The 42nd David A. Karnofsky Memorial Award Lecture: Understanding.

Abstract

The Dutch philosopher Baruch Spinoza (1632 to 1677) taught us in the 17th century that “there is no method without a preexisting idea.” Apart from inspiring me throughout my career, Spinoza has been a central figure in my life and the work I conducted for the largest part of my career at the VU University Medical Center (VUMC) in Amsterdam. In Spinoza, my family background and the city of Amsterdam come together. My ancestors and Spinoza lived not far apart on the same street, Houtgracht, in ancient Amsterdam. Quite recently, I discovered that my mother was a direct descendent of Spinoza. I am therefore proud of my background and the NWO (Netherlands Organisation for Scientific Research) Spinoza Prize, which I received in 1997 in recognition of our translational cancer research at the VUMC in Amsterdam. Translational research has been the focal point of our research endeavors over the past decades and continues to be so. Translational research means establishing a bridge between basic research and clinical oncology and crossing that bridge—back and forth—with the aim of taking diagnostics and treatment from bench to bedside, and vice versa. Translational research is geared toward understanding at the molecular level the cellular changes occurring in our patients. Therefore, we need to study the patient’s blood, other body fluids, tumor fluids, liquid biopsies (circulating tumor cells and DNA), and tissues in the laboratory, in a multidisciplinary patient-centered approach. In doing so, we have to stay open minded and observant, and allow ourselves to be triggered by unexpected findings that call for further investigation, and be ready to move away from rigid guidelines if our results so dictate, on the way to truly personalized medicine. In this article, I will review some of our achievements in five domains of cancer research and management of patients with cancer to illustrate how translational research may contribute to our understanding of the patient, the disease, and the treatment. I will present a number of individual patients from whom we have learned a lot, who have taught us precious lessons and led us to formulate new working hypotheses to be tested in future studies. “Each patient is a pearl”; we should treat each patient as a pearl using our translational research capabilities.