ANOTHER year is about to end and, as usual, the sums are being drawn up. On the other hand, dealing with the past is essential to face the challenges of the present and the future. A maxim that is valid in all fields, even in medicine, where progress is increasingly rapid and new knowledge raises questions, both new and unknown. They offer a reading on the subject, perfect for preparing for the coming year Silvio Monfardini, director of the Geriatric Oncology Program of the Palazzolo Institute Don Gnocchi Foundation in Milan, e Lodovico Balducci, professor of Oncology and Medicine at the University of South Florida and head of the division of cancer geriatrics at the Moffitt Cancer Center & Research Institute, who chroniclers of a first-hand story. In two articles published on Asco Post by title “The History of Medical Oncology in Europe, 1955–1985“, Monfardini and Balducci tell the dawn of European medical oncology up to the mid-1980s, through the stories of its protagonists, and retracing the development of clinical studies and protocols that are now taken for granted. first article is dedicated to the pioneers of European oncology, the second explores the birth of the discipline in different countries. The hope – the authors write – is to inspire young oncologists to bring the same optimism and determination to their work as those who preceded them. The reason is reminiscent of a quote from the French philosopher Auguste Comte, reported at the beginning of this essay: “It is impossible to know a science without knowing its history”.
The beginnings
European medical centers dedicated to cancer research and treatment have existed since 1909, when the Institute of Cancer Research was established within the Royal Marsden Hospital in London. Back then, in North America, the treatment of solid tumors was almost exclusively the preserve of surgeons and radiologists, while hematologists cared for patients with leukemia and myeloma, treated with transfusions and palliative care for pain control. However, we have to wait until 1953 to have a complete oncology center, the one established at the Institut Jules Bordet in Brussels.
Thirty years of progress
Monfardini and Balducci trace the birth of medical oncology in Europe back to the 1950s, when some internal doctors, in addition to managing the symptoms of tumors, began the first attempts to treat neoplasms using alkylating agents and antimetabolites. It was the phase of empirical protocols that could undergo changes “on the day”, applied up to the development of toxicities. “In the following decade – they write – numerous antineoplastic drugs were developed and in 1968 the American doctor Byrl James supported the creation of a specialty of medical oncology dedicated to systemic hormonal and cytotoxic chemotherapy”, recognized by the American Board of Internal Medicine in 1972.
In Europe, meanwhile, the action of Byrl James (recognized father of medical oncology), led Georges Mathé to do the same in France, where the discipline was called “internal cancer medicine”. In the same years, the first study protocols started by the Groupe Européan de Chimiothéarapie Anticancéreuse (GECA) in 1966 for the management of leukemia, lymphoma (then called haematosarcoma) and metastatic breast cancer were tested. And in Italy? There was Gianni Bonadonna, considered the founder of Italian oncology, who in 1973 defined medical oncology as a branch of internal medicine and developed the first clinical protocols at the National Cancer Institute in Milan. Thus the figure of the oncologist was officially born, not without some hostility on the part, above all, of other internists and radiotherapists. “The pioneers of European medical oncology have had to endure the skepticism and derision of the medical establishment,” say the two authors: “They also faced serious opposition from an entrenched medical system. Those in charge of medicine in general hospitals did not see the need to create an additional medical specialty for oncology. Medical oncology has often been perceived as a threat to the established disciplines of surgical and radiotherapy oncology ”.
Cancer, what it means to cure the elderly
by TIZIANA MORICONI
International cooperation
European medical oncology owes much to North American oncology: many of the “fathers” of medical oncology of the Old Continent were trained in the United States. But the support and collaboration have continued over the years leading, after the establishment of national scientific societies, to the birth of the European Society of Clinical Oncology (ESMO) and the European Organization for Research and Treatment of Cancer (EORTC), to the establishment of a two-way dialogue and the affirmation of Europe as an area of interest for the development of new drugs and their testing.
Learn from the past
Monfardini and Balducci talk about controversial topics, such as the ethical and methodological questions of clinical trials. Together with solid science – they write – optimism and determination are the tools needed to overcome suspicion, endure opposition and achieve constant improvement in patient care. “It’s important for all of us, including our younger colleagues, to understand how we got to where we are,” he recalls James O. Armitage, Joe Shapiro Professor of Medicine presso il Nebraska Medical Center, past president dell’American Society of Clinical Oncology e dell’American Society of Blood and Marrow Transplantation, nell’introduction to the essay: “It’s also important to recognize the heroes who brought us here as role models to emulate.”
Image credits: The Asco Post
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