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The dawn of a golden age of medical oncology

Hakan Mellstedt
European Society for Medical Oncology

The coming decades will be the golden age of medical treatment in oncology. Today about 60% of all cancer patients can be cured. It is expected that within 10–15 years this rate will rise to 75%. These impressive achievements are primarily attributed to novel medical therapeutic approaches, particularly targeted therapies, and also, in part, to early detection. As for more conventional treatments, such as chemotherapy and hormonal therapy, their level of use is expected to remain more or less unchanged.

Targeted therapies
Targeted therapies offer the possibility of multiple treatment options. Many new drugs will target the angiogenesis process (the formation of new blood vessels in the tumour), which are crucial for tumour cell survival. Therefore, a focus on destroying these tumour vessels, and thereby killing the tumour cells, is of primary importance. Drugs inhibiting pathological signalling systems within the tumour cells are under development. Drugs that can specifically turn off such signals eliminate the prerequisite that is necessary for tumour cells to survive. Monoclonal antibodies, which activate the immune system and interface with abnormal signals, also provide important weapons for treatment.
In addition, new vaccines are expected to be part of the therapeutic arsenal against cancer. They can be divided into prophylactic and therapeutic vaccines. Prophylactic vaccines will be used for prevention – a possibility in viral-associated cancers. There are great hopes are being placed on prophylactic vaccines for use against hepatocellular carcinoma and cervical cancer, with the hope that cervical cancer may be eradicated. Other vaccines are therapeutic and will be used earlier on in the course of the disease or as secondary prevention to avoid relapse.

Novel targeted therapies will also be used in combination to better target multiple defects within the tumour cells. However, targeted therapies will not be without induced side-effects, although these can be quite different from those experienced with chemotherapy (ie, hypertension bleedings, intestinal necrosis with bevacizumab or rash from erlotinib). Some side-effects may even be severe, as witnessed by the recently reported case of CD28 targeting antibodies and resulting in life-threatening consequences to healthy volunteers from the UK.

Another breakthrough in new drugs for cancer treatment is that many of them can be administered orally, adding significant practical advantages for both oncologists and patients.
In summary, the role of medical oncology in treating cancer remains central. New developments add not only to improvements in antitumour efficacy of treatment approaches, but also heighten the supportive care offered to patients in order to provide them with the best possible treatment options and quality of life.

The voice of medical oncology in Europe
Because medicine is involved in almost every aspect of cancer treatment, the European Society for Medical Oncology (ESMO) believes that cancer patients should be treated by qualified medical oncologists. In Europe, ESMO is a highly respected institution in the field of oncology and the leading professional society of medical oncologists. The major focus of all ESMO activities is to improve the prevention, early diagnosis and treatment of cancer, as well as the follow up care of cancer patients. Through its Cancer Patient Working Group, and in addition to working with patient advocacy groups, ESMO organises patient and family seminars in accordance with its mission to embrace patients’ needs. The initial theme of patient–physician communication has led to the forging of a patient–physician partnership – to which patients bring their needs and direct experiences, while physicians contribute with evidence-based science – in a united effort to improve healthcare services throughout Europe.

Current developments in oncology indicate the need for treatment by multidisciplinary teams. To this end, ESMO offers multidisciplinary programmes that foster collaboration between different disciplines within the Society such as medical oncology, radiation oncology, surgical oncology, paediatric oncology, oncology nursing, oncology pharmacy and basic research.

ESMO addresses global inequalities in cancer care through the statistical analysis of data concerning discrepancies in the prerequisites for the practice of oncology in Europe and developing countries. The summary reports from this data analysis help to identify necessary improvements in the infrastructure of those countries that have less than optimal healthcare systems. They also help to face the challenge of reducing disparities in the quality of care available to patients residing in different European countries. Furthermore, they will provide further evidence of the need to recognise medical oncology as an independent specialty throughout Europe and worldwide.

Together with the Organization of European Cancer Institutes, ESMO is seeking to identify the necessary criteria for medical oncology units in comprehensive cancer centres. In addition, the new ESMO Oncology Accreditation Committee will examine accreditation criteria for the quality control of patient care and physician education in European cancer institutes, oncology centres and major university oncology departments.

Standardised training in medical oncology, based on a solid background in internal medicine, has been defined in the Recommendations for a Global Core Curriculum in Medical Oncology, produced by ESMO in joint collaboration with the American Society of Clinical Oncology (the training curriculum was published in the November 2004 issues of both Annals of Oncology and the Journal of Clinical Oncology). The ESMO Examination in medical oncology certifies medical oncologists and is required to practice medical oncology or be a full member of medical oncology societies in several European countries.
Information, knowledge and experience combine to form the backbone of excellence in clinical practice. Following the publication of the ESMO Policy on Palliative and Supportive Care, for example, the Society has moved ahead to identify “designated centres of integrated oncology and palliative care” that meet a comprehensive list of criteria and are capable of providing specific training in this important aspect of patient care.
ESMO continues to serve its members by supporting them in their daily practice and careers. The ESMO Minimum Clinical Recommendations assess diagnosis and treatment of various cancers. They are intended as guidelines for clinical practice and prerequisites for basic healthcare services. For ESMO members who seek a specialist’s opinion on difficult and complicated cases, a web-based clinical discussion forum that allows them to consult directly with ESMO Faculty members is available on the ESMO website. For young oncologists, ESMO offers a career development programme of fellowships, translational research unit visits, masterclasses, special educational activities, oncology handbooks – and much more.
The great strides and improvements that are on the horizon bring with them the need to transform a wholly scientifically oriented organisation into a society focusing on a multidisciplinary approach to oncology and one that is willing and able to face the multifaceted aspects of cancer care and research. As the voice and driving force of medical oncology in Europe, ESMO is eager to continue to expand its role in multidisciplinary oncology in order to meet the challenges that lie ahead.