ECC 2015: Scientific Co-chair Peter Naredi, MD, PhD, Previews European Cancer Congress

Gabriel Miller


September 21, 2015

Editor's Note:
In advance of the 2015 European Cancer Congress (ECC), taking place September 25-29 in Vienna, Austria, Peter Naredi, MD, PhD, professor of surgery at Sahlgrenska University Hospital in Gothenburg, Sweden, and scientific co-chair of ECC 2015, spoke with Medscape and provided an introduction to the most important themes of this year's meeting, including a focus on elderly cancer patients and a track for young oncologists.

ECC is held every other year and brings together many European cancer societies, including the European Cancer Organisation (ECCO), European Society for Medical Oncology (ESMO), European Society for Radiotherapy & Oncology (ESTRO), European Society of Surgical Oncology (ESSO), European Association for Cancer Research (EACR), European Oncology Nursing Society (EONS), and European Society for Paediatric Oncology (SIOPE).

Medscape: The theme of this year's ECC is "reinforcing multidisciplinarity." What are the benefits of bringing various cancer specialists together for one major meeting?

Dr Naredi: In my view, our ECC is unique because we normally have two kinds of meetings. One kind is organized by organ-based societies—for example, breast cancer—and here several different disciplines come together and discuss the multidisciplinary treatment of breast cancer. From these conferences we have learned a lot about how you can activate your audience, how you can make a meeting more stimulating.

The other kind of meeting is like the American Society of Clinical Oncology (ASCO) annual meeting, or the European Society for Medical Oncology (ESMO) meeting, which is held every other year, when it is not in conjunction with the ECCO meeting. It is a meeting where several different disciplines attend, but really that doesn't make it multidisciplinary. If you take the ESMO or the ASCO meeting, the vast majority of attendees are medical oncologists and the program is, if you look at it critically, very medical oncology- and pharmaceutical-oriented. There is nothing strange with that because there are a lot of new scientific findings and new studies coming out, so there is always the possibility of filling a conference like that with interesting news.

But in cancer care there are so many other disciplines. So when we say "reinforcing multidisciplinarity," before we got the scientific committee together, we discussed how we can improve this year so that more and different disciplines feel that they are engaged in this conference.

I will not say that we have come all the way, but I think we have given this conference more thought than we had at earlier conferences in terms of looking at more sessions and really trying to bring different views together, and to make the sessions not monodisciplinary but more multidisciplinary.

We also took away some tracks because we thought there were too many, and it was too easy for surgical oncologists to just stay in the surgical oncology track or for radiotherapists to just go to the radiotherapy sessions and so on. We didn't take away that many, but we were over 30 tracks before and now we are under 30.

We also added something we call "integrated sessions." Here we really tried to make them more integrative and multidisciplinary to tackle a topic that we are discussing from different viewpoints.

We hope these changes will increase the movement of people during the conference so they don't stick to just a few tracks.

Medscape: Do you have examples of these new approaches?

Dr Naredi: One good example is cancer in the elderly. We all agree and really believe that cancer in the elderly is a very, very important topic, and usually it has been a track by itself. Our worry is that then there is only a small group of people going to these sessions because they are very interested, but this topic is not only for a few cancer professionals. Cancer in the elderly is a topic for everyone. So we took away the track and we looked at integrating the topic "cancer in the elderly" into many other sessions. So if you go to a melanoma session or if you go to a session on colorectal cancer and new drugs, if it was appropriate and if the track committee found it interesting, they added a topic on elderly cancer patients into that.

The topic "cancer in the elderly" has not decreased in this congress but it is not that visible because it is now all over. This is how we increased the number of speakers and the number of sessions around this topic.

The other example is immuno-oncology. We didn't have an immuno-oncology track 2 years ago. We added an immuno-oncology track because it is what everybody is talking about right now, but we also realized that this is only the tip of the iceberg. There are so many lectures and abstracts in different tracks about immuno-oncology because we have been working on integrating these important—and now very popular—topics into the full program.

Medscape: The oncopolicy track is very interesting this year. Many of the sessions are titled "Time Bombs in Oncology" and cover issues of survivorship, treatment inequalities, and, as you mentioned, cancer in elderly populations.

What was the thought process behind the "Time Bombs in Oncology" approach?

Dr Naredi: The oncopolicy track was started three or four ECC congresses ago, and we always put a lot of effort into it and thought it was very important. It comes in the middle of the day, sometimes for a full day, yet it has been very difficult to attract a large group of delegates to it. When people come to this conference they normally go to the cancer type they specialize in, so when we discussed this, we said, "How can we increase the attendance?" because we think our oncopolicy topics are important. We know that this is what we discuss in our daily care. This is what we discuss when we talk about our workload. People think these questions are important; they just don't get attracted enough to go to the hall where this session is.

The board of ECCO discussed this and came up with the idea: What are all of these things? They are "time bombs." This is what we work on in our society and our organization when we are working on policy the rest of the year, so we continued in this way and that is how we got to these three different "time bombs": cancer survivorship, cancer in elderly patients, and the oncology workforce.

We also located the oncopolicy sessions much more centrally in the conference. The whole point is to make people more aware that we actually have a very interesting oncopolicy program.

Medscape: I also found it interesting that there is such a focus on young oncologists at ECC this year. There is a track specifically for young oncologists in the program, and the introductory note to the program mentions the importance that young oncologists have been given at this meeting. What was the thinking behind developing this separate track, and what, in your mind, are the most significant issues facing this group of young physicians?

Dr Naredi: First of all, I want young oncologists to come to conferences where they get added value. The financial situation is such that it is very difficult for cancer professionals to go to a conference. If you have a pharmaceutical company to pay part of your trip, it is not that difficult. But if you take nurses or surgeons or pharmacists or others, there is no money. So these groups have to be very picky when they choose what kind of meeting they want to go to this year or even only every second year.

We have the advantage of having a really high-profile scientific program. It is great to feature late-breaking abstracts, but that is not really the key thing for young oncologists. The key for them is to feel that they had an influence on the program, especially including issues that they cannot discuss at their national meeting or regional meeting, or even at their workplace.

Many of these are mentorship sessions or sessions on improving training, but these don't only come up at the young oncologists program. They also come up at the society sessions where we talk about training programs and how to keep up with quality care.

But if you are a young oncologist and you go to this meeting, you can really focus on these questions: How can I plan my career? How should I reflect personally when I am—hopefully—not yet burned out but when I start to feel that this career is becoming too much for me? These are the kinds of sessions young oncologists are provided with here.

Medscape: As scientific co-chair, you played a significant role in developing the scientific program for this year's meeting. What are the most exciting areas of scientific research that are being presented this year?

Dr Naredi: I must say that I am surprised by how ASCO was just a few months ago and still the ECC meeting comes up with so many really fascinating phase 3 trials. I would even dare to say that several of them will be clinically practice-changing.

There is also the amount of really well-performed, mostly global studies. We have a few in rare cancers, which were extremely difficult to perform, and the presentation of these trials—again, I dare to say—will change our way of practicing.

And then, of course, the era of immuno-oncology is fascinating. It is amazing, now, to see that we are learning how to use the immune system in not one tumor type like melanoma but in so many different types of cancer. Immuno-oncology is in the spotlight right now.

Medscape: The most interesting areas, in my opinion, are where different specialists don't necessarily agree on the correct treatment, so I am particularly interested in some of the debates and sessions that discuss very clinically important topics where perhaps surgeons don't agree with oncologists, and maybe neither agree with radiation oncologists. In other words, there are differences of opinion about how one should move forward.

Are there particular controversial topics that you think are the most clinically relevant and that you would direct attendees to?

Dr Naredi: This is an excellent question because it is the difference between just going to a meeting because you normally do it and going to a meeting and feeling like, "Wow—I wouldn't have found this added value by just looking at the Web session or reading an article or listening to somebody at home."

If I were to be critical, I would say that I don't think we are all the way there yet at this meeting, because even though we have controversial sessions, mostly we are at the stage of presenting really interesting data. But we really don't confront each other with it.

I can give you an example. There are several abstracts at this meeting from the EURECCA initiative—a group that looks at quality assurance in different tumor types in Europe. These trials put together, for example, data from 10 registries in 10 different countries and then look at not only the inequalities in survival across countries, but at what kind of treatment patients get, as well as the guidelines in those countries. Here we can see that we have very large differences in how we actually treat patients. If we look at adjuvant chemotherapy after surgery of colorectal cancer, in some countries it is almost never given and in other countries maybe a third will get it. And there could be fantastic debates because, of course, this is either overtreatment or undertreatment. Because it is given in one country and not in another, you could really argue here, but unfortunately we are at the stage where we merely present the data at these meetings. There will be one or two questions about it but there really will not be a debate. I hope that we will be able to do more of this in the future.

However, we have a number of these presentations on abstracts that don't present clinical phase 1, phase 2, or phase 3 trials but are presenting epidemiology data—and even better than that, quality assurance data— from European registries.

I like to attend these sessions because it is an eye opener for many who go, to see how very different it can be to treat a patient in a country 1000 km or even only 50 km away.

More often the kind of debate we have today is like, "Okay, we have drug A and we have drug B—which one is the better one?" You can have a very strong feeling, but when you start asking yourself about the real outcome for patients, often it is not that big a difference.

Medscape: What else would you like attendees of this year's ECC meeting to know?

Dr Naredi: The influence we try to give to our patient organizations. We have a patient advocacy group with a board member on the ECCO board, and they have participated in organizing the scientific program. So while patients don't have a track, they are involved as much as possible in multiple different tracks. They have been very pleased with that; at least that is the signal that I have received. We try always to take that into consideration—what are we presenting in these sessions from a patient's point of view?

Having the patients involved in a multidisciplinary conference like this is very important. It is very easy to forget their perspective when we are being presented with new drugs or molecules. The patient representatives involved in the planning do not go into details but they make us remember that we are actually at meetings for the patients and provide a much more holistic or global view. They are reminders of why we have the conference, and they come up with very good ideas focusing on important questions, compared with those questions that really do not need to be highlighted at this conference.

Somewhere between eight and 10 patients have been involved in different tracks. Whenever there has been a track where there was a patient representative who wants to be involved and has the competence, that person has been on that committee and can then, of course, influence that track's program. This is not only survivorship and palliative care; this is as much organ-specific, like breast cancer. For example, diagnostics from the patients' point of view: How important is it that we do molecular assays? So they have been participating in the whole program.

Peter Naredi, MD, PhD, has disclosed no relevant financial relationships.


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