Dr Etienne Brain

Intro text: 

Interview with Dr Etienne Brain, new member of the BIG Executive Board 2018-2022

What particular expertise do you think you will bring to the BIG Executive Board?

Content: 

Through the EORTC, I have been exposed to the European research environment since the early 2000s. This has been an incredible and formative experience, because of both the multicultural aspects found across Europe and the historical academic commitment of EORTC to surpass frontiers. I want to share these two acquired particularities within the board to help address research questions with global effects, rather than highly specific drug- or refined disease setting-dependent ones, especially for neglected groups of patients such as the elderly.

Editor: 

What inspired you to pursue a specialisation in older patients? What are the challenges faced by older patients and their treatment options?

Unmet clinical needs may be identified in any tumour and setting, generating relevant hypotheses for clinical trials. However, there is a glaring difference when it comes to age, disadvantaging older patients, even though most cancers occur in this group. Breast cancer is not an exception to the rule, with patients aged 65 and older soon representing 60% of all cases, but ironically representing barely 10% of those enrolled in registration trials. Moreover, when enrolled, they usually are highly selected and far from representative of those found in daily practice.

As a result, implementing most innovations in the clinic remains challenging. This is reflected in expansion cohorts, or real-life data series, which commonly show increased rates of side effects or compliance issues in older patients. We need to change the way we perform trials to better cover the real ageing population.

What was a defining moment in your career?

In 2005, I published in the JAMA the safety data of a large French academic trial investigating the role of taxanes in the adjuvant setting for early-stage breast cancer. It shaped my mind, making me understand the utmost importance and value of being able to rely on an independent academic network, never relinquishing persistence to publish results, even when they do not reach the optimistic expectations.

What are the biggest challenges currently faced by all stakeholders of the breast cancer research area? How do you think BIG can play a significant role in this context?

The main challenge is developing patient-centred research jibing with reality, meaning what patients need and not what drugs can do. Given the competition across borders, fuelled by conflicting interests from firms, this needs some self-critique to understand and accept that only a true international collaboration such as what BIG offers can ward off the many roadblocks.

When I was 10 I dreamed of…

… being a doctor. I never gave up, except I shifted from a wish to become an orthopaedic surgeon for children to medical oncology. Would I have to live my life over again, I would follow the same path with similar determination, but never forgetting music along the way.… being a doctor. I never gave up, except I shifted from a wish to become an orthopaedic surgeon for children to medical oncology. Would I have to live my life over again, I would follow the same path with similar determination, but never forgetting music along the way.