In conversation with the 2018 Heine H. Hansen Award winner, Fabrice Barlesi


FEATURE

In conversation with the 2018 Heine H. Hansen Award winner, Fabrice Barlesi


FEATURE

The Heine H. Hansen Award is presented each year by ESMO and the International Association for the Study of Lung Cancer (IASLC) to an investigator who has made an outstanding contribution to the field of lung cancer. This year, the award was given to Fabrice Barlesi (University of Aix Marseille and Assistance Publique Hôpitaux de Marseille, France), for his clinical and translational research in thoracic oncology. A principal investigator for many international clinical trials, Barlesi led the pioneering Biomarkers France study, the largest biomolecular profiling study ever conducted in patients with non-small cell lung cancer. He explains to us what the award means to him and how team work is everything.

How do you feel about receiving the Heine H. Hansen award? What does it mean to you personally and professionally?

I feel extremely honoured and proud to receive this award. However, I see it as recognition for the work of my teams in Marseille, and also that of the French Thoracic Intergroup, rather than for me as an individual. From a professional perspective, it encourages us to continue with the work we have been doing in Marseille and provides a good indication that our research to identify new drug targets and immunotherapies for lung cancer is contributing significantly to the field.

What drove your initial interest in lung cancer?

My interest in lung cancer came about by chance really. I had a memorable exchange with a patient very early in my career as a resident (I can still recall the patient’s name today). At that time there had been good progress in treatment for a number of solid tumours, such as breast and colorectal cancers, but there were still very few therapeutic options for lung cancer. However, all of that was about to change as new adjuvant treatments and biological agents started to be introduced, so it was an exciting time. In addition, I worked with a strong team of thoracic surgeons and I had many discussions with them that really inspired me to help improve the outcomes of patients with lung cancer.

How has molecular profiling changed the outlook for
lung cancer patients?

Only a few years ago, lung cancer was viewed as a single disease. While it has been evident for a long time from a clinical perspective that lung cancer is a condition with many subtypes, it is only recently through molecular profiling that we have been able to show that these tumours have very different characteristics. Now when we characterise a patient’s disease, we don’t only consider the clinical picture and scan findings, but also the molecular drivers. With this knowledge, we can offer precision therapy to help achieve improved patient outcomes.

“Advances in molecular profiling mean we can now be far more precise when we characterise a patient’s disease.”

How far have we come in the field of biomarkers since you started out?

I am always fascinated by the speed with which molecular profiling has evolved in lung cancer. Only 10 years ago, there was really only one biomarker, while now we are able to screen for more than 300 molecular alterations. However, this rapidly changing field also generates many questions and challenges; for example, how can we prove that precision medicine is superior to more conventional treatments? This is why we have so many large biomarker-driven trials, such as the SAFIR programme. We need to educate patients and be able to explain to them, as well as colleagues, the rationale for taking multiple tumour biopsies. Other challenges relate to how we improve patient access to novel drugs. Many of the newer agents targeted at specific molecular alterations are only available in trials for early-stage disease. Therefore, I think we need to set up networks across Europe to facilitate the tracking of patients who may be eligible for trials as soon as they are initiated. The timely registration of drugs is another challenge; because it is no longer possible to conduct large randomised controlled trials of patients with relatively rare molecular alterations, the efficacy of these agents tends to be demonstrated in small studies. Regulatory agencies need to be convinced of the value of these treatments, and governments need to be persuaded to reimburse them, in the absence of data from classical randomised controlled trials.

“The biomarkers field has evolved remarkably quickly over the last 10 years, and there are still many unanswered questions and challenges.”

You have acknowledged that your mentor, Jean-Pierre Kleisbauer, had a big impact on your career – can you explain a bit more about this and how he inspired you?

Jean-Pierre was one of the pioneers of a changing treatment landscape for lung cancer. About 50 years ago when it was generally accepted that there were no effective therapeutic options available for the disease, he decided that patients deserved better and changed this view; he was the instigator of thoracic oncology in Marseille. I would also like to acknowledge Frances Shepherd; she was deeply influential and changed my vision of lung cancer care while I was a young fellow at the Princess Margaret Hospital in Toronto.

What do you think is the next big thing in lung cancer biomarkers?

I think the next big thing will be that treatment for lung cancer will become less tumour-focused and will increasingly consider the tumour microenvironment and specific patient characteristics. It is clear that we will not only be interested in tumour cells but also immune cells and other factors related to the immune response. We will also face challenges relating to choice of biomarker assay, its accuracy and ease of use, and the interpretation of large volumes of data that will be generated for each patient.

“Treatment for lung cancer will increasingly consider the tumour microenvironment and factors related to the immune response.”

What are you currently working on?

I am currently working on two large projects. The first is the Pioneer Project, based at Marseille University and Marseille Immunopôle. Launched in November 2017, it aims to explore the biological characterisation of patients, their tumours, and changes related to treatment with immunotherapy. Patients will be screened before, during and after therapy. Those who progress in the first four months of treatment will be eligible to participate in an immune rescue trial. It is a huge project that is being conducted across several French centres and is funded (> €25 million) by both public and private partners. I am also involved with a second French biomarker study to determine whether we can implement routine molecular genotyping for all patients in France, as we did in 2013 with the Biomarkers France study. The idea is to look at how next generation sequencing techniques and circulating free DNA analysis has changed our ability to identify molecular alterations and provide patients with bio-guided treatment.

How important to you in your work is your team?

“A strong team is everything”

When you are successful it is because of your team; it is not possible to do anything alone, regardless of your skills and energy. Winning this award is a huge deal to all members of my teams; they were so thrilled that our work has been acknowledged by ESMO and IASLC, oncology societies renowned throughout the world.