Wywiad z prof. Theo de Reijke,
MD, PhD, FEBU
przewodnicz±cym EORTC GU group

Fotografia 1

Profesor Theo de Reijke, Członek Honorowy PTU, jest znakomicie znany urologom w Polsce, dzięki Jego nadzwyczaj owocnej działalno¶ci w European Board of Urology i dzięki opiece, któr± otaczał i nadal otacza EBU Examination w naszym kraju. Prof. Theo de Reijke jest przewodnicz±cym EORTC GU group. Jego aktywno¶ć w tej organizacji jest przedmiotem wywiadu, którego udzielił mi korespondencyjnie w marcu 2008 roku.

I cordially congratulate you on commencing the presidency of the European Organization for Research and Treatment of Cancer - Genito-Urinary (EORTC GU) group. How long have you been working for EORTC? How long have you been the chairman of EORTC GU and how long will take your cadency?
When the former chairman of the Academic Medical Center, Karl Heinz Kurth moved from Rotterdam to Amsterdam, his first action was to apply for membership of the European Organization for Research and Treatment of Cancer - Genito-Urinary (EORTC GU) group again. He had been active already for many years in the EORTC GU group. Since we had many patients willing and eligible for the ongoing EORTC GU group trials I also could become a member in the early '90's. I have met in the EORTC GU group many famous urologists, radiation oncologists and medical oncologists and I have learned a lot during the discussions during the group meetings. After having served as member for several years I was elected as a member of the Prostate Cancer DOG (Disease Oriented Group), became secretary and finally chairperson of the Prostate Cancer DOG.
In 2005 I applied for secretary of the EORTC GU group and was elected as such. Due to some unforeseen circumstances I was asked to become chairperson of the EORTC group in 2006 during the 30th anniversary of the EORTC GU group, a position that will last for a total of 3 years and after this period I will still serve in the EORTC Executive as past-chairman.

Please tell us about the EORTC history and structure. What are the objectives of EORTC activity?
The European Organization for Research and Treatment of Cancer (EORTC) was founded in 1962. The aims of the EORTC are:

• to conduct, develop and co-ordinate cancer research in Europe with the aim of improving cancer treatment and diminishing cancer related problems,
• to set up educational programs to improve the quality of clinical research, and
• to disseminate the results of EORTC studies.

The means by which these are accomplished are by carrying out multicenter, multinational and intercontinental clinical trials and research projects on the methodology and practice of cancer clinical trials. The EORTC is also involved in the development of new anticancer agents and treatment management strategies. It organizes educational courses, symposia and workshops to educate and disseminate state of the art knowledge in cancer treatments.

Today, approximately 2000 clinicians, pathologists and researchers collaborate in the EORTC through a network of more than 350 institutions from 31 different countries. Participants include approximately 4000 to 5000 new patients per year in some 120 phase I, II, and III trials. The Data Center of the EORTC was set up in 1974 and is located in Brussels. Its database now consists of more than 100.000 patients treated within EORTC protocols across all types of cancer.
Within the field of genito-urinary cancer, in 1970 a French speaking group, which focused mainly on testicular cancer, joined an English group that focused on novel treatments for prostate cancer. They developed into an international English speaking group dealing with the entire field of oncological urology. The first meeting of this EORTC GU group was held in Villejuif, Paris, in August 1976. During the 1980s, the EORTC GU group expanded and approximately 1000 patients were entered on a yearly basis in its phase II and III clinical trials. In the 1990s, the EORTC GU group joined the GU Global Group which discusses and facilitates intercontinental clinical trials in uro-oncology in collaboration with other large research organizations such as the SWOG, NCI-C, MRC, etc.

Could you present us the most important scientific achievements of EORTC GU gropup so far?
In the different field sofuro-oncology the results of the EORTCGU group trials have in fluence durological clinical practiceand the published reports are being cited regularly.

Non-muscle invasive bladder cancer
Over the past 30 years the EORTC GU group has carried out 12 Phase III trials comparing different adjuvant intravesical in still ations and oral treatments. The group has also published a number of prognostic factor analyses, meta-analyses and combined analyses.
The definition of risk groups was an important achievement and the recently published risk tables which can be used to determine the risk for recurrence and progression based on simple tumour characteristics are very important.
Together with other groups it was found that in the low risk group one immediate post TURB chemotherapy instillation reduces the risk on tumour recurrence with approximately 40%. In a meta-analysis it was found for the first time that BCG maintenance reduced the risk on progression compared to chemotherapy. Also, it was demonstrated that in Carcinoma in Situ BCG reduced the risk on short-term and long-term treatment failure significantly compared toche mother apy.

Advanced bladder cancer
In patients that are unfitforcisplatin it was recently shown that a combination therapy with carboplatin was as active as cisplatin based chemotherapy although the response rates are low and toxicities high. The largest study ever performed in patients with advanced bladder cancer was the EORTC intergroup study comparing neo-adjuvant chemotherapy before radical cystectomy or external beam radiotherapy. At the last evaluation in 2006 a significant increase in 3-years survival was demonstrated from 50 to 56%.

Renal cell cancer
In a surgical phase III trial the role of lymphadenectomy was investigated. It was demonstrated that only a low number of positive lymph nodes was found. Toxicity was not significant,butdue to the low number of lymph node positive patients, no data on survival could be demonstrated. Partial nephrectomy was compared with radical nephrectomy. Interesting finding was the relatively high percentage (12%) of non-maligant tumours removed. Morbidity in the nephron sparing group was slightly higher, but no differences in oncological out come could be demonstrated. In patients with metastatic RCC it was demonstrated that the role of nephrectomy was important if a patient was treated with interferon concerning improvement of survival.

Testicular cancer
An important finding was that patient streated in high volume hospitals had a better survival compare with those centers that incidentally treated patients with testis cancer.
A combined study of the EORTC and MRC has shown that one course of carboplatin might be as good as adjuvant radiotherapy, although follow-up is still too short to draw definitive conclusions.
Patients with non-seminomatous tumours stage I can be treated conservatively provided a close follow-up is guaranteed. In the higher stages three course of BEP are sufficient if the patient can be categorized in the good prognosis group and four courses should be given in the intermediate- and poor prognosis group. Carboplatin cannot replace cisplatinum.

Prostate cancer
The EORTC GU group was the first to demonstrate that maximal androgen blockade was not superior compared to orchiectomy or LHRH analogue treatment alone.
In patients with non-metastatic prostate cancer who are not candidates for treatment with curative intent, delayed hormonal treatment resulted in no difference was observed in prostate cancer death compared to immediate hormonal treatment. Survival in the deferred treatment arm is predicted by the PSA doubling time.
Several trials have been done in collaboration with the radiation oncology group of the EORTC. In high risk group the addition of three years of hormonal therapy resulted in an improved survival. Patients that underwent a radical prostatectomy and where pathology showed positive margins or seminal vesicle invasion benefited from adjuvant radio therapy concerning biochemicalrelapse.

Which of the scientific programmes, out of all EORTC-GU programmes run currently, you consider the most promising?
The currently running programmes are the joined study with the SWOG comparing intermittent hormonal therapy and continuous hormonal therapy in patients with metastatic prostate cancer.
Another important trial investigates the role of adjuvant chemotherapy in patients with advanced bladder cancer.
The trial that investigates the duration of BCG treatment(1 versus 3 years) and the dose of BCG therapy (full versus 1/3) is closed and evaluation of the results is now awaited. Furthermore, we will set up a prospective quality control study on the 3-months recurrence rate following transurethral resection of bladder tumours.

Present us, please, your own concept of the EORTC-GU activity in the future.
Since the differences in the trials investigating new treatment modalities will be small, it is essential that we identify those patients and more specific those tumour characteristics that benefit most from the treat ment under investigation. Translational research is the way to go forward in order to identify these patients. Tumour material, urine or blood should be collected in order to investigate these samples with the nowadays available methods. The EORTC has decided that inall new studies this should be part of the trials.

I know, that in EORTC the researchers from Poland work actively. What is your opinion about Polish activity in EORTC-GU?
We have some very active Polish centers that participate in the EORTC GU group trials, but we need more input from the Polish centers. I have been several times in Polish urological hospitals and I know that there is a great dedication to provide the optimal care for the patients. The standards are high and that is why I would enjoy inviting Polish centers to participate in the EORTC GU group studies.

If, for example, a center, that so far has not worked for EORTC would like to start the cooperation what are criteria that it should fulfill and how should it be declared?
If an institution wants to become a member of the EORTC GU group an application form can be obtained through the EORTC headquarters (www.eortc.be) or through the secretary of the EORTC GU executive Susanne Osanto (S.Osanto@lumc.nl). Prefe-rably this application should be supported by the whole team, because if a member leaves the hospital we do need the follow-up of the patients entered in the EORTC trials. Since we have many studies that involve also radiotherapy and medical oncology, the best way to apply is if the colleagues from radiotherapy and medical oncology also support the application.

Thank you very much for this interview. I wish you and EORTC-GU fruitful work in uro-oncology field.Isuppose,the EORTC-GU session will interest many participants of our Congress.
I am very honoured that the EORTC GU group is invited to present an EORTC session during the upcoming 38th meeting of the Polish Urological Association. The programme we have proposed and which was accepted by the organising committee is as follows:

• History and achievements of the EORTC-GU group and how they changed clinical urological practice
• Difficulties in performing clinical trials in Europe, the new European legislative
• Ongoing studies in the EORTC GU group

I am looking forward coming back again to Poland and meeting many Polish urological friends.

prof. Andrzej Borówka