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J
JCO Japanese Journal o
f
Clinical Oncology
Japanese Journal of Clinical Oncology, 2019, 49(1) 96–99
doi: 10.1093/jjco/hyy155
Advance Access Publication Date: 5 November 2018
Letter
Letter
Responding to the challenges of international
collaborations between the east and the west –
report of the first JCOG–EORTC symposium and
a perspective from young JCOG and EORTC
investigators
Kozo Kataoka
1,2,3,
*, Orit Kaider-Person
4
, Bernd Kasper
5
,
Patrick Starlinger
6
, Carmela Caballero
7
, Jessica Menis
8,9
,
Lizza E. Hendriks
10
, Mitsumi Terada
3,7
, Laurence Collette
7
,
Kenichi Nakamura
2,3
, Denis Lacombe
7
, and Haruhiko Fukuda
2
1
Division of Lower GI, Department of surgery, Hyogo College of Medicine,
2
JCOG Data Center/operations office,
National Cancer Center,
3
International Trials Management Section, Clinical Research Support Office, National
Cancer Center Hospital, Japan,
4
Radiation Oncology Unit, Oncology Institute Rambam Medical Center, Israel,
5
Sarcoma Unit, Interdisciplinary Tumor Center, Mannheim University Medical Center, Germany,
6
Department of
Surgery, Medical University of Vienna, Austria,
7
EORTC Headquarters, Belgium,
8
Drug Development Department,
Gustave Roussy Cancer Campus Grand Paris, France,
9
Department of Surgery, Oncology and Gastroenterology,
University of Padua, Padua, Italy, and
10
Department of pulmonary diseases, GROW –School for Oncology and
Developmental Biology, Maastricht University Medical Center, The Netherlands
*For reprints and all correspondence: Kozo Kataoka, 1-1 Mukogawa-cho Nishinomiya, Hyogo, Japan. E-mail:
kozokataoka@hotmail.co.jp
Abstract
International/intercontinental collaboration is necessary to set up new innovative clinical trials for
cancer treatment. However, the infrastructure, especially Asia–Europe academic partnerships, to
enable such collaboration has not been fully structured and differences and similarities between
the research groups have not been well studied. In 2015, collaboration started between the biggest
cancer research organizations in Asia and EU, Japan Clinical Oncology Group (JCOG) and
European Organisation for Research and Treatment of Cancer (EORTC). Following the first pilot
collaboration study, the first scientific symposium took place in December 2017 in Tokyo. Before
the symposium, a working visit for EORTC investigators from the Early Career Investigator initia-
tive (ECI), willing to develop projects within the JCOG–EORTC partnership, was held. In addition to
the digest of the working visit and symposium, we aimed to describe the differences and similar-
ities between the two groups and to identify key factors for collaboration from the perspective of
the young investigators of the networks. These findings are described in this article.
Key words: JCOG–EORTC, ECIs, EORTC fellowship
Introduction
Nowadays international collaborations are strategically important
to take up the challenges of modern clinical research such as, but
not limited to, multidisciplinary quality assurance programs and
subgroup fragmentation of diseases. Intergroup studies, notably
those done between the Europe and North America have changed
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practice and/or brought additional knowledge (1–3). Such collabor-
ation between Europe and Asia is essential to allow knowledge
development and cross expertise.
Based on this background, since 2015, the Japan Clinical
Oncology Group (JCOG) and the European Organization for
Research and Treatment of Cancer (EORTC) have been working
together to promote partnership in research and to identify strategies
for successful collaborations between the East and the West (4,5).
The JCOG is the largest multicenter clinical study group for cancer
in Japan which is mainly funded by national research grants (6–8).
The EORTC is the largest international clinical research organization
in the Europe, conducting multidisciplinary clinical trials in all
tumor types. The first pilot collaborative study, the EORTC1527/
JCOG1609INT/ESSO02 [Diffusion-weighted Magnetic Resonance
Imaging Assessment for Liver Metastasis to improve surgical plan-
ning (DREAM) (NCT02781935)], has already recruiting patients
with colorectal liver metastases since 2016 (9,10).
As part of this effort, the first JCOG–EORTC Clinical Research
Symposium was held in Tokyo in December 2017. The purpose of
this symposium was to deepen the mutual understanding about the
current perspectives of both cooperative groups and strengthen this
initiative to promote further collaborative projects. Common scien-
tific strategies and unmet needs that could be translated into poten-
tial clinical trials were discussed at the meeting. This symposium
was linked with the Early Career Investigator initiative (ECI), which
provided an opportunity of travel grants for young EORTC investi-
gators willing to develop projects within the JCOG–EORTC part-
nership. This was a unique opportunity to motivate the young
investigators to come up with new collaboration projects.
In this article, as well as the digest of the symposium, and the
site visit of ECIs and EORTC visiting Japanese medical fellows, the
differences and similarities between the two groups are assessed,
including key factors for successful collaboration.
Digest of JCOG–EORTC symposium
In the two-days meeting, several topics were discussed from both the
JCOG and EORTC side, respectively. On Day 1, the overview and
experience of international clinical trials in both groups were dis-
cussed. It was identified that both academic cooperative groups have
similar structures, moreover the flexible EORTC structure imple-
menting international clinical trials was presented. Details regarding
structures in both groups have been described elsewhere (5). At the
end of the session, the results of surveys sent to key JCOG and
EORTC investigators were presented and indicated that, despite the
existing challenges, the majority of investigators in both territories
are supportive of international collaboration. The result of surveys
will be published in another report. Next, translational research
infrastructures were also discussed to find ways for future collabora-
tions. In both JCOG and EORTC, unique biobanking infrastruc-
tures, JCOG biobank system and SPECTA platform as well as
internal Advisory Committee for translational research, have already
been incorporated. Although there are still some challenges for col-
laboration to overcome, such as shipping of materials and regula-
tory matters, it has been agreed that it is already time to start
working on collaborative translational research using the materials
each group already has.
On Day 2, the similarities and differences were discussed from
the statistical point of view. Two educational topics were presented
from each group; Adaptive design from EORTC and statistical
measures for time-to event from JCOG. Then standard statistical
methodology was compared and discussed. Discussion topics were;
one-sided test vs. two-sided test in superiority setting, timing of event
for progression free survival, policy for interim analysis and popula-
tion for analysis (Intent to Treat vs. per-protocol). It has been con-
cluded that differences of statistical methodology in each group were
minor and they were basically similar. Afterwards strategies of three
disease-oriented groups in JCOG and EORTC (gastrointestinal, lung
and brain) and examples of ongoing clinical trials were presented.
Lastly, in the panel discussion, the key factors to success for this col-
laboration were discussed to enable future collaboration. First, it has
been agreed that mutual communication such as attendance of dis-
ease group meetings in both groups is the first step for collaboration
to share common clinical questions and to establish a worldwide net-
work. Second, it has been agreed that there is an urgent need to
develop the infrastructure which can facilitate international collabor-
ation. Financial resources to cover the activities such as networking,
management of trials, and centralization and quality assurance of
human biological material and other type of data such as imaging
scans, should be secured. Therefore, it has been agreed that, to
achieve these factors, both groups need to assess the feasibility of
research questions early on, in terms of financial and regulatory
aspects and aim to achieve common solutions. Furthermore, every-
body agreed that a good common clinical research question should
come first.
The experiences of EORTC ECIs and Japanese
EORTC fellows
Research fellowships and site visits by young investigators might be
one of the efficient ways to foster reciprocal understanding of each
other’s culture and research environment. As part of JCOG–
EORTC symposium, several ECIs were enabled to visit a Japanese
cancer center and to attend the symposium. ECIs were requested to
submit the application forms including their research collaboration
ideas and winners were selected based on the score of the applica-
tion forms. The score was given carefully and impartially based on
(1) purpose to join this program, (2) passion for collaboration, (3)
academic background, (4) quality of idea of collaboration project,
(5) experience of collaboration experience and (6) quality of applica-
tion form, by the JCOG–EORTC steering committee members. Six
ECIs were selected and visited Japanese hospitals for 3–4 days.
During their visits, they discussed similarities and differences
between their hospital and the Japanese visit hospital. A medical
oncologist and a pulmonologist from the EORTC lung group who
visited the thoracic oncology division in National Cancer center
Hospital, Tokyo, mentioned the higher incidence of early stage can-
cer in Japan compared to Europe. They also mentioned genomic dif-
ferences as Epidermal Growth Factor Receptor (EGFR) mutated
lung cancer is more common in Japan. Furthermore, differences in
drug metabolism in Japanese and Caucasians may lead to different
standard drug doses and other adverse events. Regarding radiother-
apy, a young radiation oncologist from the EORTC radiation group
and European Society for Radiotherapy and Oncology (ESTRO)
noticed that the patient population receiving radiotherapy is differ-
ent (30% in Japan and 60% in Europe), probably due to a Japanese
focus on surgery and a higher percentage of early disease in Japan
due to screening. A young surgeon from EORTC GI group and
European Society and Surgical Oncology (ESSO) who visited hepa-
tobiliary and Pancreas division pointed out the difference in the
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historical role of surgeons. He mentioned that while in Europe, the
medical oncologist has been working closely together with the sur-
geon, the Japanese surgeons seem to integrate these two disciplines,
as clinical oncology remains a fairly ‘young discipline’in Japan.
These aspects should be fully recognized and considered in a collab-
oration project.
On the JCOG side, since 2015, three Japanese fellows already
experienced the actual clinical trial situation in Europe through an
EORTC medical fellowship. Japanese young investigators men-
tioned that not only scientific aspects, but also operational aspects
are needed to understand in collaboration. They said that since
Japan is a ‘homogeneous’country in many senses, Japanese have to
understand the complicated and diverse Europe regulations and dif-
ficulty of financial support in pan-Europe clinical trials (5,11,12). It
took some time to launch the first pilot trials due to preparation
time for translation and contracts. Despite the several differences
mentioned, all the ECIs and Japanese EORTC fellows concluded
that it is first step to know the differences and similarities between
the Europe and Asia for successful EORTC–JCOG collaboration
which can affect the practice of all over the world.
Summary and future perspective
The main objective of this exercise was to address the needs for clin-
ical trial collaboration and where Asia can enter in such initiatives.
In this symposium, the similarities and differences between the two
groups were fully discussed; the two groups are similar in the basic
structure of headquarters, translational research infrastructures and
standard statistical methodology, but they differ in the standard
treatment in some disease groups, the infrastructure facilitating
international clinical trials, details of statistical methodology, regula-
tory process and financial support. These have been addressed in a
previous collaboration paper (5). Additionally, during the sympo-
sium, it has been agreed that mutual communication should be
maintained across disease groups to facilitate development of trans-
versal projects with common scientific questions. This will poten-
tially open more opportunities for collaboration and financing. Both
groups need to be vigilant in obtaining alternative sources of fund-
ing academic pursuits. Lastly, the working visit by ECIs made us
realize that such personal and dynamic interaction across cultures is
one of the most effective ways to bridge the gap between the two
groups. For young investigators it is easier to come up with clinical
questions relevant for both groups when they have the chance to be
engaged with experts and mentors and when they are exposed to
different working environments early in their career. Furthermore,
by giving young investigators opportunities to be involved in the
management of clinical trials, they can better understand clinical
unmet needs or operational issues across countries. Such knowledge
and understanding are critical for a sustainable Asian-European col-
laboration. An example of the active involvement of an ECI in a
clinical trial is in the EORTC lung cancer group which appoints a
young investigator for each new trial to manage the clinical trial
together with a senior investigator.
Several initiatives are ongoing to further expand the portfolio
between JCOG and EORTC. First, the opportunity for further com-
munication has already been prepared. A second JCOG–EORTC
symposium related to quality of life has taken place last September
2018. In disease group level, EORTC–JCOG exchange program has
been already started. Some Japanese investigators have been invited
to the disease group meeting to share their thoughts. Additionally,
several Japanese applicants are now under negotiation with EORTC
headquarters for the future EORTC medical fellow. Through these
exchange initiatives, the chance to come up with attractive common
clinical question will certainly increase. After increasing the oppor-
tunity for mutual communication, the next step is to secure the
grants. To make this initiative visible, one of the solutions may be to
invite fund bodies such as pharma companies to the future sympo-
sium for encouraging them to find the value of our collaboration
and getting support from them. The advantage of the combined net-
works of EORTC and JCOG must be used as a leverage to seek for
funding and support internationally.
Conclusion
With the working visit and the first joint scientific symposium, sev-
eral challenges have been identified such as differences in standard
treatments and regulatory matters including financial support.
However, we have reasons to be optimistic because through a series
of these collaborative projects, we found that we have a common
vision and mission for practice changing, high quality clinical trials.
The field of cancer research is evolving very fast so that academic
networks like JCOG and EORTC need to work together to define
and direct the future of cancer research. The exchange program,
such as ECI program and EORTC fellowship is one of the routes to
bridge the gap between the Asia and Europe and to foster the inter-
national academic trial platform which helps conducting global
intercontinental clinical research smoothly.
Appendix
All authors of this articles are below:
Kozo Kataoka, Orit Kaider-Person, Bernd Kasper, Patrick
Starlinger, Carmela Caballero, Jessica Menis, Lizza E. Hendriks,
Mitsumi Terada, Laurence Collette, Junko Eba (JCOG Data Center/
operations office, National Cancer Center, Japan), Kenichi
Nakamura, Denis Lacombe and Haruhiko Fukuda.
Acknowledgements
The authors thank EORTC investigators and JCOG investigators who
answered the questions, especially Yuko Kitagawa, Yasuhiro Matsumura,
Ken Kato, Sabine Tejpar, Serge Evrard, Vassilis Golfinopoulos, Yuichiro Ohe,
Takeshi Sano, Junki Mizusawa, Yukihide Kanemitsu, Masanori Terashima,
Benjamin Besse, Ryo Nishikawa, Taro Shibata, Michael Weller, Toshirou
Nishida and Hitoshi Nakagama for their presentation and Makiko Watanabe
for her involvement as steering committee.
Funding
This work is supported by Practical Research for Innovative Cancer
Control from Japan Agency for Medical Research and Development,
AMED (18ck0106211h0003) and Global Clinical Trial Development
Project of Japan Agency for Medical Research and Development,
AMED (16lk1203001j0001, 17lk1503003j001, 18lk1503003j002).
The National Cancer Center Hospital, which also functions as the
headquarters of the Japan Clinical Oncology Group, is appointed as
Global Clinical Trial Core Centers of AMED.
Conflict of interest statement
None declared.
98 JCOG and EORTC exchange initiative
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