Practicing Outside the Pharma Box in Breast Cancer

When Martine Piccart, MD, PhD, was a child, she sometimes watched her father, a gynecologist, talk to his patients. She remembers his respect for them and their families and the way he communicated, focusing on the positive but not shying away from delivering bad news.

“He always took the time to explain in detail not only what was happening but also let them know that there was a plan,” Piccart said. “I remember him saying, “This is what we are going to do.’”

Several decades later, she brings the same positive but direct manner to her practice focusing on breast cancer, particularly metastatic breast cancer. Piccart is scientific director at the Institut Jules Bordet (IJB) and a professor of oncology at the Université libre de Bruxelles, both in Brussels, Belgium. She is the cofounder and immediate past chair of Breast International Group (BIG), which works with more than 50 international academic research groups to collaborate on trials.

She was drawn to pediatrics initially—and temporarily. “The little babies with the high temperatures, they scared me,” she said. Piccart moved into oncology and completed a fellowship at New York University (NYU) Medical Center in the 1980s, spurred on by her experiences with a relative who was treated for colon cancer. Three medical oncologists, Franco M. Muggia, MD, and James L. Speyer, MD, at NYU and Marcel Rozencweig, MD, at IJB encouraged Piccart to expand her focus beyond patient care. Rozencweig, in particular, pulled her into new drug development.

Early on, she realized that research and developing drug trials had to be an integral part of her job, because she was frustrated by how many clinical problems had no solution. This was particularly true in metastatic breast cancer, which remains incurable.

FIGHTING FOR INDEPENDENT RESEARCH

Running trials through pharma might be an easier route for a successful career, Piccart said, but it is not the kind of research she admires most. She ends up spending a lot of her time trying to find funding on her own to help support academic research. Piccart said that she hopes future oncologists will continue the fight for independent research.

“I am very uncomfortable knowing that in some countries, when you put your patients in a trial as an oncologist, it’s not the institution that gets the money, it’s the oncologist, and I find that totally unethical,” she said. “I am really, really convinced that protecting academic research is protecting patients. Companies are never going to be motivated to see if a 6-month treatment is as effective as a 12-month series, because you know the 12-month series brings in more money.”

Pharmaceutical industry research is important, and these companies drive valuable innovations, she added. However, industry-driven research must be balanced with independent research.

“I have been dreaming of a better model of partnership between academic investigators and the pharmaceutical industry,” she said. “The best model is one that guarantees some independence from the pharmaceutical industry but where you can also accept that, for some aspects, pharma runs things more efficiently.”

She helped found BIG in part because of her desire to maintain that independence. At first, she said, investigators were wary of working with the group because they were not used to very large international collaborations. The realization that BIG could recruit 5000 women into a trial in about 3 years, rather than a decade, convinced many to join the network. That resulted in stronger studies that produced results faster, which helped save women’s lives, Piccart said.

Through BIG, she helped develop the AURORA project, which is receives much of its funding through the Breast Cancer Research Foundation, in 2014. European investigators are analyzing tissue and blood samples from 1000 patients with metastatic breast cancer while capturing their clinical evolution through successive therapies.

Piccart initiated AURORA because she wanted to improve the understanding of metastatic disease. A great deal of breast cancer research focuses on women with early disease, but upward of 30% of patients will progress to metastatic disease, which has 5-year survival rate of just 27% for women in the United States, according to the American Cancer Society.

“I cannot tell you how frustrating it is, as a doctor—we have these drugs that work prettywell, but we cannot cure these women at the end of the day. So, we decided it was time to create a network to do something for these women, and we built a very ambitious research program across Europe,” she said.

BEING A TEAM PLAYER

Piccart met her husband, Michael Gebhart, MD, coordinator of the Institut Jules Bordet Soft Tissue and Bone Tumour Multidisciplinary Oncology Team, in medical school. She played piano and he played the violin.

“I like chamber music [and] I like to play with other people rather than alone. And that is also something that you need to do in a medical profession—you need to be a team player,” she said. “You don’t have answers to everything. You need to work with your colleagues.”

Piccart carefully perfected her “team player” approach over the years. She credits her success as a doctor and an investigator to the help she received from her friends, particularly the late Aron Goldhirsch, MD. She called the development of BIG, which Goldhirsch helped to found, one of the biggest successes of her career.

Piccart added that maintaining a network that sprawls across not only physical distance but also different cultural practices and beliefs requires a lot of time, plus some psychological skills. Disagreements happen; people get protective of their work; and someone, often Piccart, has to help repair the damage or else the partnership can fall apart. Keeping it all running is a challenge, but it’s a challenge that she loves.

“One day at a time,” she said. “You have to have this in your mind when it’s becoming difficult, because you have all these obstacles, but you need to be focused and not be discouraged at the very first challenge. So keep trying, and tackle one thing.”

One of the most important things she’s learned from her years as a doctor is that the profession is a 2-way street. As much as she brings to her patients, they offer as much to her. “I have been impressed by so many women, their courage, and how they can impress you,” she said.

“I once thought maybe I should write a book about these women, because sometimes you just wonder where they find the courage to continue.”