15th Congress of the European Society of Surgical Oncology (ESSO), 15–17 September 2010, Bordeaux, France
Interview with Professor Jean-Yves Blay (University Claude Bernard, Lyon, France)
The role of EORTC – clinical trials, translational research, molecular trials and more
What are your plans in EORTC for the next couple of years?
Clearly EORTC is facing an important period of its existence because, being a network organisation which is working so much into academic clinical trials, we are facing challenges which we have not been facing in the past in that, probably because of a lot of constraints around the European directive and the cost of clinical trials, the cost of academic clinical trials is increasing. So in this context EORTC has a goal to maintain and expand its mission to do practice changing clinical trials in a purely academic setting.
The European Commission has apparently admitted that the data they have collected shows that there has been a decrease in people going into clinical trials, patients in cancer clinical trials, of 10%.
Is that not a disgrace?
Yes, it’s probably not the way we should go forward. Clinical research should improve, certainly in terms of quality that’s something which should be done and EORTC is committed to that. But in terms of handling a large number of protocols in terms of being able to fund important questions to be addressed in clinical trials, we are facing difficult times and this is something we have to take into account. Right now, our goals for EORTC in the next two years or so are really to try to implement an inter-group strategy; to try to work with our partner organisations working in the academic setting in Europe and elsewhere because clearly EORTC has the mission, vision and expertise to do that in Europe and it’s probably a unique network in this perspective. We also want to select more and more clinical trials based on translational research and that’s probably the core of our work, this is going to be the core of our work in the future.
Until recent years I would say that probably translational research was seen, for the clinical researcher, as a tool to improve the quality of the trial but not being integrated in the trial itself. Right now what we want to do is what we call molecular trials which means trials based on a true molecular understanding of the subset of the disease and integrating novel targeted therapy in these subsets.
But you’ve had a major achievement with the glioma trial that EORTC ran with MGMT subtypes showing the temozolomide effect when you didn’t see it in anything else. That was a classic and it’s a very good advertisement for EORTC.
Yes, absolutely. That was a really practice changing trial; cancer changing and paradigm changing trial and this is exactly the way we want to go forward. Particularly at the time where the number of targeted therapies is so much increasing that we will have to be smart in designing our trials because we do not have enough resources in the academic world to do all the theoretical trials which could be done with each targeted therapy. So we have to select the subtype, give the treatment and also innovate in our accrual capacity, that’s why the inter-group, and also our capacity to identify very rapidly surrogate markers for activities. Because I don’t think we can wait for ten years to get the final answer.
Now you’re, among other things, a sarcoma expert. How is translational science impacting on management of sarcoma with surgery, intelligent chemotherapy, where it exists, and radiation? Where are you thinking there?
Clearly sarcoma has been something very much evolving in the last ten years, probably because twenty years ago we were splitting sarcoma into bone sarcoma and soft tissue sarcoma, and soft tissue sarcomas were all the same. We now know that this is a big mistake, it was done at the time. Now we split into histological subtypes, there are probably more than fifty different histological subtypes of sarcoma and probably more than 100 molecular subtypes. It is now quite clear that each histological and probably molecular subtype should have specific treatment. So this has an impact on the quality of surgery where margins are important, where the quality of margins may be different from one histotype to another; that’s still debated. That’s also the case for radiotherapy, which are the subtypes in which we should give radiotherapy? For instance retroperitoneal liposarcoma well differentiated with MGMT amplifications, there is a question on this subset which is going to be addressed by EORTC very soon. This level, and probably while not ending that at this level, also on systemic treatment, the classic example now is GIST with imatinib. But we now know that imatinib is probably not active in all nine or ten different subtypes of GIST, which means that we have to make a distinction between the molecular subtypes of GIST in order to treat them accordingly. That is true for GIST with imatinib, that is probably true for all sarcoma subsets, even with chemotherapy. So I would say that right now we are relying more and more on the molecular characterisation of these tumours in order to be able to design rational clinical trials. This is why we face a problem, because it’s a problem of numbers so the only way is to merge.
You’re pushing multi-disciplinarity, which has always been a feature of the EORTC, certainly since my time. And you’re at ESSO, speaking at the surgical symposium, what’s your message for the surgeons?
Well the message for the surgeons is extremely clear. We will need to integrate more and more molecular classification in the management of the patient and while everybody agrees that probably the medical oncologists, radiotherapists, surgeons, should be associated in treatment decision making process, what we probably will have to integrate, very soon, is that the molecular biologists, along with the pathologists, will have a key role to design, not only clinical trials, but also routine treatment for patients. That is going to be very much practice changing because that’s not trivial and that needs regrouping of analysis, quality control and a lot of things which were expanding multi-disciplinarity, that’s the message.
Professor Blay, thank you very much indeed. Good luck with your presidency of EORTC and thank you for speaking to ecancer.tv.