What is the Future of Cancer Research?
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Cancer is the second leading cause of death in Europe after cardiovascular diseases. Each year, nearly 3.5 million new cases of cancer are diagnosed in the EU countries out of which more than 1.5 million deaths. Facing this significant number, investment in clinical cancer research remains crucial.

It is with this perspective in mind that the European Organisation for Research and Treatment of Cancer (EORTC) was founded in the early ‘60s to provide patients with the best treatments. Today, the organization still remains at the forefront of clinical cancer research.

Explaining basic and clinical research, the challenges, patient information and rights, the role of the EORTC and research perspectives, these are all topics that this small but dense book attempts to synthesize. Ultimately, this book is aimed at all those directly or indirectly related to this serious disease, patients, economic and political decision-makers, pharmaceutical manufacturers and of course, physicians.

Françoise Meunier is one of the foremost specialists in the field of oncology. Since 1991 she is responsible for the coordination of the scientific activities and strategies of the EORTC. She was appointed Senior Research Associate at the FNRS (1990) while Head of Infectious Diseases Department and Microbiology Laboratory at the Institut Jules Bordet in Brussels. She is also a member of the Royal Academy of Medicine of Belgium, the European Academy of Cancer Sciences and the Scientific Committee of IMI (Innovative Medicines Initiative) of the European Union.



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EAN13 9782803104192
Langue Français

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What is the future of cancer research? Clinical research challengesin Europe
Foreword by János Frühling
Académie royale de Belgique rue Ducale, 1 - 1000 Bruxelles, Belgique www.academieroyale.be
ISBN : 978-2-8031-0419-2 © 2014, Académie royale de Belgique
CollectionPocket Books Academy Académie royale de Belgique www.academie-editions.be
Crédits Grégory Van Aelbrouck, Laurent Hansen, Académie royale de Belgique Cover: Académie royale de Belgique
With support of
Bebooks - Editions numériques Quai Bonaparte, 1 (boîte 11) - 4020 Liège (Belgique) info@bebooks.be www.bebooks.be
Informations concernant la version numérique ISBN 978-2-87569-152-1 A propos Bebooks est une maison d’édition contemporaine, intégrant l’ensemble des supports et canaux dans ses projets éditoriaux. Exclusivement numérique, elle propose des ouvrages pour la plupart des liseuses, ainsi que des versions imprimées à la demande.
The work entitled ‘What is the future of cancer research? Clinical research challenges in Europe’ is perhaps, after taking a quick glance at the title, of interest to a wider audience than initially anticipated. This somewhat dense little volume full of important data with appropriate comments, is targeted to oncologists in the broad sense of the word, not just care givers, but also all those that are affected one way or another by this serious disease. In addition, one needs to also include economists and political decision makers at both the national and European levels without neglecting the pharmaceutical industry. Historically, the EORTC, founded in 1962 by a group of European visionaries including Professors G. Mathé (France), H. Tagnon (Belgium), D. Van Bekkum (The Netherlands) and S. Garratini (Italy), has provided a unique platform for European cancer research. The initiative was initially based on several principles:
Bring Europe to an integration level similar to that of the United States for the treatment of cancer; Obtain a critical mass of patients by gathering pat ients with cancer from several European countries with already well-establ ished medical infrastructures so as to be able to draw valid conclusions concerning cancer treatments; Attain a high level of scientific credibility for European cancer research with a special focus on excellent collaboration among institutions; Be in a position to submit the research results to the scrutiny of a statistically valid analyses ‘of high resolution’ so as to assert the validity of the obtained results; As an ultimate goal, to improve the management of c ancer and related problems by increasing survival but also patient's quality of life; Start significant fundraising to ensure the continuity of the EORTC so as to secure optimal treatments for both current as well as future patients.
When the organization was founded, research work was initially centralized in Belgium at the Bordet Institute. The Netherlands, Belgium, France and Germany were the first participating countries and formed the core of the EORTC. A data center managed by Dr. M. Stacquet was created to centralize data and manage the very first randomized studies. Professor Françoise Meunier, a Medical Doctor and PhD who received her degrees from the Université libre de Bruxelles, was ideally suited for the position of Director General thanks to her extensive experience in internal medicine and infectious diseases which affected patients with cancer. In addition, she had pursued research for two years in the United States at the Memorial Sloan Kettering Cancer Center, a very prestigious research institute, and with this exceptional background, she took charge of the EORTC in 1991. Since then and during the last 23 years, the EORTC research facilities have evolved to keep pace with methodological advances and scientific requirements, and the size of the research staff has expanded with the increasing challenges of conducting high quality cancer clinical research. From then on, the EORTC became more important, tria ls were conducted in additional European countries, and new scientific paths were opened that were of interest not only to the specific organ linked pathologies but also the therapeutic cancer disciplines included in the oncological activities. Scientific collaboration with the pharmaceutical industry increased facing the emergence of numerous potential new drugs that needed to be evaluated.
We live in a society facing tremendous economic changes, one where the position of healthcare and any medical activity must be constantly questioned so as to adapt to the reality of financial constraints that do not respect the borders of countries or continents. The solidarity concept leads to permanent changes endorsed by most of the medical communities. However, in this context we are currently witnessing the emerging of a two-tier medicine even in western European countries and the current legal framework development of personalized medicine (whilst being extremely promising for cancer research) may in the long term generate unsolvable economic challenges if one has the aim to make everybody benefit from the best available treatments. The European legal framework related to the regulation of applied clinical trials, not always the most welcome, has created a dangerous precedent that hopefully Europe will be able to overcome, and this, thanks to the ten years of relentless negotiations skillfully led by Professor Françoise Meunier among others, in order to reach harmonization among Member States. Unfortunately a lot of challenges remain to be solved still at the level of oncological diseases treatments, notably all matters regarding the conduct of international clinical research and the establishment of biobanks, but als o insurance coverage and relations with the pharmaceutical industry. One must not forget that all EORTC clinical trial protocols are defined according to the strictest scientific conditions and that all results obtained and validated by a solid statistical methodology will bring practical and tangible results at patient level where the EORTC played a decisive role as catalyst and as an unique European scientific network with an independent clinical research infrastructure. This book will guide each reader through this complex world of applied clinical cancer research whilst becoming familiar with the fabulous and successful saga of the founders of the EORTC.
Prof. J. Frühling Honorary permanent Secretary of the Royal Belgian Academy of Medicine
E PID EMIOLOGIC AL D ATA Cancer is an ancient disease. Contrary to what some people may think, it is not a th disease that appeared in the 20 century! In fact, some tumors have been found on very ancient corpses, specifically mummies and prehistoric animals. Skulls identified and dated between 1800 and 1400 B.C. (the Bronze Age) have also exhibited bone tumors. In fact, Hippocrates (460 to 377 B.C.) described breast cancer quite well. Today cancer is the second leading cause of mortality in Europe after cardio-vascular diseases. Approximately 3.500.000 new cases are diagnosed every year in Europe, and unfortunately 1.500.000 people will die of the disease on an annual basis. However, the chart below (Figure 1) describes the decrease in mortality per cancer in Europe (all types) and its evolution (based on 100.000 people) between 1970 and 2013.
FIGURE I Source:MalvezziM.et al., “European cancer mortality predictions for the year 2013”, Annals of oncology, 24 (3), 2013, p. 1-9.
On the basis of epidemiological data and incidence forecasts, Europe, including Belgium, must prepare to face the reality of more and more diagnoses of cancers. Incidence, which is to say the number of new cancer cases, will continue to increase due to a variety of reasons:
The incredible progress in early detection measures colonoscopy, PSA (Prostate Specific Antigen) testing, etc.); Smoking, particularly in women (who started later than men); Ageing of the population.
One should not underestimate the spectacular drop in childhood mortality (mainly due th th to infectious diseases) that occurred over the course of the 19 and 20 centuries, and there has been a significant decrease in adult death rates linked to causes other than cancer, such as traffic accidents, infectious diseases (pneumonia, tuberculosis, septicemia) as well as cardio vascular diseases and diabetes. The called ‘Age Pyramid’ in Europe is changing, people are living longer, and the percentage of elderly people is increasing. Since 65% of new cancer cases are observed in patients of 65 years of age and above, the ageing of the population is largely responsible for an ever increasing number of new cancer cases. One should also bear in mind that the life expectancy nowadays has increased considerably from 55 years of age in 1900 to 80 years of age today. The late start of a smoking habit in women (after World War II) is linked to an increase of lung cancers in women when, paradoxically, the mortality linked to this type of cancer in men has steadily decreased following an earlier decrease in smoking in that gender.
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