Dr. Wildiers Will Receive the 2023 B.J. Kennedy Geriatric Oncology Award

By Mindy Tanzola, PhD

Breast cancer researcher and medical oncologist Hans Wildiers, MD, PhD, of the University Hospital Leuven in Belgium, has been named the 2023 recipient of the B.J. Kennedy Geriatric Oncology Award. Dr. Wildiers coordinates the Leuven Multidisciplinary Breast Cancer Center and has authored more than 350 peer-reviewed papers since 2003. He has been active in the International Society of Geriatric Oncology (SIOG) as president and has chaired the Cancer in Elderly Task Force of the European Organisation for Research and Treatment of Cancer.

Dr. Wildiers will be presented with the award during the Opening Session of the 2023 ASCO Annual Meeting on June 3. Dr. Wildiers shared how he first became interested in geriatric oncology, how the field has evolved over the years, and the research questions that have yet to be answered.

Geriatrics and Oncology: Combining Two Interests

Dr. Wildiers first became interested in geriatrics as a subspeciality during his medical training.

“I think that people see life different[ly] when they age, and we can learn so much from older people,” he said.

Yet he was also drawn to oncology because of its scientific nature and the great progress that had been made in cancer treatment. He decided to focus on oncology and completed a PhD in angiogenesis in cancer, but he had not lost his interest in the care of older adults. While completing his PhD, Dr. Wildiers wrote a review article on the pharmacology of anticancer drugs in older adults after finding that such a resource did not exist.¹

“It was my first work in the field, and apparently it attracted attention from key people,” he said.

He went on to become a medical oncologist with a focus on breast cancer, although he remained acutely aware of the challenges of caring for older patients, as there is less research in this population and treatment decisions are more complex.

“It is a very delicate balance between overtreatment and undertreatment,” he said, “that is much less present in younger [patients].”

A Network of Mentors Paving the Way

Dr. Wildiers cited multiple mentors who were influential to his career, many of whom are previous recipients of the B.J. Kennedy Geriatric Oncology Award.

“I was very much motivated by Lodovico Balducci, MD, FASCO,” he said.  “He was so enthusiastic when he gave lectures about this topic and opened the eyes of many for this field.”

In fact, while working on his PhD, Dr. Wildiers was inspired by a visit to one of the first geriatric oncology clinics, the Senior Adult Oncology Program at Moffitt Cancer Center in Florida, run by Dr. Balducci and Martine Extermann, MD, PhD.

Other mentors include Matti Aapro, MD, of Genolier Cancer Center, and Etienne Brain, MD, PhD, of the Institut Curie, with whom he continues to collaborate. He also spoke highly of Arti Hurria, MD, FASCO, who was a trainee with him. Although they were the same age, “she really guided me in the field,” he said, noting that her passing was a real tragedy and a loss to the field.

He considers the SIOG community as the biggest inspirator of this work and his career, calling it a wonderful group of motivated health care workers trying to improve the care of older persons with cancer.

Evolution of Geriatric Oncology: From Assessments to Interventions

When Dr. Wildiers first started in geriatric oncology, there was little application of geriatric thinking in the oncology clinic. Therefore, early studies focused on the application of geriatric assessments into the oncology population.^2-5 These assessments would sometimes reveal issues that oncologists were not previously aware of—such as malnutrition, functional decline, and cognitive problems—and would influence treatment decisions, prognosis, and ability to tolerate therapy.

The field has since moved toward addressing the question of “What’s next?” if a geriatric assessment uncovers an issue.⁶ Recent studies have shown that geriatric interventions improve outcomes and quality of life in older patients with cancer.^7,8 Dr. Wildiers noted, however, that implementing geriatric interventions within the environment of current health care systems has proven to be a substantial challenge, citing this as a current focus of the SIOG and others.

Contributions to Guidelines and Clinical Research

Throughout the years, Dr. Wildiers has made many contributions to the field of geriatric oncology. He has contributed to the development of clinical guidelines for the treatment of breast cancer in older patients, starting with the first SIOG guidelines in 2007,⁹ and has conducted multiple clinical trials focused on this population. In one study, Dr. Wildiers and colleagues showed that in older and in frail patients with HER2-positive metastatic breast cancer, the combination of metronomic oral cyclophosphamide with trastuzumab plus pertuzumab is a highly active regimen with excellent tolerance.¹⁰

A major current interest of his is the biology of cancer in the context of aging. In his research, Dr. Wildiers asks questions about whether cancer is different in older people, how therapy affects aging, and its effects on the immune system. He is also continuing to lead trials investigating the optimal treatment approaches for older patients with breast cancer while contributing to studies evaluating geriatric interventions for patients with cancer.

During his lecture at the 2023 Annual Meeting, Dr. Wildiers hopes to highlight some of the issues, challenges, and opportunities in caring for older patients with cancer while also sharing some philosophical lessons he has learned. He shared a quote that was also cited by Dr. Hurria: “If you want to go fast, go alone. If you want to go far, go together,” adding that sometimes in life, there is a need to go fast to pursue an idea. But in order to go far, collaboration is essential.

Read more about the 2023 Special Awards recipients.

References

1. Wildiers H, Highley MS, de Bruijn EA, et al. Pharmacology of anticancer drugs in the elderly population. Clin Pharmacokinetic. 2003;42:1213-1242. https://doi.org/10.2165/00003088-200342140-00003.PubMed
2. Bellera CA, Rainfray M, Mathoulin-Pélissier S, et al. Screening older cancer patients: first evaluation of the G-8 geriatric screening tool. Ann Oncol. 2012;23(8):2166-2172. https://doi.org/10.1093/annonc/mdr587.PubMed. Epub 2012 Jan 16.
3. Kenis C, Decoster L, Van Puyvelde K, et al. Performance of two geriatric screening tools in older patients with cancer. J Clin Oncol. 2014;32(1):19-26. https://doi.org/10.1200/JCO.2013.51.1345.PubMed. Epub 2013 Nov 25.
4. Decoster L, Van Puyvelde K, Mohile S, et al. Screening tools for multidimensional health problems warranting a geriatric assessment in older cancer patients: an update on SIOG recommendations. Ann Oncol. 2015;26(2):288-300. https://doi.org/10.1093/annonc/mdu210.PubMed. Epub 2014 Jun 16.
5. Wildiers H, Heeren P, Puts M, et al. International Society of Geriatric Oncology consensus on geriatric assessment in older patients with cancer. J Clin Oncol. 2014;32(24):2595-2603. https://doi.org/10.1200/JCO.2013.54.8347.PubMed
6. Kenis C, Decoster L, Flamaing J, et al. Adherence to geriatric assessment-based recommendations in older patients with cancer: a multicenter prospective cohort study in Belgium. Ann Oncol. 2018;29(9):1987-1994. https://doi.org/10.1093/annonc/mdy210.PubMed
7. Mohile SG, Mohamed MR, Xu H, et al. Evaluation of geriatric assessment and management on the toxic effects of cancer treatment (GAP70+): a cluster-randomised study. Lancet. 2021;398(10314):1894-1904. https://doi.org/10.1016/S0140-6736(21)01789-X.PubMed. Epub 2021 Nov 3.
8. Li D, Sun CL, Kim H, et al. Geriatric Assessment-Driven Intervention (GAIN) on chemotherapy-related toxic effects in older adults with cancer: a randomized clinical trial. JAMA Oncol. 2021;7(11):e214158. https://doi.org/10.1001/jamaoncol.2021.4158.PubMed. Epub 2021 Nov 18.
9. Wildiers H, Kunkler I, Biganzoli L, et al. Management of breast cancer in elderly individuals: recommendations of the International Society of Geriatric Oncology. Lancet Oncol. 2007;8(12):1101-1115. https://doi.org/10.1016/S1470-2045(07)70378-9.PubMed
10. Wildiers H, Tryfonidis K, Dal Lago L, et al. Pertuzumab and trastuzumab with or without metronomic chemotherapy for older patients with HER2-positive metastatic breast cancer (EORTC 75111-10114): an open-label, randomised, phase 2 trial from the Elderly Task Force/Breast Cancer Group. Lancet Oncol. 2018;19(3):323-336. https://doi.org/10.1016/S1470-2045(18)30083-4.PubMed. Epub 2018 Feb 9.