My contributions as a clinician, researcher, and teacher have been well balanced.
I served as Section Chief, Solid Tumor Oncology (GU/GI) at Hospital del Mar in Barcelona for 7 years. Many patients with GU cancer especially bladder carcinoma were referred to me for consultation. I saw patients over 2 clinic days per week. The clinical practice included 7 full-time GU/GI oncologists, 1 laboratory-based GU oncologist, 1 dedicated GU research nurse, and 1 dedicated study coordinator.
In my research, I have focused on the development of new systemic treatments for cancers--in particular, bladder cancer and the search for prognostic factors and potential therapeutic targets. I developed the MCAVI (methotrexate, carboplatin and vinblastine) schedule for unfit patients (Cancer 1992) as the control arm for the EORTC 30986 study vs. GemCarbo (gemcitabine carboplatin) (JCO 2010). I reported the superiority of cisplatin vs. carboplatin in the randomized trial of MVAC (methotrexate, vinblastine, adriamycin and cisplatinum) vs. MCAVI (Cancer 1997). To improve the combination of CG (Cisplatin/Gemcitabine), we conducted an investigational phase I / II study with the 3-drug regimen of PCG (paclitaxel, cisplatin and gemcitabine) (JCO 2000). In 2001, we reported the feasibility study of the combination of GemCarbo (EurJCancer), which was used as the experimental arm of the EORTC 30986 study for a randomized trial of patients unfit for platinum (JCO 2012).
We confirmed the value of the MSKCC prognostic factors in the first-line treatment with chemotherapy in bladder cancer (TCG [paclitaxel, cisplatin, and gemcitabine] study, Cancer 2002). We also described, in the same group of patients, the role of ERCC1 expression as a predictor of CDDP (cisplatin) response in bladder cancer (Ann Oncol 2007).
Within the EORTC, I was the chairman of the Advanced Bladder Cancer Committee, and study Chair and co-chair for the 30987 and 30986 studies. To confirm the results of triple therapy with TCG, we designed the 30987 study, the largest study conducted in advanced bladder cancer comparing CG versus TCG (JCO 2012).
Looking for second-line options in patients failing platinum, we reported the phase III study of vinflunine versus placebo, which led to the approval of vinflunine in the European Union (JCO 2009). Based on this study, the role of prognostic factors in second-line treatment was described (JCO 2010).
In the area of new therapeutic targets, we reported the study of sunitinib in front-line therapy. In collaboration with Jonathan Rosenberg (DFCI), we analyzed the molecular profile of the Spanish bladder cancer patient series (ASCO 2011). Based on findings of PI3K mutations, we are studying in preclinical models the efficacy of PI3K and TOR1-2 inhibitor drugs in bladder cancer cell lines.
In RCC, the innovative contribution has been the clinical study exploring the role of the chemotherapy switch benefit described in the preclinical models by Dr. Hanrahan at M.D. Anderson Cancer Center in Houston.
My teaching duties have ranged from preceptor to UPF (Pompeu Fabra University) medical students, mentor to medical oncology residents and junior staff (Hospital del Mar), and presenter of national and international talks. Currently at DFCI I have the chance to teach and mentor several of our residents and oncology fellows in the clinical and translational field of urothelial cancer. This gives a great personal and professional satisfaction as well providing me with some very gratifying feedback. My passion for teaching is also fulfilled by the mentoring of two outstanding recently licensed doctors in their way to Urology and Oncology Residency; Dr. Jeffrey Leow and Dr.William Martin-Doyle. Both of them have finished a Master at the School of Public Health, Harvard and have worked closely with me to use state of the art and modern meta-analysis tools to pool together all the information on high grade T1 urothelial bladder and upper urinary tract tumors.
Since taking on my new DFCI role in March 2013, my contributions include:
Assumption of duties as Director of the Bladder Cancer Center
GU patient care, primarily bladder cancer patients
preliminary preparation of an application, with a letter of interest, for a grant in the area RFA-CA-12-018 (PQB3): Research Answers to NCIs Provocative Questions Group B (R21): Evaluating the functional consequences recurrence and progression-of epigenetic mutations derived from pT1G3 bladder tumor sequencing
submission of a proposal involving PROFILE, and using the OncoMap system and other clinical/research data for analysis in non-prostate GU tumors (urothelial transitional/non-transitional, penile, adrenal, and kidney), in collaboration with Toni Choueiri
involvement in the design of the new DFCI Bladder CRIS project
participation in the roll-out process for the four core GMAPs (GU-Management & Assessment Pathways), which include Prostate, Bladder, Renal, and Testicular cancer, with dedicated involvement in bladder cancer pathways
advising a group of Harvard students on the project Adjuvant Chemotherapy in Invasive Bladder Cancer: A 2013 Updated Systematic Review and Meta-Analysis of Randomized Trials (Eur Urol, epub Aug. 28)
lecturing on bladder cancer for the Medical Oncology recertification exam
service on a monthly GU Oncology Tumor Board at BWH
Director of DFCI CRIS Project. Chairman of the Gelb Center
Director of DFCI GU Seminars
In addition, 22 Research Investigations and 18 Other Peer Reviewed Publications, several of them first- or senior-author contributions, have been published since then. Three new Clinical Guidelines are also in print.
I look forward to making future contributions to the Harvard community in terms of clinical expertise and innovation, research, administrative service, and teaching/training.