EURACAN : European network for Rare adult solid Cancer

In response to the European call for European Reference Network (ERN), 3 ERN candidate in the domain of rare cancers:

  • ERN for adult rare solid cancers: EURACAN  (EUropean RAre CANcers)
  • ERN for adult rare haematological cancers
  • ERN for paediatric cancers

 

EURACAN network

Context

There is a very large number of different rare cancer types, with a list of over 300 conditions matching this definition in recent publication (Gatta et al 2011). Rare cancers are affecting all organs, and a variety of histological subtypes and molecular subtypes are emerging following the progresses of genomic classifications. The EURACAN ERN gathers all rare adult solid cancers.

In EURACAN, rare adult solid cancers are grouped in 10 domains corresponding to the RARECARE classification and the ICD10. These domains are also based on preexisting successful collaborations, in particular for clinical research and expert networks active in the last 10-20 years. Productive collaborations were developed within these networks, for clinical trials (eg within EORTC tumour groups or as national groups), for establishing guidelines (with ESMO, EORTC or tumour groups) and for generating national or multinational networks (eg ENETS, Conticanet, EuroBoNET…). Research projects supported by FP6, FP7, and H2020 grants have been completed in these different components of EURACAN. Based on this previous work and existing structures, EURACAN distinguished rare cancers in 10 DOMAINS specifically.

 

Areas of expertise: the 10 domains of EURACAN

G1       Sarcoma of the soft tissue, bone and viscerae (Sarcoma)

G2       Rare neoplasm of the female genital organs and placentas (Rare GYN)

G3       Rare neoplasm of the male genital organs, and of the urinary tract (Rare GU)

G4       Neuroendocrine tumours (NET)

G5       Rare neoplasm if the digestive tract (Rare GI)

G6       Rare neoplasm of endocrine organs (Endocrine)

G7       Rare neoplasm of the head and neck: Salivary gland tumours, nasopharyngeal cancer, nasal and sinonasal cancers, middle ear (Rare H&N)

G8       Rare neoplasm of the thorax: Thymoma, mediastinum and pleura (Rare Thoracic)

G9       Rare neoplasm of the skin and eye melanoma (Rare Skin/Eye melanoma)

G10     Rare neoplasm of the brain, spinal cords (Rare Brain)

 

Thus, EURACAN domains gather groups of rare tumours defined by common histologic features such as sarcoma & NET, or by common organ of origin (eg skin, thoracic, GYN). It was also important to define SUBDOMAINS, on the basis of specific histological classifications, organ of origin within some DOMAINS.

EURACAN subdomains

G1: soft tissue/visceral sarcoma (G1.1) and bone sarcoma G1.2)

G2: Trophoblastic disease (G2.1) and rare ovarian cancers (G2.2)

G3: rare urogenital cancer, testicular cancers (G3.1); other subgroups may be subsequently identified;

G4: for the NET group, subdomain may emerge in the future (pancreatic,  small  bowel, carcinoid)

G5: peritoneal (G5.1), biliary tract  cancers (G5.2) and anal cancers (G5.3)

G6: in the future, G6.1. Iodine refractory thyroid, and G6.2. Adrenal cancers will emerge

G7: salivary gland tumours (G7.1)

G8: thymic  tumours (G8.1)

G9, rare skin cancers, and eye melanoma: Eye melanoma was identified as a subdomain (G9.1);In G10 Brain cancers: it is anticipated that subdomains will emerge (ependymoma, non glial tumours, PCL etc)..

 

All rare cancers share similar difficulties for their management:

1) Need for an expert pathological and molecular diagnosis performed in reference centers, 2) The need for regularly updated clinical practice guidelines, despite limited scientific evidence,

3) A need for improved communication toward patients, advocacy groups, and general practitioners to ensure proper recognition and prevent delays,

4) difficulties in referal, while outcome is better in large centers with multidisciplinary comprehensive expertises,

5) the need for multidisciplinary management of these patients, involving experts in all key specialty fields: pathology, molecular biology, imaging, nuclear medicine, surgery, radiotherapy, medical oncology, organ oncologist, palliative care, etc

6) The need to develop clinical, translational and basic research dedicated to these rare cancers,

7) The need to exchange scientific information, expertises, and clinical trials, and to refer patients across centers when the complexity of treatment and clinical situations requires.

Health care providers in EURACAN have most often expertise on more than one rare malignancies. By organizing this multitumor integrated multinational network, by centralizing knowledge and experience, medical research, training, and resources. EURACAN will enable a major improvement in the access to excellence diagnosis and treatment for European patients. and unify the avaialbility of optimal clinical practices in the EU.

 

 

 

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