‘Independence’ the priority for the longstanding European Organization for Research and Treatment of Cancer, Winette van der Graaf tells Applied Clinical Trials in interview.
Later this year, the European Organization for Research and Treatment of Cancer (EORTC) celebrates its 60th anniversary, invoking its independence in assessment of therapies—and not just drug therapies, as it likes to emphasize. Its new president, who has just taken office, places the same stress on the organization's independence. Winette van der Graaf, a prominent Dutch medical oncologist, told Applied Clinical Trials in a recent interview that she is highly conscious of "EORTC's great history as an independent organization in Europe."
At a time when the reliability, impartiality, and even the credibility of clinical trials is again under attack in Europe—and beyond, particularly as public skepticism mounts over the pharmaceutical industry's claims of a patient-centred approach, her stance puts down a firm marker. EORTC, she emphasizes, makes up its own mind about the design and conduct of the trials it initiates and becomes in involved in.
In her day-job, van der Graaf leads a personalized oncology group in the Netherlands Cancer Institute in Amsterdam, currently concentrating on adolescent and young adult cancer and on sarcoma. She is also a professor of transformative oncology at Erasmus MC in Rotterdam, and was previously team leader in clinical and translational sarcoma research at The Institute of Cancer Research, London and a consultant in the sarcoma unit of The Royal Marsden Hospital. Her background also includes spells at the universities of Groningen and Nijmegen. Her perception over the years of the impact of EORTC on the way clinical trials are run is that "it has had an important influence in changing the practice of trials, bringing people together to do research that really matters."
She is acutely aware of the risks —even for academics—of being too close to the commercial sector, perceiving almost a form of contamination affecting the thinking about trials "There is a difference on the one hand between starting with the clinical question that really needs an answer and the approach on the other hand that results from sitting every day on advisory boards of pharmaceutical companies," says van der Graaf. EORTC benefits, she adds, from the combined input of a selection of bright academics focusing on the challenge with minds open to the choice of possible solutions: "It can be a surgical question or a radiotherapy question, or it can be a question related to molecular tumor markers."
It can of course also be a drug treatment—"and for that we need pharmaceutical companies," she says, noting that some companies come happily to EORTC because of its acknowledged expertise. But she draws a clear distinction between when a company wants to do research with its own protocol and when EORTC is involved in a trial. "It's a different mindset," says van der Graaf. There are no assumptions that the company has the best protocol, but instead the automatic response is to explore how—and whether—it could be improved: "We think about how we would like to shape the trial." In her work in The Netherlands she also participates in clinical trials sponsored by drug firms. "if I think they are good enough," she notes. For van der Graaf, the ideal is that independent researchers build the protocol together with the company as the starting point. She points to what she describes as "problems" in the design of some of the trials that are run uniquely on the initiative of the industry.
EORTC's claim is that its clinical research has helped make progress in the treatment and management of cancer by evaluating new molecules, refining existing treatment regimens, identifying biomarkers, and assessing patients’ quality of life. Many of its 1,400-plus studies since 1962 have led to practice-changing treatments and the establishment of new standards of care, often revealing accepted standards as ineffective or redundant, it boasts, listing "landmark studies in loco-regional treatments such as organ preservation, in specific populations such as rare tumors, and in advanced disease stages" among its highlight achievements.
And van der Graaf has her own ideas about ways she sees EORTC evolving. "We now have a policy project in place for increasing patient involvement in our work," including in trial design, she says. She highlights a particular challenge in patient engagement that has had little public discussion: language, and, more specifically, fluency in English. The prevalence across Europe of English in professional interactions with patients leaves many out of the loop, and can tend to imperil and even distort the representativeness of exercises aimed at patient engagement, and the comprehensiveness of communication, she suggests. She also has expectations that a new EORTC council bringing together the scientific chairs of its 18 distinct groups and task forces will bring added cohesiveness to the organization's work and ensure a multidisciplinary discussion of the issues that are meaningful across EORTC's work.
A process that begin in 1962 with the founding of an international (but tiny) organization under Belgian law as Groupe Européen de Chimiothérapie Anticancéreuse under the presidency of Georges Mathé of Villejuif in France has led over the years to an organization with more than 130 collaborative groups and 750 institutions worldwide, with a staff of 250. Winette van der Graaf now takes her place among a roll-call of past presidents that also includes figures such as Silvio Garattini, Henri Tagnon, Gordon McVie, and Roger Stupp as EORTC readies itself to face an ever more urgent need for improved understanding and treatment of cancer.