I firmly believe that over the next 20 to 30 years, we will see an astounding leap in our ability to prevent, cure, and manage most cancers.
—Eduardo Cazap, MD, PhD
Eduardo Cazap, MD, PhD, is founder and first President of the Latin American and Caribbean Society of Medical Oncology (SLACOM). In 2008, he was elected to a 2-year term as President of the International Union against Cancer (UICC). The ASCO Post recently spoke with Dr. Cazap about his roots in oncology and his mission to enhance global cancer care.
What inspired your decision to pursue a career in oncology?
When President Richard Nixon signed the National Cancer Act of 1971, I was just graduating from medical school in Argentina. Cancer was a new and exciting field, so after completing my residency in internal medicine, I applied and was accepted for a 2-year training program in oncology at the military hospital in Buenos Aires under the supervision of Prof. Roberto Estevez, who is considered the father of Argentinean and Latin American chemotherapy.
Back then, we were limited to a few anticancer drugs, and we were called chemotherapists, not oncologists. The concept at the time was far from the multidisciplinary one of today. In a nutshell, we were doctors trained to administer chemotherapy.
That said, in Argentina, the disciplines of solid tumor oncology and hematology are separate. As a student, if you are interested in cancer, you must choose one or the other as your career path. I chose oncology. This model still exists.
Were there any pivotal experiences early on in your career that helped shape your future role on the international stage?
Yes, I had the opportunity to be involved in a very interesting project conducted by a couple of institutions in Argentina, the NCI in the United States, and several international organizations, which was called the Collaborative Cancer Treatment Research Program (CCTRP). I was fortunate to be one of the young investigators on the CCTRP team that went to the United States. Our U.S. counterpart for the project was Georgetown University in Washington, DC. The Lombardi Cancer Center affiliated with Georgetown had just been launched, and the Director was ASCO Past President Philip Schein, MD.
One of our clinical trials was in gastric cancer, looking at the then new agent epirubicin. The trial was successful, and we reported the results in the journal Tumori. Epirubicin subsequently received approval in Japan and then later in the United States. We also participated in a study of the FAP regimen (fluorouracil, doxorubicin, cisplatin) and published our findings in the NCI’s Cancer Treatment Reports.
This early experience was an important juncture in my career. Even though I came from a country with limited resources, those valuable contacts and international collaborations helped me to become proactive and forward-looking, as I led the way to using external resources to help build better cancer research and care in Argentina.
Focus of Investigations
You are internationally recognized for work in breast cancer. What were your early clinical trial interests?
My early interests were less personal choices and more decisions driven by other forces. I essentially began my investigations where the funding took me. For instance, about 30 years ago we received some fairly generous support from Bristol-Myers in looking at cisplatin and carboplatin in cervical cancer.
Breast cancer has classically been considered a major problem of developed nations, much more so than in developing nations. However, over the past 20 years, my interest in breast cancer developed largely because of the prevalence of the disease in our region. For example, Uruguay, which sits on the northwest border of Argentina, is a small country with only 3 million people, and it has one of the highest breast cancer incidence rates in the world.
Since most of the world’s breast cancer treatments came from data gathered in developed nations, we were treating our patients in Uruguay and Argentina with therapies that were designed for patients who had biologic differences. To me, that was a contradiction, so I began conducting breast cancer investigations in Latin America to develop treatments better tailored to those populations.
In fact, in one of my lectures, “Breast Cancer as a Global Health Problem,” I presented the genetic map of the world demonstrating that the genetic-based distribution of breast cancer varies quite a bit geographically. It is not clinically sound to develop one-size-fits-all therapies by extrapolating trial data originating from disparate regions.
Has this region-targeted approach led to clinical trials in Argentina?
Yes, we’re currently doing several breast cancer trials. One is in collaboration with a group from Memorial Sloan-Kettering Cancer Center led by Dr. Larry Norton. Interestingly, this particular trial is funded completely independent of the pharmaceutical industry. Since we are developing trials that answer questions about our patient populations within specific regions, our mission doesn’t really connect with the pharmaceutical industry, which tries to develop drugs that can be marketed to as many patients as possible.
Access to Cancer Care
Is access to care an issue in Argentina?
In Argentina, a law was passed about 10 years ago that covers people with catastrophic illnesses such as AIDS, some neurologic diseases, and cancer. Under the law, if a person is diagnosed with cancer, he or she must have complete insurance coverage for all medical treatments. Moreover, our unions and private businesses are also obliged to provide coverage for their workers, so between the government and the private sector, we have, in effect, universal coverage for cancer care. Naturally, there are some delays and limitations within the system, but on the whole, it works well, providing quality care for all our patients with cancer, regardless of their economic status.
Please tell the readers about your leadership role at the UICC.
Today, UICC is an international cancer control organization, which realizes that control goes beyond the diagnosis and treatment of cancer. We must emphasize the complete spectrum of cancer, including education, prevention, and registration data. Over the past 15 years I have been totally engaged in promoting cancer on the global agenda.
With a growing worldwide cancer population that is outstripping the capabilities of the existing doctor force, it is vitally important to have outreach efforts from worldwide organizations like UICC and ASCO, along with governmental support. We need a massive collaborative effort.
Are you optimistic that we are up to the challenges posed by the global cancer problem?
I am eternally optimistic. If you look at the dramatic increase in early detection and cure rates over the past several decades, how can you not be optimistic? I firmly believe that over the next 20 to 30 years, we will see an astounding leap in our ability to prevent, cure, and manage most cancers. Ultimately, we are all responsible for successful results in our collective War on Cancer. If each party clearly understands their vital role, we will advance in winning that war. ■
Disclosure: Dr. Cazap reported no potential conflicts of interest.