathways, clinical pathways, share of resources. So EONS will be there, the European Organisation of Nurses, ECPC will be there, the European Cancer Patients Coalition, ESSO surgical oncology, ESMO medical oncology, ESTRO will be there, all around the table just to, in a very simple way, say to all the other ones what they are doing in education.

Thank you very much indeed, Angelo, I wish you very well in the next few months through the OECI Meeting in Amsterdam and let’s hope we can make a big impact. I am sure we can, the will is there and the way is there, and we just need to find the time in our very busy weeks to make it happen.

Thank you.