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Fortunato Ciardiello: “My ESMO, ambitious and transnational”

By 10 Ottobre 2016Maggio 12th, 2021No Comments

How does it feel to be the President of an international organization which debates and decides on critical issues of the global health agenda and at the same time a doctor who visits his patients everyday at the hospital? We asked Fortunato Ciardiello, President of the European Society of Medical Oncology (ESMO) now celebrating in Copenhagen its annual congress. We talked about future challenges of Oncology, access to pharmaceutical innovation, budget, political strategies. Oh, and of course about patients. Because that’s what an oncologist cares the most about: his patients.

At the end of every congress, what does the President of ESMO bring back to the doctor who sees his patients in Naples? And at the beginning of every congress what does the doctor who sees his patients in Naples bring to the President of ESMO?This is a very important question, because first of all we are medical oncologists, which means physicians. When we talk at international meetings about personalized medicine, precision medicine and individualization of treatment we always think at a scientific level about the huge number of genes involved in cancer, the complexity of a tumor escape, but we forget sometimes that we are just talking about people. So the doctor that is in me says: “You know, I’m not treating breast cancer, I’m treating this lady of 58 years of age who had her life messed (psychologically, socially and maybe economically) three years ago after her breast cancer diagnosis. She experiences a life-threatening situation, a great change in her life. What can I do as an expert to help her?”. This is the vision. And that’s why the motto of ESMO congress this year is “From disease treatment to patient care”. Disease treatment is easy, it’s basically what you do with animals in preclinical models. What is really important is patient care, and that is a completely different thing. I guess and I hope that our congress and our Society are moving from disease to patients.

ESMO can play an essential role at a global level…
This is our ambition. We are the only member-based professional Society, a worldwide Society in Oncology. You know, ASCO (American Society of Clinical Oncology) and even the ASCR (American Society of Cancer Research) have a global membership, but they are American Societies and obviously – although they have in their agenda some international activities – ASCO and ASCR are dealing in one country: a very big country, but one country. When we are at ESMO – even if we limit our attention to Europe, and now we are extending our attention globally – it’s clear that we’re too different in terms of guidelines, in terms of providing the best information to our members, in terms of promoting access to the right diagnostics and treatments in a global environment, with so many different health systems. That’s why I think ESMO is the only professional Society today in Oncology that has a true global vision, given the nature of being transnational. But we try to complete this task paying great attention to our roots: being European means sharing common values integrating different cultures, different problems, different solutions. This is the only way we could serve our community in Europe and outside Europe. For example last year we started the ESMO Asia annual Congress in Singapore and we’ll do it again this year in December and every year in the next future. We’ve chosen Singapore because it’s a small country where people from different countries can gather, and also in terms of geopolitical situation is the best place to go because we’re not bringing Europe to Asia, we are meeting Asia and trying to work together with our Asian colleagues. As ESMO President I think this is our pride. Americans are first Americans and then they think globally. So although ASCO is a great Society, although they are bigger than us and they are more influential than us, they are an American Society. Our ambition is to be something else, a transnational Society with a strong European identity that looks everywhere in the world and works with all countries.

How we could match innovation and access?
This is the big challenge. We can match organizing better resources and spending our budget in a smart way: this means that whatever comes from research and goes to the clinic should be sustainable because the goal is not that only 100 out of 10,000 people can get that kind of results, but that all 10,000 can. It’s not easy and I still think that the best opportunity to reach this goal is within public healthcare systems: their budget limitations is also paradoxically the answer to our problem, because it’s a matter of using the resources at the best.

Which instruments do we have to reach this goal?
For example ESMO is helping since more than 20 years with our clinical practice guidelines. We started when our Eastern Europe colleagues asked us to give some minimum requirements for diagnosis and treatment. Now they are the best known in the world evidence-based guidelines in Oncology. We implemented a standardised, generic, validated approach to stratify the magnitude of clinical benefit that can be anticipated from anti-cancer therapies: The European Society for Medical Oncology Magnitude of Clinical Benefit Scale (ESMO-MCBS), publishing our position paper in “Annals of Oncology”. This is the ESMO approach to judge the added value of a new treatment: in terms of efficacy and balance with toxicity, not in terms of money. But this is the basis then for saying: “If this is an added value, how can we make this accessible in terms of costs?”. That’s exactly the next step we’re working on. Another underevaluated (or no evaluated at all) issue is that even unexpensive drugs started to be unavailable, because companies do not produce or distribute them anymore. I’m talking about drugs like tamoxifen, the cornerstone of hormone therapy in breast cancer: in some countries it’s not easily available. These drugs are starting to be rare not because they are expensive – they’re very cheap, indeed –, but because they are not profitable today. For example in rare diseases, in some hematological diseases, in some adolescent tumors or pediatric tumors all drugs, all chemotherapies are starting to become no longer available. These are all the issues that as a transnational Society ESMO is trying to address: not to solve, because we are no politicians. We give our informed contributions as professionals.

David Frati