RF Robin Foa - Interviewee
RF EHA has grown considerably over the years. It started in the ’90’s and it’s grown progressively year after year. I must say that Barcelona last year was a particular success because if we compare it to the year before in Berlin we had over 1,500 participants more than the previous year. It was a record attendance of over 9,000 people in Barcelona and if we add the company, pharma people that put this all together to a figure of 10,000, which in Europe is something quite remarkable I must say. Why that happens might be different. I think obviously the quality of the scientific programme is a key point. I think its improving year after year and obviously in the different sessions educational and scientific. There is a lot of science. There are a lot of trials presented. We are careful at covering not only neoplastic conditions but also non-malignant haematology which is very important. We are careful for instance at covering paediatric haematology. It should be a forum for all forms of haematologists and one key point that shows the success is, and I’m happy to say this, that we had 26% of participants that were non-European. So that means with over 9,000 that 2,000 people were from outside Europe. Obviously it is becoming a very attractive forum for haematologists worldwide.
IV Under your presidency what is the EHA doing in Europe and indeed elsewhere?
RF I think a very important point is that we have strategically decided that we have to evolve in many directions because it has become a very successful organisation and I think it’s important to highlight that it’s not only the yearly congress. If I just open a little parenthesis, it used to be every other year and then from ’99 onwards, in fact in Barcelona ’99, it became a yearly congress to show how this congress has been successful. But it’s not only the congress there are many other activities in Europe and as you mentioned outside Europe. We are doing educational activities in Europe and outside Europe. We are doing scientific workshops. We have many committees in EHA to develop various activities. To give examples we have for instance what we call an age-net project which is financed by the EC, the European Commission so we have European funding and this is to develop a passport, a curricular passport for haematologists in Europe to try to harmonise how a student should actually train in haematology. This one could be and I’m not sure that it will, but it could be taken by Brussels as an example of how we should train our young haematologists. There is a circulation of the haematologists in Europe as in other specialities but we need training and we’re taking this as a key point of our development, as for instance CME points. CME points are a reality in some countries not in others. We are giving CME points.
IV I think I’m getting the point that education to you is extremely important. I’d like to come back to perhaps more about that but the actually cancer science, a haematology science but in our case on E Cancer TV the cancer site showing what sorts of topics and issues will be aired and are you looking into seriously right now at the EHA?
RF Well we actually follow specific areas. For the congress we have a scientific programme committee. We are divided into many committees because if not we couldn’t fulfil all the goals of the society, so for the congress we have an SPCS programme committee composed of many experts in different areas and they obviously cover various fields of oncology.
IV There is a lot happening isn’t there?
RF There is very much happening in haematology and as I very often say and I hope that my colleagues don’t get offended but all the major advancements in the management of cancer come from haematology. This is a reality not because I’m a haematologist. If you think about what is very fashionable today, intelligent targeted treatment.
IV Vascular therapies?
RF That is a reality for three forms of leukaemia. It started with acute promyelocytic leukaemia years ago and by learning or understanding the molecular abnormality underlying the disease at a receptor level we understood that we could induce a different delta cell with a vitamin and this is retinoic acid and the cells differentiate. In combination with chemotherapy that has changed the natural course of the disease and that have improved the prognosis of kids with APL. Then we have the fantastic story of the tyrosine kinase inhibitors. If you think about chronic myeloid leukaemia it is an illuminating example of the advancements in cancer, particular in haematology. The Philadelphia Chromosome was discovered as the first sign of genetic abnormality in cancer in one form of leukaemia which was chronic myeloid leukaemia obviously in Philadelphia and a good 50 years ago in fact. From that we learnt the molecular configuration or the molecular abnormality and then the tyrosine kinase came on the scene. In the last 10 years we’ve learned how we can treat targeting exactly the defect of that form of leukaemia. It’s changed the treatment.
IV It is exciting indeed.
RF It is fascinating and now the same inhibitors are used in acute lymphoblastic leukaemia with a Philadelphia abnormality, so we are in fact curing or treating abnormalities in acute leukaemia without chemotherapy at least for the induction phase.
IV And you even find that when there are mutations which evade some of the first generation TKI’s you’ve got second generation, even third generation and now that very elusive mutation of T3 or 5Is is being perhaps being caught up with isn’t it?
RF Well, we are trying. Let’s say that with the first and second what you have said is absolutely correct. The second generation are active against many mutations for the first are less active. There is still a problem of 315 mutation and with new drugs we are trying to see if we can overcome this resistance but there are monoclonal antibodies too that could be effective on that and we in fact heard a presentation this morning on that at ASH. There are many things that could develop exactly in that area. Haematology is a front runner in this. All this development and research is translating into better management of research or translating into better management for patients of all ages. We’re talking about kids and others but also for elderly it’s a total revolution and each is very careful at targeting all these different diseases and in our programme this is very actively pursued.
IV Keeping up with everything is a problem and education as you say is really important to you. You’ve got online services. You’ve got CME. How does it all work and what are you working at in education right now?
RF Education as you say has been very high in priority within EHA. You mentioned a website which contains all information about how EHA develops that includes also educational tools. I’ll give you one example which is a format that we developed many years ago. It started with an idea we had in Rome and we started in Rome with what we called tutorials. Tutorials are a form of education which is different from a workshop or different from a consensus meeting. It’s an educational format for a limit number of participants up to 100 in order to be very interactive and we have also a voting box system, so that means that the participants actually interact and we have multiple choice questions. We have a limited faculty. It’s a meeting over two and half days with a limited faculty of eight to nine people who give a talk, present clinical cases and have test cases with the audience, and these cases are then uploaded to the website.
IV It is astonishing, yes.
RF It means that if you’re not there you can go on the website and it’s free for everybody. I would like to underline that. It’s not only for members of EHA. They can see the cases and every three months we upload cases with multiple choice questions so they can earn CME points directly from our website.
IV How effective do you think the whole CME system is becoming in actually improving therapy in the real world?
RF Well, I would divide the question. If you’re asking me what I think about CME in general, I think it’s very variable. I mean it’s implemented and active in some countries but much less in others, so I don’t know. In the UK, yes but in others no. what I feel is that one day I imagine that Brussels European Commission will take this up as obligatory probably for Europe so we will be in a position to actually manage to give European points, so EHA CME points.
IV So you’ve got this on board and you’re doing all the right things. You have a journal of course and that’s extremely important. You have an outreach programme too. Tell me just a little bit about the outreach? What are you doing there?
RF Yes, the outreach is very high on my list of priorities but I feel that since EHA has become such a big and established organisation and although I’m obviously not a politician, I feel it’s the duty of Europe to actually consider that there are other areas close to central Europe for which we can be ‘useful’ and I’m thinking about eastern Europe. I’m thinking about the Middle East. I’m thinking about Iran and Iraq. I’m thinking about northern Africa. These are areas which are in close proximity to Europe.
IV And are you doing things now?
RF We are doing things exactly in that line. We are definitely doing this and one example is the tutorials I mentioned earlier. Tutorials started in Europe and then we decided to extend them outside Europe. To give you one example we’ve gone to many areas, we’ve gone to the Baltic States. We had a tutorial at the beginning of this year in Lebanon. We’ve been to Turkey. We’ve even been to Brazil in collaboration with Brazilian scientists of haematology, very successful, four tutorials in Brazil and it’s not stopping. It’s going to other areas. At the end of the year we should be going to the Gulf area and next year again, and we’re going to Ukraine and Russia.
IV So really the EHA is a major global player and in fact you have collaboration with ASH, the American Society of Haematology and the Japanese Society of Haematology. For clinicians what would you like to leave them with finally, if you could wrap up and tell us what you’d like doctors to think about the EHA and be planning about being involved?
RF I would like them to think as a major organisation that we’re trying to target all haematologists and in fact I would add and this is for the future, not only haematologists, we are targeting patient organisations which is very important and in future also other categories in the health system, but haematologists in all respects, scientists or clinicians. As I always say haematology is not too different to the world of scientists or clinicians. They all work together but I think there should be a forum for everybody where we cover education, where we cover science and we cover outreach programmes. So it’s not only the congress, we’re doing so many activities. You mentioned the journal. The journal is Haematologica which started from fusing two journals; Haematologica the oldest journal in the world and Haematology journal and now we have a very strong journal. Our plan is to develop it to become very large and if I can say one final thing. You mentioned ASH and the Japanese Society; I think it is very important. We are doing a lot with the two major societies of America and Japan. We are doing joint symposia with ASH at EHA and at the Japanese Society and at our congress with Japanese groups, so we’re doing joint activities. With ASH we developed this very important education programme for young scientist which is called translational research in haematology and it started this year. We will develop this every year in Europe and it’s an extremely important project for young upcoming haematologists.
IV Well, a vibrant organisation indeed, and it’s really good to have a vibrant Robin Foa with us on eCancer Television.