Dr Bertrand Tombal

Joseph Ischia: Thank you for joining us here in Australia, Bertrand. It’s an absolute pleasure to have you. We would like to get some of the key points from your talks that you’ve been giving here at ANZUP regarding the role of research in surgeons and how we can do a better job.

Bertrand Tombal: So, thank you for having me here. So, I am a surgeon like you, so when I embarked at 15 years ago was EORTC my goal was so we can promote surgery amongst research organizations because indeed we’ve come to the crucial point where if we look at prostate, bladder, renal cell carcinoma there is clearly that demand of pushing the drug earlier. So, if you want to do this trial you are going to need more surgeons. As a surgeon, we would love to do research but it’s very complicated for us, so my view on this and this is the view my organization has been taking is actually trying to think that it is not the surgeon that should go to the research because if it would be working, we would know it by now, but is clearly designing research methodology that can be applied to the surgeon without disrupting its everyday environment and we’ve been working on that for several years and we found that actually the commonplace between the surgeon in his private practice and the surgeon in a research institution is quality insurance because we need good data for our research but more and more, the surgeons, they need good data for themselves because they have to be reliable. They have to answer to the patient demand about quality surgery so our view is that by implementing quality insurance program that can actually be offered to the surgeon, the surgeon can collect data that we can use for further research, but the surgeon can also have like a peer review analysis of its own activity. We know that we have been doing that for GI surgery. The net result is that every surgeon is getting a little bit better, so that’s my view on this because really that is an emergency. We need to get the surgeon back into research.

Joseph: Yes, you’ve made a very interesting point regarding the theme of this year’s conference is putting patients first. How do you feel about trials and putting patients first?

Bertrand: One of my major, I would say, default is that I am always extremely skeptical and picky on the way we design some medicine as evolving, and tomorrow I’ve got to give that talk about global trial in prostate cancer and what they bring to us and then I say, but the title of this meeting is like putting the patient first, so I have analyzed all these data and say, “Do they really put the patient first?” So, actually they put the drug first, which is a totally different question. I must say I’ve got mixed feelings of that. I mean, we have had a lot of great answers about the activity of the drug, but we’re still missing a lot of information about what is the real benefit for an individual patient, and I like to challenge for instance, Chris Sweeney, about we went from Docetaxel to nobody to Docetaxel to everybody but that was not the question. The question was which patients need Docetaxel. On this regard, I may conclude on the little failure yet a great opportunity for groups like ANZUP and EORTC is that now that we got the question to the drug answer, it’s time to ask the question for the patient.

Joseph: If you could make a universal change, something to improve research in urology, what would it be then? What’s the one thing we are doing badly you think we really need to pick up?

Bertrand: I think that research, if we want to change the world, we have to make the development of drug a three-step instead of two-step. The company does the research and then the government approves and usually they approve based on research that has been done. So, my universal model would be that for a period of time, all the drug they get kind of transient approval where a groups like ANZUP, EORTC we can test who is benefiting from this really, and then we are coming to our payers, to our government because we should not forget it’s more taxes with the better use of the drug which I fix. I still have 15 years left to do that but that would be my perfect goal.

Joseph: Excellent. Well, Bertrand, thank you very much for joining us here in Sydney.

Bertrand: You’re welcome.

Joseph: It is an absolute pleasure to have you.

Bertrand: Thank you.