The New Global Era of Cancer Research

How will cancer research evolve in an era of global communication and data sharing? How will patients benefit from increased collaborations across borders? What challenges are on the horizon?

Fortunato Ciardiello

Fortunato Ciardiello
Second University of Naples, Italy

Alexandru Eniu

Alexandru Eniu
Cancer Institute “Ion Chiricuta”, Cluj-Napoca, Romania

Cancer does not care about nationality. It exhibits total disregard for borders, geographic boundaries, or socioeconomic status. It strikes individuals on every continent without discrimination. Cancer is a global scourge, and so requires a global solution.

For a long time cancer research projects were nurtured within individual laboratories, each striving to be the first to achieve a ground breaking discovery.

But the advent of the internet – enabling an extraordinary new era of instantaneous global communication and data sharing – is allowing and encouraging cancer researchers around the world to join forces to bring the best quality medicine to patients.

Big Data is transforming so many aspects of life, so it should come as no surprise that it is doing the same in cancer research. No longer are we restricted to working with limited patient data from within our own borders. As the information and communication technology transcends those borders, researchers are now able to access and share vast amounts of data, and are able to find meaningful answers to questions that we were never able to pose in the past because the information simply wasn’t there.

This new global era of cancer research is working hand in hand with the development of personalised cancer therapies, offering hope to patients with relatively rare cancers and cancer subtypes. Whether it is a cancer resulting from a rare oncogene, or a patient with a particular cancer biomarker that makes them less likely to respond to conventional therapy, our rapidly advancing knowledge of the pathophysiology of cancer and techniques such as high throughput sequencing mean that for the first time, we have treatments that can help these patients.

However researchers still face the often insurmountable challenge of finding enough of these rare patients to participate in clinical trials of relevant targeted treatments.

By expanding cancer research networks globally, we can find these patients wherever they live, and through collaboration with local oncology researchers and research institutions, bring these isolated individuals into large, suitable-powered clinical trials.

Many oncogene-addicted non-small-cell lung cancers, such as those driven by the ALK mutation, affect just a few per cent of patients with NSCLC. In a country such as Romania, it is nearly impossible to run a clinical trial aimed at testing treatments in this group. But with pan-European collaboration and initiatives such as the cancer centres of excellence, a much larger network can be established that brings together enough of these otherwise rare patients to make a clinical trial feasible.

The global approach to cancer research is also important in expanding cancer research and treatment into populations that have been previously neglected for reasons of geography, economy, culture, and logistics.

Much of cancer research in the past focused on populations in the developed world, in big industrialised Western nations. As a result there has been a gap in our understanding of cancer biology, particularly for cancers that are more prevalent in emerging economies.

It has also meant that cancer patients in these developing nations have been missing out on many of the advances that cancer patients in the developed world now take for granted. This disparity between rich and poor – not only between nations but within nations – has denied many patients access to the treatments resulting from our cancer research labours, even when those treatments are viewed as the basic standard of care.

Clinical trials therefore not only provide an opportunity for research in these underrepresented populations but also give patients in developing nations access to the highest standards of care available across the world.

It’s not only patients who are benefiting from increased collaboration across borders. Young oncologists now have access to training from the very best specialists around the world, through training and educational initiatives such as ESMO’s fellowships programmes. If we improve the quality and the knowledge of the next generations of oncologists throughout the world, we are helping to deliver a better quality of care to our cancer patients.

This new era of trans-national collaboration is not without its challenges, and cultural and linguistic boundaries will continue to make some collaboration more difficult than others.

In some parts of the world, patients still view clinical trials with suspicion, and are reluctant to volunteer themselves as guinea pigs. Doctors also may face the difficulty of entrenched beliefs in traditional and alternative healing practices that often mean patients hesitate to even consult a doctor in the first place.

However organisations such as ESMO are well placed to help researchers overcome these issues. With its territory spanning so many countries, cultures, languages and ethnicities, ESMO has unique cross-cultural experience. Expanding the horizons of cancer research to regions such as Asia and Africa is no more challenging that working through the differences from one side of Europe to the other.

ESMO is also well placed to work with organisations around the world to harmonise the laws governing clinical research and data protection, which have been a sticking point for many cancer researchers trying to access de-identified patient data for retrospective analysis.

ESMO is not a political organisation, and as such cannot deliver political solutions to the many challenges that cancer researchers, oncologists, and patients face within their country of residence.

However as an organisation representing members from over 130 countries, it is uniquely placed to serve as a multi-national, multi-cultural voice for the cancer community: serving researchers, clinicians, and through them, cancer patients. It has already invested in initiatives such as the first ESMO Asia Congress in Singapore in December 2015 and the Emerging countries committee – among others. With its feet firmly planted in Europe, ESMO is ready, willing, and able to be on the forefront of this new global movement of cancer collaboration.

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The New Global Era of Cancer Research Read Fortunato Ciardiello and Alexandru Eniu