The crucial link ANNUAL REPORT

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1 The crucial link ANNUAL REPORT 2012

2 On the front page: KEVIN PULIDO, patient at Gustave Roussy s Child and Adolescent Cancer Department. The crucial link Past, present and future; care-givers, patients and families; research, care and teaching; local, national and international partners So many bonds forged each day by Gustave Roussy s teams. So many relationships nurtured around the care provided by the teams of doctors and care-givers, the energy of researchers and the solidarity of families and volunteers. So many forces working together to beat cancer.

3 SUMMARY Discover Gustave Roussy Interlinked portraits Our Key Missions Key figures Actors of the cancer network Governance Highlights 2012 Management board interview See further 20 A global problem 22 A global mementum 24 The scientific project Cancer Campus 25 Therapeutic innovations 26 Precision medicine Act on Care Research Teaching Fundraising Financial Results 2012 activity Auditor s report 2012 balance sheet 2012 profit and loss account Overall annual use of resources Uses of donations and bequests Gustave Roussy s scientific publications Synthesis International comparisons International publications Our 2012 annual report and its annexes can be found online The activity of the departments and the tumor boards Presentation of the research groups gustaveroussy.fr heading: annual reports ANNUAL REPORT 2012 / GUSTAVE ROUSSY 03

4 CATHERINE VERGELY, director of ISIS, an association of parents and friends of the children treated at Gustave Roussy. There are dozens of volunteer associations helping out at the Gustave Roussy Institute. Our work has been recognised to be of public interest; we form an integral part of the hospital system by helping to improve the quality of life of cancer patients. We know that our role is important. I ve had highs and lows, as the weeks go by. Sometimes, activities organised for the patients by volunteers have helped us escape. These moments are truly important. KEVIN PULIDO, a patient at Gustave Roussy s Department of Child and Adolescent Cancer

5 Pr FABRICE ANDRÉ, oncologist and Head of The Unit for Translational Research at Gustave Roussy. Generosity of the public and solidarity of our donors are essential for the success of cancer research programs currently being conducted at Gustave Roussy. I would sincerely like to thank all our donors; it is their generosity that allows us to exist. Donating money to research is something very tangible. Every month, by donating a few dozen euros by automated bank transfer, I am actively helping to fund a team. My contribution allows a research program to exist. The more of us there are, the more we can do to advance research. CHRISTELLE DUMONT, sponsor of Professor Fabrice André s team for research against breast cancer.

6 CAROLE MAZELIER, medical-technical manager in nuclear medicine. Every day, thanks in particular to the training we are given, I can improve my skills for the benefit of the patients and thus serve them better. I share that with all my colleagues. We see what is at stake and it makes our work all the more meaningful. I am keen to pass on, through the training I provide to the medical teams at Gustave Roussy, the correct methodology for conducting clinical studies under optimal conditions for patients. Dr ISABELLE BORGET, a university lecturer in health economics at Université Paris-Sud Gustave Roussy.

7 I am proud to follow a training program focused on innovation and to rub shoulders with the brilliant people at Gustave Roussy. I consider myself very lucky to have had this opportunity to spend 3 years studying in such a stimulating and scientific environment. NILS TERNÈS, master s student, part of the Path to excellence in cancer studies group Fondation Philanthropia, and pursuing an education at the Cancer Sciences School Université Paris-Sud and Gustave Roussy. Pr MARTIN SCHLUMBERGER, director of the Cancer Sciences School Training young talent is fundamental to make sure there is a constant renewal of innovation in care and oncology research. These are the talents which, tomorrow, will beat cancer.

8 DISCOVER GUSTAVE ROUSSY OUR KEY MISSIONS THREE PILLARS: CARE, RESEARCH AND EDUCATION The Gustave Roussy cancer center, founded in 1926 by professor Gustave Roussy, distinguished itself from the very beginning by its wholly integrated approach to research, care and teaching; today, it is one of the ten world leaders in the fight against cancer. Its internationally renown professionals are specialists with regard to all different types of cancer, at all stages and at all ages. As an expert center in dealing with complex cancers, Gustave Roussy brings together cutting-edge medical care and human support. Gustave Roussy s specificity is also based on its therapeutic innovation, which today puts it at the forefront in very promising areas such as personalised medicine which takes into account the patient and their tumour s genetic characteristics and tomorrow s therapies (immunotherapy, DNA repair inhibitors, epigenetic modulators). AT THE FOREFRONT OF CENTERS IN THE FIGHT AGAINST CANCER A key actor on the European and international oncology scene, Gustave Roussy applies a global approach to cancer, employing multidisciplinary teams to care for each patient and define by a multidisciplinary process the best treatments for them. Top level research, conducted at the very heart of the Institute, is aimed at the integration of basic, translational and clinical approaches, so that the results can be applied as quickly as possible for the benefit of the patient. The teaching provided to the students, researchers and practitioners, enables them to bring into practice new developments in cancer treatment, and introduce innovations. The Institute is a driving force in the dissemination of knowledge and training by exporting its working models, its experience and medical expertise abroad. Further, numerous academic partnerships are nurtured with the greatest cancer centers in the world for worldwide research projects. Gustave Roussy s holds a central position in the project Cancer Campus a campus of international scope which structures, around the Institute, university activities in research and health innovation and Grand Paris, a future Greater Paris Area which links the major economical centers of mainland France. 08 ANNUAL REPORT 2012 / GUSTAVE ROUSSY

9 A GLOBAL FRONT-RUNNER IN CANCER TREATMENT INNOVATIONS FOR OVER 90 YEARS Our missions: care, research, train, and mobilise. Our vision: set up the best group of researchers, doctors, care-givers, teachers and donors for the benefit of each patient. Our commitment: create the medicine of tomorrow by speeding up the translation of scientific and medical discoveries to new treatments for cancer patients. Our values caring creativity distribution energy A mission of public interest Gustave Roussy is a private health care establishment of public interest and a not-for-profit organisation. As a Cancer Center, its status has been established by decree (number ) of 1 October 1945, modified by decree (number ) of 2 May 2005 and by the HPST law of 21 July 2009 concerning hospital reforms and relative to patients, health and territories. There are 18 ex-officio members on the Board of Directors, chaired by the Prefect of the Paris region, the Prefect of Paris. He determines general policies, conducts evaluation processes and controls the execution of policies. At executive level, Gustave Roussy is led by a physician, appointed for 5 years by the Minister of Health, after consultation with the Board of Directors and the National Federation of Cancer Centers. The General Director, who manages the general conduct of the establishment, is aided by the Assistant General Director who is in charge of the operational management of the Institute, appointed by the Minister of Health, and the Research Director who is appointed for 5 years by a decree of the Ministers in charge of Health and Research. Gustave Roussy is a member of UNICANCER, which federates the Cancer Centers in France. ANNUAL REPORT 2012 / GUSTAVE ROUSSY 09

10 KEY FIGURES ACTIVITIES AND TEAMS an overall budget of 290 M 2,600 employees 20 M raised from the public Of which 20% A research budget of 60 M 530 physicians 965 care-givers 270 researchers CARE 47,000 patients of which 11,400 first visits per year 200,000 consultations 24% of the patients involved in a biomedical research program (compared with 11% nationwide) 356 hospital beds and 88 beds/chairs in day-care RESEARCH 29 research groups divided into 13 units 1,300 international scientific publications Almost 2,500 patients treated by a personalised approach between 2009 and the end of clinical studies in progress, more than 50 sponsored by Gustave Roussy Over 130 patents filed TEACHING 2,800 medical students, 40,000 hours nurse students, engineers and researchers trained every year 17 University degrees of initial and/or in-house training every year 26 university teachers 214 teaching practitioners 3,400 electronic or paper publications 10 ANNUAL REPORT 2012 / GUSTAVE ROUSSY

11 THE ACTORS OF THE CANCER NETWORK As a global public health issue, the fight against cancer requests, by its very nature, a global and combined approach between its many different actors: research centers, universities, hospitals, other centers involved in the fight against cancer both in France and on the international scene, pharmaceutical and biotechnological industries, supervisory authorities, patient associations, small and large donors, sponsoring firms So many driving forces joined together to encourage innovation in care and research. Departmental Council for the Val de Marne region Campus Grand Parc Cancer Campus (Villejuif) Departmental Council for the Paris region Grand Paris ONCO 94 Inserm EORTC Union for International Cancer Control PATIENTS Inca Front-line health professionals Fondation Gustave Roussy Cancer Sciences School CNRS AP-HP MMO Plan Cancer Natixis Patient Associations Organisation of European Cancer Institutes Université Paris-Sud SOCRATE ANSM French National Cancer League Federation of Cancer Centers of France PACRI Groupe Dassault MOSCATO Erasmus University MC Unicancer University Department of Medical Studies University Department of Pharmaceutical Studies SAFIR ARC Printemps HAS NCI ARS French Ministry of Higher Education and Research French Ministry of Social Affairs and Health Fondation Philanthropia MD Anderson University Cancer Center Department of Sciences UFR Law Economics Managementnt Donors Karolinska Institute Donors PA Attitude University Hospital Sharjah (UAE) DKFZ Odysséa Research sponsors Gustave Roussy Transfert Route to excellence in cancer studies Fondation Philanthropia ENS Cachan INSTITUTIONS CARE ORGANISMS RESEARCH ORGANISMS TEACHING PARTNERS FUNDRAISING AND PATRONAGE Génopôle Évry biocluster Institut Curie Institut Pasteur WIN Consortium ANNUAL REPORT 2012 / GUSTAVE ROUSSY 11

12 GOVERNANCE PROMOTING EFFICIENCY, INTEGRATION, FORWARD-THINKING AND TRANSPARENCY Gustave Roussy has implemented, at the general management level, a governance model to guide its activities in care, research and teaching. This model, which guarantees an overall perspective and responsiveness, allows the main strategic and operational guidelines to be defined, while assuring that long-term decisions are made and that sustainable growth is assured. Gustave Roussy is implementing a contractualizing model with its medical departments to define objectives and budgets. This principle of delegation and co-governance is a key element in developing common projects and the participatory principles in running the institution. THE COMPOSITION OF THE BOARD OF DIRECTORS OF GUSTAVE ROUSSY ON 31 JULY 2013 EX OFFICIO MEMBERS (18) Mr Jean Daubigny President, Prefect of the Paris region, Prefect of Paris Mr Laurent Garnier Member of Val-de-Marne s General Council Dr Jean-Marie Le Guen Member of the Council of Paris Professor Serge Bobin Dean of the Faculty of Medicine Mrs Véronique Paquis Representative of the Ministry of Research Professor Fabien Calvo Representative of the National Cancer Institute Mr Thierry Damerval Representative of the Institute of National Scientific Studies and Medical Research Mrs Mireille Faugère Managing Director of Welfare Paris Hospitals Mr André Rouquié Member of the Economic, Social and Environmental Council Professor Claude Huriet Mr Jean-Pierre Davant Mrs Annie Podeur Qualified Individuals Mrs Catherine Vergely Mr Jean-Pierre Escande Users Representatives Dr Dominique Valteau-Couanet Dr Sylvie Bonvalot Members of the medical personnel Mrs Christine Fontaine Dr Pierre Duvillard Members of the Works Council MEMBERS ACTING IN AN ADVISORY CAPACITY Mr Pierre Dartout Prefect of the Department of Val-de-Marne Represented by Mr Ivan Bouchier Assistant Prefect of L Haÿ-les-Roses Professor Alexander M.M. Eggermont General Director of Gustave Roussy Mr Claude Évin General Director of the Paris regional Health Agency SECRETARIAT Mrs Katia Laffargue Cabinet Chief INVITED MEMBERS Mr Éric Vechard ARS Territorial Representative (Val-de-Marne) MANAGEMENT AND ADMINISTRATION OF GUSTAVE ROUSSY Mr Charles Guépratte Assistant General Director Professor Éric Solary Research Director Mrs Sophie Beaupère Director of Activities and Finances Mr Robert Servat Director of Financial Affairs, Treasurer Dr Ellen Benhamou Borowski President of the Medical Commission Mr Stéphane Stépanian Director of Investments and of Logistics Mr Philippe Bourassin Director of Human Resources Mrs Christine Lascombe Communication Director Professor Michel Ducreux Medical Coordinator Mrs Anne Montaron Care Management Mrs Psylvia Dewas-Tasseau Project Manager Mr Jean Gatinaud Auditor (KPMG) 12 ANNUAL REPORT 2012 / GUSTAVE ROUSSY

13 GENERAL MANAGEMENT International Task Team General Director A. M.M. Eggermont Assistant General Director C. Guépratte Research director É. Solary Internal contractualisation assistance and performance support task team V. Brière ACTIVITY UNIT Medical Coordinator M. Ducreux RESEARCH AND TEACHING Research Management É. Solary Clinical Research Management G. Vassal Teaching Management M. Schlumberger HEAD OF STRATEGY Quality and Management of Risks Management E. Minvielle Radioprotection N. Guilabert Legal Affairs Department N. Verotte Communication Management C. Lascombe HEAD OF PROJECTS Care Sectors M. Di Palma Project Cancer Campus G. Lenoir TUMOUR BOARDS Cervico-facial Pathology S. Temam Thoracic Pathology B. Besse Gastro-digestive D. Malka Breast S. Delaloge Gynecology C. Lhommé Endocrine tumors E. Baudin Urology B. Escudier Dermatology C. Robert Soft Tissues - Bone A. Le Cesne Neurology F. Dhermain Haematology V. Ribrag Paediatric Pathology J. Grill Early Trials J.-C. Soria Genetical oncologist O. Caron DEPARTMENTS Medical Oncology K. Fizazi Child and Adolescent cancer research department D. Valteau-Couanet General surgery D. Elias Cervico-facial cancer research F. Janot DITEP* J.-C. Soria Acute care B. Gachot Medical imaging M. Schlumberger Medical Pathology and Biology J.-M. Bidart Pharmacy F. Lemare DISSPO** S. Dauchy Ambulatory care M. Di Palma Operating rooms J.-L. Bourgain Radiotherapy E. Deutsch DEPARTMENT OF HUMAN RESOURCES AND FINANCE Activity and finances management S. Beaupère Medical information service M. Mons Financial/treasury affairs R. Servat Human resources Ph. Bourassin Care management A. Montaron Information systems management N. Mezaour Investments and logistics management S. Stépanian Fundraising and Partnerships E. Le Roy Fondation Gustave Roussy * DITEP: Department of therapeutic innovations and early trials (created in September 2013). ** DISSPO: Interdisciplinary Department of supportive care for onco-haematology patients. Medical physics D. Lefkopoulos ANNUAL REPORT 2012 / GUSTAVE ROUSSY 13

14 DISCOVER GUSTAVE ROUSSY HIGHLIGHTS 2012 JANUARY INAUGURATION OF THE NOVALIS TX Gustave Roussy installed a high-precision stereotactic radiotherapy system, financed partly by the Institute s donors. LAUNCH OF THE PROGRAMME LIVING WITH CANCER unconventional care facilities are set up to improve the wellbeing of patients: art, culture, sport, physical well-being. To find out page 34 FEBRUARY Gustave Roussy brings together its teaching activities within the Cancer Sciences School, together with Université Paris-Sud, to offer training programs in new cancer-related jobs. MARCH ALLIANCE OF PARISIAN INSTITUTES FOR CANCER RESEARCH (APICR) in cancer research in the Paris region, in the context of APICR, a national project of Future Investments in Health. To find out page 40 To find out page 42 APRIL FIRST PUBLIC/PRIVATE PARTNERSHIP IN CLINICAL RESEARCH FOR GUSTAVE ROUSSY This partnership with Sanofi aims to facilitate the patients access to new drugs according to their tumour s molecular profile. JUNE Launch of the international study WINTHER, the first of its kind in the world. This trial is conducted over a period of two years in Gustave Roussy (Fr), MDAnderson (USA), McGill University (Canada), Sheeba Medical Center (Israel) and Val d Hebron (Spain). To find out page ANNUAL REPORT 2012 / GUSTAVE ROUSSY

15 JULY ACCREDITATION OF SIRIC STATUS Roussy the label Integrated cancer research site for the SOCRATE project, which brings together three innovative programs (DNA repair, tumour immunology, molecular medicine). OCTOBER SEPTEMBER FOUNDING OF THE THORACIC ONCOLOGY INSTITUTE Gustave Roussy and the Marie Lannelongue surgical center have founded a joint institute to offer global and multidisciplinary care to patients with thoracic cancers. NOVEMBER ARRIVAL OF A STATE OF THE ART MRI SCANNER Gustave Roussy strengthened its technical platform with a high resolution and highprecision MRI Scanner of 3 Tesla, which is capable of detecting very small tumors and a spectral scanner which allows the dose of X-rays in MRI-guided radiotherapy to be reduced by 30%. THE ODYSSÉA RACE IN PARIS 2012 The 2012 edition of the event: the Odysséa race raised 320,000 for the support breast cancer research which was donated to Gustave Roussy to finance its clinical research programs and the development of personalised treatments. RECOGNITION OF THE SAFIR 01 TRIAL AT THE ESMO CONGRESS The first results of the SAFIR 01 study demonstrates the feasibility and value of analysing molecular portraits of breast cancers, in order to detect molecular changes that can be treated with targeted therapies. To find out page 29 DECEMBER PARTNERSHIP WITH NATIXIS TO SUPPORT RESEARCH Natixis has chosen to sponsor three new research groups at Gustave Roussy over a three year period to contribute to the development of personalised medicine, in the context of Gustave Roussy s program Révolution Cancer. ANNUAL REPORT 2012 / GUSTAVE ROUSSY 15

16 MANAGEMENT BOARD INTERVIEW INCREASE IN ACTIVITIES AND PROJECTS COHESION AND MOBILISATION OF TEAMS DEDICATED TO PATIENTS The increase of Gustave Roussy s activity is accompanied by the launch of major projects and of structural research programs. Interview with Professor Alexander M.M. Eggermont (General Director), Charles Guépratte (Assistant General Director) and Professor Éric Solary (Research Director). What are the results of Gustave Roussy s activity throughout 2012? ALEXANDER M.M. EGGERMONT : After many years of growth, number of interventions and overall productivity has risen again in This effort, in which all of the Institute s teams have participated, demonstrates their strength and collaborative spirit. This year has also been marked by the launch of a number of major projects, in particular the construction of a building largely dedicated to personalised medicine or precision medicine, the founding of the Cancer Sciences School, and the development of major research programs. In summary, 2012 was a remarkable year in terms of the achievements of our missions and the implementation of our strategic vision. CHARLES GUÉPRATTE : It is largely this growth in activity which has allowed us to balance our budget, despite the freeze in public financing caused by the challenging economic conditions and which made us initially fear a deficit. Thanks to the continued momentum, supported by everyone, we have been able to increase the number of patients treated while maintaining an excellent quality of care. This is evidenced by a 2% rise in overall activity concerning full hospitalisation, and 4% for ambulatory care. Our ability to implement new structures, such as the new diagnosis in a day which, like the model of the one set up 8 years ago for breast cancer, has now been expanded to other types of tumours too. The considerable number of long-term projects started in 2012 demonstrates the responsiveness of all the teams in the face of practical developments. In 2012 we also finalised the internal contractualisation process with the drafting of contracts setting out targets and means by the medical and surgical departments. Additional income came from the treatment of foreign patients with CHARLES GUÉPRATTE Assistant General Director serious medical conditions. The value of our expertise is demonstrated by our first partnership with a foreign hospital; a Gustave Roussy unit was established in Sharjah (UAE). Lastly, we must acknowledge the support of private enterprise, in particular donors and sponsors (companies) and associations. >>> 16 ANNUAL REPORT 2012 / GUSTAVE ROUSSY

17 >>> In a difficult financial context, and despite their own challenges, they maintained their financial support and solidarity. A. E. : Indeed, that is an essential factor. To develop our projects, we must further increase our resources. This is why we are going to continue to enhance our expertise, both in France and on the international scene. After Sharjah, we are planning to sign new agreements with other hospitals or Cancer Institutes abroad. We also wish to position ourselves to win tenders, in the framework of the Big Loan (for France), and the Horizon 2020 program at European level. What is the current state of cancer research and what are your plans in this field? ÉRIC SOLARY : The progress in DNA sequencing has given us a more precise knowledge of tumour cells genetic anomalies. Moreover it has been demonstrated that novel agents for immunotherapy seem quite effective in treating cancer. Further, a considerable number of new drugs with various mechanisms of action have come onto the market. These advances signify a breakthrough in research and care. The priority areas of research at Gustave Roussy are: precision medicine which takes into account the patient and their tumour s genetic specificity; immunotherapy; DNA repair; haematology and stem cells. A. E. : These four priorities are at the very heart of our research programs, launched in January Completed by a medical-economic analysis, they strengthen our project which was supported by the large fundraising campaign, Révolution Cancer, initiated in Each theme mobilises basic, translational and clinical research groups and integrates studies of different types of tumours, whether common or rare. New research teams have been established and others will be set up during the next five years. >>> Pr ALEXANDER M.M. EGGERMONT General Director Pr ÉRIC SOLARY Research Management ANNUAL REPORT 2012 / GUSTAVE ROUSSY 17

18 MANAGEMENT BOARD INTERVIEW Massive investments in the fight against cancer. >>> The ICRS award (the integrated cancer research site) for our SOCRATE program strengthens our position: we employ an integrated approach to treating cancer which combines research, clinical trials and care. E. S. : Further efforts should enable us to better understand the wide variation of tumours and the mechanics of genetic mutations. Clinical trials are also necessary to validate the concept of precision medicine by achieving the right combinations of drugs, in particular, and eventually try to implement these advances in the early screening stage and personalised preventions. Will Gustave Roussy continue to invest in equipment? C. G. : The research programs which Alexander M.M. Eggermont and Éric Solary have just spoken about are themselves accompanied by investments in cutting-edge equipment and the development of technological platforms. The Scientific Project Management (SPM) Unit has been created to bring together the Research Management, those in charge of large research programs, the Director of Human Resources and the Activity and Finances Management. This unit validates each research program s financial commitments, with regard to equipment in particular. In a larger context, Gustave Roussy invests each year to renew its materials and to ensure that it remains at the forefront of technology. Pr ÉRIC SOLARY Research Management So, in 2012 an MRI machine was replaced, a new scanner was installed and the Novalis TX, a new and high-precision radiation machine, went into service, thus enabling us to upgrade radiation therapy services. It is our 7 th accelerator, and we intend to purchase yet another one in the years to come. E. S. : To conclude, I would like to highlight the major interest of another project, carried out in conjunction with the Curie Institute: the construction of a 5,000m² building at Villejuif, dedicated to preclinical research. This building will be part of the large national research facilities ities in France. 18 ANNUAL REPORT 2012 / GUSTAVE ROUSSY

19 How would you summarise Gustave Roussy s strategy in the coming years? A. E. : In the Institute s guiding principles, you find a major objective which is shared by all three of us, and by all employees: pursue a strategy centered completely on the patient. One of our priorities is to offer the patient the very best technological platforms in imaging, radiotherapy and in sequencing and other cutting edge diagnostic procedures, with as much comfort as possible. We are going to continue to invest in Pr ALEXANDER M.M.EGGERMONT General Director these fields, hoping that we can quickly transform the most advanced technologies into new standards. Of course we will continue further integration of our significant commitments to basic, translational and clinical research with treatment programs, both in the domain of common and rare cancers. We are planning to further increase clinical trial activity, especially in the field of early drug development. On the international scene, as Charles Guépratte mentioned, our objective is to valorise our expertise and expand our partnership strategy. Gustave Roussy is an Institute that benefits from its territorial development as well as its international scope. These two dimensions are combined in a project which is ongoing at an urban campus the Cancer Campus which federates, inside a bio park, activities in research and in health innovation, with numerous partners like the AH-HP and both public and private research institutions. Gustave Roussy and the Cancer Sciences School, which is linked to the Medical Faculty of the Université Paris-Sud, is at the heart of a network which has both a local and a global dimension, bringing together cutting-edge expertise, a wide range of skills, modern tools and committed teams: it is an excellent combination to improve patient care. CHARLES GUÉPRATTE Assistant General Director ANNUAL REPORT 2012 / GUSTAVE ROUSSY 19

20 See further A GLOBAL PROBLEM_22 A GLOBAL MEMENTUM_24 THE SCIENTIFIC PROJECT CANCER CAMPUS_25 THERAPEUTIC INNOVATIONS _26 PRECISION MEDICINE_28

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22 SEE FURTHER THE FIGHT AGAINST CANCER, A GLOBAL PROBLEM According to the latest WHO report, approximately 13 million new cases of cancer are recorded each year throughout the world. Thanks to the research conducted, increasingly innovative therapies are proven to be effective. A BETTER UNDERSTANDING OF THE DISEASE The considerable achievements of the research projects conducted over the past few decades have given us a better understanding of the causes and development stages of different types of cancer and how best to treat them. The transformation of a healthy cell into a tumour cell is a process involving several stages. The shift from a precancerous lesion to a malignant tumour is the result of interactions between genetic factors, which are specific to the patient, and external elements. The latter are divided into three categories: physical carcinogens (e.g: ultraviolet radiation, ionising radiation ), chemical (e.g.: asbestos, elements resulting from tobacco smoke, aflatoxin, arsenic ) and biological (e.g.: infections caused by certain viruses, bacteria or parasites ). Another crucial parameter is ageing. Cancer incidence increases with age, no doubt due to the accumulation of specific risks throughout a lifetime, in combination with a loss of effective repair mechanisms. AN INCREASINGLY PRECISE CHARACTERISATION The fight against cancer involves prevention, early detection, disease management and research. With early detection and adequate treatment, the chance for cure is high for many types of cancer, in particular some of those which are the most widespread (breast cancer, cervical cancer, oral cavity cancers and colorectal cancer). Cancer treatment involves commonly a combination of one or more types of treatment surgery, radiotherapy or chemotherapy. The aim is to cure the disease or to considerably prolong the patient s life while also improving his quality of life during the treatment period and the post-cancer stage. Another component currently is the in-depth study of molecular characteristics of both the patient s genetic constitution and the abnormalities of his tumour. Cancer research, in developed countries, has changed in dimension. Technological advances allow an increasingly precise characterisation of tumours. In clinical research, new drugs and new therapeutic approaches are shown to be effective each year. Molecular medicine, also known as personalised medicine or precision medicine, has opened up significant new possibilities. Finally, immunotherapy has recently become a very promising field to be explored in depth. For Gustave Roussy, pain management, psychological support, accompanying activities and palliative care are now crucial elements of treatment planning. The basic research conducted at the Institute has, in particular, enabled new mechanisms to be discovered which allow the cell to repair its DNA. In translational research new genetic, hereditary or acquired, mutations which are predisposed to the development of cancer have been discovered these past years. 22 ANNUAL REPORT 2012 / GUSTAVE ROUSSY

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