Prof. Angelo Di Leo will be presented with the ESMO Lifetime Achievement Award during the Opening Ceremony of the ESMO Congress 2019 taking place in Barcelona, 27 September - 1 October. (1) Over the course of a 30-year career focused on research in breast cancer, Di Leo has played a key role in the evaluation of molecular markers with potential predictive value and coordinated a number of international phase III trials in new adjuvant therapies. He spoke about the turning points of his life and work in an interview.
What attracted you to medical oncology and cancer research?
I first came into contact with the Istituto Nazionale dei Tumori in Milan, Italy, when I was still in medical school and my mother was diagnosed with breast cancer. I went there not as a doctor, but as the family member of a patient. That’s when I decided I wanted to specialise in oncology. After graduating in 1989, I moved to Milan to pursue postdoctoral training in medical oncology and had the privilege to begin my career in a wonderful research environment led by two renowned professors, Gianni Bonadonna and Umberto Veronesi, who had been responsible for curing my mother.
Where has your career taken you?
From Milan I moved to Brussels, where I spent almost 10 years working at the Institut Jules Bordet with Martine Piccart, an internationally renowned breast cancer expert. Then, in 2003, I was offered a position as Head of the Medical Oncology Department at the Hospital of Prato, near Florence. It was completely unknown at the time, being quite far outside of the clinical networks and main oncology centres in the country, and its research programme was non-existent. I realised that everything had to be created from scratch. However, I also saw many people there who were very motivated to activate this new unit in both a clinical and research setting, so I decided to take the bet. Within five or six years, we were attracting patients from various parts of the country and developing strong research programmes, particularly in the area of breast cancer. Now, 16 years on, I am proud of what we created and of the young, multidisciplinary team that joined the adventure and helped to make it happen.
What has been your most important scientific finding?
In the 1990s, my colleagues and I began to think that treatment for breast cancer patients needed to be personalised. We pioneered research into the biology of the breast tumour in order to understand precisely which molecular targets were the most relevant for the therapies available. At the time, we had chemotherapy agents known as anthracyclines, which were very active but also quite toxic. We published the first work identifying biomarkers– specifically topoisomerase IIα – that could predict the efficacy of anthracyclines in the adjuvant therapy of breast cancer patients, and thus help to recognise women for whom this treatment was unnecessary. In the 25 years since then, I have spent most of my career trying to tailor treatment of breast cancer patients based on their real risk of disease relapse and on the biology of each individual tumour.
What do you think will be the next big thing in breast cancer research and treatment?
There is a general consensus worldwide that this disease is quite heterogeneous, and that treatment needs to be personalised. Although most biomarkers cannot yet be safely recommended in standard practice, we do feel we are very close to finally moving some of them into the clinic. Currently, most of the challenges associated with translating our discoveries into clinical practice are due to the difficulty of obtaining good tumour biopsies. Thanks to the progress being made in liquid biopsies, we will soon be able to test for biomarkers with a simple blood sample – that will be a game-changer.
As for treatment, I think we will use less and less chemotherapy in early breast cancer, which can sometimes be cured with local therapy alone. For metastatic breast cancer, I believe a combination of endocrine and targeted therapy, including new biological agents, will substantially improve the way we control the disease. Immunotherapy also looks particularly promising for triple-negative breast cancer.
What place has ESMO had in your career?
When the ESMO President called me to announce that I had won this award, I had a flashback to my first contact with the organisation in 1992, when I attended my first ESMO meeting in France. There were between 500 and 700 oncologists present. After that, I regularly participated in the biannual and eventually annual congresses. I watched the Society grow exponentially, and saw its meetings begin to attract an international audience from all over the world, with 25,000 to 30,000 medical oncologists regularly coming together in recent years and having a huge impact on future research and clinical practice.
How do you feel about winning this award, and how do you define success?
For me, it is a huge pleasure to receive such a prestigious award from what is now a global society. I believe I have had two major achievements in my career: one has been to create this place in Prato, starting from nothing, where patients now come to be cured of such a critical disease as cancer with a lot of confidence in our programme. The other is that I have had the opportunity to work with and develop a team of young but extremely skilled oncologists and researchers – most of themunder40. Ultimately, there is just one question that defines success: What will remain of your work after you leave? I’m proud to say that the programme in Prato will successfully continue without me one day.
What message would you like to leave to your team?
Believe in what you do and don’t give up – difficulties can be overcome when you do things with passion. Passion is also the key to having an interesting life and a fulfilling career. Collaborate with the best people worldwide, and always put the patient at the centre of your activities. Promote young colleagues, because they are key to ensuring your institution or project will have a future. These are the lessons I have learned in my own lifetime.
Who has been an inspiration to you in life?
Umberto Veronesi, who attracted me to Milan as a very young doctor, and Martine Piccart, who taught me a lot about medical oncology, breast cancer and international collaboration. My long-time friend Aron Goldhirsch, though we have never worked in the same institution, has consistently inspired me with his way of thinking about breast cancer treatment and clinical trials. Of course, my family has also been a key source of strength and support: Laura, my wife, is a medical oncologist, too, so we have been able to discuss problems and advise each other throughout our respective careers.
References
- Prof. Angelo Di Leo will receive the ESMO Lifetime Achievement Award and will present a Keynote Lecture entitled: “Adjuvant therapy of breast cancer: Targeting tumour biology may not be enough” during the ESMO 2019 Opening Ceremony, Friday 27 September, 11:45-13:30, Barcelona Auditorium