The 9,000 delegates at the Federation of European Cancer Societies conference, "ECCO 10," held in Vienna, Austria this year, left with three clear messages:
Researchers should make the most of existing modalities of surgery, radiotherapy, and chemotherapy.
Cracking the human genetic code will surely lead to a revolution in cancer treatment.
Realistically, that revolution is still a distant dream.
The latter message means a shift in perspective from treating the tumor to treating the patient and it introduced quality of life issues into mainstream ECCO for the first time.
ECCO delegates heard that it is now possible to measure the impact of cancer and treatment on a patient's well-being in a scientifically acceptable way, to collect the data in clinical trials, and to use the data as endpoints. Over 8% of papers now have quality-of-life assessments a sixfold increase since 1980.
Ten years ago, quality of life would have been in a side hall; this year it was the centerpiece EORTC symposium. "It's a reflection that, realistically, cure is often not the way to go," said symposium chairman Ann Cull, Ph.D., Western General Hospital, Edinburgh. "We have got better at long-term control of cancer: more people are living with cancer and we have to help them live well."
The ECCO 10 program highlighted the importance of teamwork, or a multidisciplinary approach in maximizing existing knowledge. "If all disciplines work together, survival benefits accrue and a survival advantage up to 20% has been demonstrated in institutions where multidisciplinary care is routine," according to Professor Niall O'Higgins, M.D., outgoing FECS president.
Presenters pushed for bigger, better-designed physician and patient-friendly clinical trials to speed up findings. "Patients are prepared to try new approaches but physicians have a responsibility. Trials need to address important questions, be well-designed, and seek a lot of participation; then you get your results in a year or two," according to Martine Picccart, M.D., Ph.D., chair of EORTC's treatment division.
Low-Key Debate
A head-to-head but low-key debate on tamoxifen for breast cancer prevention drew a huge audience. Bernard Fisher, M.D., Allegheny University of Health Sciences, Pittsburgh, said results of the National Surgical Adjuvant Breast and Bowel Project trial in the United States were conclusive. "I do not believe we can deny those at increased risk the opportunity to take tamoxifen," Fisher said.
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Improvements in surgery and radiotherapy were major themes and, again, made possible by a multidisciplinary approach backed by the latest computer technology. Surgery is becoming paradoxically more conservative and more aggressive, said Umberto Veronesi, M.D., scientific director, European Institute of Oncology, Milan. Better techniques to spare limbs, lymph nodes, larynx, and breast are the way forward, Veronesi noted, while at the same time, liver transplants have become feasible for liver cancer.
Major improvements in radiotherapy meant more targeted treatment tailored to the tumor profile, while avoiding damage to healthy tissue. Zvu Fuks, M.D., Memorial Sloan-Kettering Cancer Center, New York, described how three-dimensional conformal radiotherapy of the prostate has allowed dose increases.
So what of the genetic revolution? "Gene therapy is a very young, but a very noisy baby," FECS scientific committee chairman Thomas Tursz, M.D., said. He compared the situation to that in infectious diseases in the 60-year period betweeen Pasteur's discovery of pathogens and the development of antibiotics the goal for oncology is to reduce the time frame.
Genetics did provide the headline that most excited conferees. Herceptin the first clinically available monoclonal antibody targeted against the Her2 gene in breast cancer was described as "a really important new strategy" by several speakers. Patients receiving Herceptin in a 470-patient trial of combination therapy in metastatic disease have shown a survival advantage over those treated with chemotherapy alone.
In Perspective
But it was the plenary lecture by Sir Richard Peto of Oxford University on causes of cancer that put everything into perspective. Four million out of the 8 million worldwide annual deaths occur at four cancer sites lung, stomach, upper aerodigestive tract, and liver. Two million are, in principle, preventable because they are linked to tobacco or hepatitis B. Two million have wide geographic variation, also indicating a role for prevention in terms of environment or lifestyle. "There is no generalized increase in age-standardized death rates from cancer, apart from the increasing effects of tobacco, which are responsible for about a fifth of all cancer deaths. On present knowledge, therefore, the most important strategies for reducing deaths from cancer are tobacco control, hepatitis B control, timely surgery, and research to find out how to do better in the future," Peto said.
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