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Giovanni Apolone

Giovanni Apolone, MD with post-doctoral degrees in Internal Medicine and Pharmacology, is currently the Scientific Director of the “Foundation IRCCS Istituto Nazionale dei Tumori” of Milan and, previously, Scientific Director of the “Institute for the Advanced Technologies and Clinical Pathways in Oncology”, a Public Research Hospital, in Reggio-Emilia (Italy). 
National Expert listed by the EMA, London UK, from 2000-2007, he spent his sabbatical leaving (2002) at the SENDO (Southern Europe New Drug Office, Milan, Italy) and at the FDA (Bethesda, USA). 
His main fields of interest are: Methodological, ethical and regulatory aspects of clinical research, with special emphasis on oncology and anticancer drugs, health care evaluation, health outcomes assessment (patient self-reported health status), development and validation of case-mix measures, education and health promotion research and programs.
He published more than 280 papers in national and international journals, including more than 175 listed in Pubmed.


The research to come: a clinical perspective

Despite the advances in our understanding of the biological mechanisms that transform normal cells in anarchic tissue, the improved capability to make diagnosis in earlier stages, the availability of a quite large number of novel treatments, from novel biologic and immunotherapy drugs to new ways in delivering radiotherapy,  the burden of this disease is still too high.
Thanks to the utilization of molecular and genomic tools we know that cancer is an heterogeneous disease,  that changes over time trying to survive and escape from  our attempt to eliminate it. As a result, we are now able to offer a more personalized care but not to offer the most appropriate and individualized treatment to each patient.
Nowadays, we cure more patients that 20 years ago, from 50 to 65% of cases but,  in Italy, cancer remains the second cause of death, incidence is increasing and the costs of care may  trigger a crisis in national health services undermining the principle of universality and free access to health care.
A lot has been done by researchers and clinicians  but still a lot remains to be done.
The Umberto Veronesi message – cancer is a treatable disease that may be defeated through a combined effort of all stakeholders by combining education, primary prevention, early diagnosis, conservative treatments, collaboration with policy makers - is a contribution to imagine what to do in the near future.
Although his perspective was clinical, he believed in science and in the principle of evidence based medicine and thus he encouraged the application of rigorous methodology in the field of oncology by introducing RCTs to test his pioneering hypothesis for conservative surgery, adjuvant treatment and sparing lymphonodus glands surgery.
He succeed and his example may help us designing a future scenario for the research to come.
Keywords to this future scenario are:  to increase citizens and patients involvement  in decision making, 2-way translational research, development and validation of predictive models to better personalized prevention, treatment and post-treatments surveillance programs, new methods to design and implement clinical studies, creation of large data-bases integrating data and information from the host and the tumor, micro-environment international collaboration through large networks of Institutes.
It is not an easy task as medicine is a conservative science but the Umberto Veronesi heritage makes me optimistic about the the outcome of our fight against cancer


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