Authors:

Silvio Monfardini

Franco Cavalli

In 1975 the Société de Médecine Interne Cancérologique (SMIC) was created ^[1]. Since the very beginning this society had an international scope as outlined in a letter to Silvio Monfardini by Maurice Schneider ^[2] “In July 1975, Georges Mathé and I decided to sponsor every year a convention in the first week end of December in Nice. The Negresco (the legendary Palace overlooking the Promenade des Anglais in Nice) opened its doors to us. The first meeting in 1975 gathered around a hundred French, Italian, Belgian oncologists and involved some American friends of Georges. At the beginning the publication of the Proceedings was a local enterprise, but later on Springer undertook it since 1979. The first board of directors of SMIC included Georges Mathé](@georges-mathe), President, Maurice Schneider, General Secretary, Paul Cappelaere, Treasurer. The council included Albert Cattan, Bernard le Mevel, Georges Meyer, Maurice Staquet, Louis Toujas, Pierre Alberto, B. Lock.

The number of attendees from different European Countries and from North and South America increased steadily every year. In 1979 the international scope of SMIC was made official and the SMIC became ESMO, with as the official language and I had the honor to serve as General Secretary”. Silvio Monfardini was then elected President and Franco Cavalli Secretary with other non-French officers such as Heine Hansen and Robert Pinedo.

Silvio Monfardini recalls: ”The first organisational meeting at the Negresco Hotel between the French and non French component of the Society was not very friendly on the Mathé’s side because he wanted to keep French as the official language of the meeting. I was speaking instead in English. But Claude Jasmin, Jean Luis Misset, Maurice Schneider answered in English and the problem of the the adoption of the English language was rapidly solved in practice”.

Silvio Monfardini adds: «Since the beginning, although still small in size, it was confirmed to have an annual meeting in Europe in Autumn, specular then and therefore not overlapping to the ASCO meeting, with the aim in the long run to compete with ASCO, attracting European Medical Oncologists partecipating but also those usually not going to the American meetings.

The importance of ESMO as a forum for European Medical Oncologists cannot be underevaluated. Prior to ESMO the main meeting grounds for the European Medical Oncologists had been provided by American organizations such as the American Society of Clinical Oncology (ASCO) and American Association of Cancer Research (AACR) or by the Union for International Cancer Control (UICC). Monfardini recalls: « In parallel with the initial steps of ESMO, under the UICC presidency of Umberto Veronesi a cancer chemotherapy courses program was launched from Geneva in 1976 for teaching medical oncology in developing countries. The Scientific Committee of the UICC cancer chemotherapy courses was composed by myself, Kurt Brunner, Derek Crowther and Danielle Olive ^[3]. The first course was held in Lybia and the second in Turkey. But a number of courses were then held worldwide, involving many European medical oncologists, who had so the chance of getting in touch among them for the first time and subsequently becoming ESMO members.

Undoubtedly establishing an European Society of Medical Oncology was initially inspired by the American Experience. This should not surprise as throughout the ‘50s the reconstruction of the European economic infrastructure devastated by World War II had the priorities over medical research.

The vision and the persistence of a number of young clinical scientists who had trained in the USA allowed Europe to march at the same rhythm than the USA since the beginning of the 70s. Among them shall be mentioned Georges Mathe, Henry Tagnon, Gianni Bonadonna and later on Derek Crowther, Robert Pinedo, Silvio Monfardini and Matti Aapro ^[4], ^[6].

These pioneers of Medical Oncology had to endure skepticism and derision. They also had to brave serious twofold opposition by the entrenched medical system. The heads of medicine in general hospitals did not see the need to establish an additional medical specialty. In the existing cancer centers medical oncology was perceived as a threat to surgical and radiation oncology. "Heads of other specialties didn't want someone new taking away patients," says Franco Cavalli. To find an explanation, we must go back to the first decades following World War II. At that time, although it may seem strange today, oncology struggled to be accepted as a real medical specialty, and university centers, paradoxically, hindered its development. "As often happens, universities were very conservative about this. For example, they didn't allow medical oncologists to have their own beds." Ticino, on the other hand, without an university (founded in 1996, with the Medical School created only in 2014), provided the right ecosystem: "Here" continues Cavalli, "I was able to create oncology wards that allowed me to do what was impossible in university centers, namely studies on new drugs." The research methods developed in the Swiss Confederation and the results on lymphoma treatment allowed Franco Cavalli to quickly integrate into this small group of French doctors gathered by the Georges Mathé at the Negresco Hotel. These common difficulties throughout Europe cemented the unity of Medical Oncologists from different countries and catalyzed the establishment of an international organization such as ESMO, which provided a forum for medical oncology whose scope has steadily enlarged to include investigators and clinician from throughout the world.

Year after year, the gathering in Nice attracted more and more people, eventually increasing its international character. At this point, towards the late eighties, ESMO members took the initiative to open up to Europe and organize the first real congress outside French borders. Franco Cavalli, who had the experience of successfully organizing several editions of a similar lymphoma conference, seized the opportunity and proposed Lugano as the meeting place, taking on the organizational responsibilities. "The ESMO congress was still small," recalls Cavalli. "There were between 500 and 600 participants. Everything was done 'in-house': the program was printed by my brother's printing press, and my dad kept the accounts." After the first Lugano edition in 1988, the ESMO Congress was held again in 1990 in Copenhagen, welcoming twice as many participants.

As ESMO was gaining more attention, the board took what Franco Cavalli calls a "fundamental, surprising decision: to have our own journal." Thanks to the small but efficient organizational apparatus already established in Lugano (functioning as secretariat of ESMO), the editorial office of ESMO's journal, Annals of Oncology, was placed in Besso at the outskirts of Lugano. Franco Cavalli, promoter of the initiative and de facto founder of the journal, became its editor. He recounts: "The first editorial office was a small flat not far from where the radio station is. A former patient of mine gave me the contact for the place; we paid little or nothing. It was so small that when both the secretary and I were there, we struggled to fit. So, I did most of the editorial work in my hospital office." In its early years, the journal gained recognition in the scientific community thanks to the collaboration of internationally renowned doctors and researchers, "but also thanks to a brief section of 4 or 5 pages of news from the oncology world, like 'gossip.' And people liked it a lot," confesses Cavalli. Today Annals of Oncology has become the most important cancer journal in Europe.

The role played over the years by ESMO for the recognition of Medical Oncology has been well summarized by one of the ESMO president David Kerr ^[5]. Since the founding in France in 1975 by George Mathe´ and Maurice Schneider, it has been ESMO’s ardent goal to achieve the recognition of medical oncology throughout Europe. Silvio Monfardini, Italy (1985-1987), continued Mathe´’s and Schneider’s efforts and actively pursued the establishment of medical oncology as an officially recognised specialty with a well-defined training curriculum. Herbert Pinedo, Netherlands (1988–1989), established ESMO national representatives in each European country to support recognition on a national basis. Hernán Cortés-Funes, Spain (1990–1991), initiated the ESMO examination in medical oncology to measure professional qualifications. In 1990, Franco Cavalli became Founding Editor of Annals of Oncology to keep medical oncologists on the cutting edge of new research developments. John Smyth (1992–1993) continued to pursue the recognition of medical oncology as a full specialty within the European Community. Contact with the European Union of Medical Specialists (UEMS) was established, and ESMO was referred to the European Commission’s Advisory Committee on Medical Training. Jean-Pierre Armand, France (1994–1995) was invited to serve on the UEMS General Board, and in 1995 medical oncology was accepted as an associate section of general internal medicine. Under his presidency, the ESMO-MORA program for continuing medical education for medical oncologists was born. Heine Hansen, Denmark (1996–1997), laid the foundations for work in Central and Eastern Europe and for publishing the Global Curriculum in Medical Oncology, a document outlining for the European Commission the need for specialised training and official recognition of our specialty ^[7]. Dieter Hossfeld, Germany (1998–1999), continued discussions with UEMS and worked closely with the Accreditation Council of Oncology in Europe (ACOE) as the ESMO representative. The establishment of ESMO Clinical Practice Guidelines set clinical treatment standards for medical oncologists in need of official recognition within the multidisciplinary oncology team. Maurizio Tonato, Italy (2000–2001), launched the MOSES survey to document the status of medical oncology in Europe and underscore the need for a qualified and well-trained professional workforce. Heinz Ludwig, Austria (2002–2003), pioneered the ESMO Patient Seminars. The seminars enhanced the patient–physician relationship and raised patient awareness of the importance of being treated by recognised professionals. Paris Kosmidis, Greece (2004–2005), sought to guarantee the future of young medical oncologists and intensified ESMO’s lobbying for recognition at both the national and EU level, meeting on several occasions with high-level representatives from the European institutions. Håkan Mellstedt, Sweden (2006–2007), strengthened the lobbying for recognition on a national level and worked closely with EU presidencies, demonstrating the pivotal role of medical oncologists in all aspects of cancer from prevention and research to treatment and aftercare. José Baselga, Spain (2008–2009), worked strategically and relentlessly on ESMO’s lobbying in key EU Members States and with the European authorities”.

Between the nineties and the 2000s, ESMO became a reference point for oncologists, paralleling the growth of the discipline itself. At the same time, pharmaceutical companies, which in the early seventies had little interest in the market, began to see oncological therapies as a huge commercial opportunity, driven by encouraging research results. Therapeutic methods were proving effective, with decreasing deaths and reduced side effects. "There was this boom in medical oncology, which also reflected on ESMO », comments Cavalli. The enthusiasm involved more and more doctors, and ESMO, as recalled by David Kerr, strengthening its stature, began to advocate for the recognition of the medical oncology title. Along this line the association developed a certification examination which, although initially had no legal value, helped attract young doctors and provide guaranties to clinics.

Since its birth the association has organized an international congress every year in Autumn, while the ASCO meeting is held in May, to allow the European Medical Oncologists to have their high level meetings without necessarily crossing the Atlantic over the years. The ESMO meetings have been attracting a growing number of participants, with significant advances in oncology research often presented. ESMO's congress activities have also included dozens, or perhaps hundreds, of other meetings, conferences, seminars, and training courses. In the laudatio of the lifetime achievements award that AACR delivered in 2024 to Franco Cavalli, it was clearly mentioned that both ESMO as well as Annals of Medical Oncology have played a very important role in the development of Medical Oncology in Europe

As cancer treatment is a public issue, both in terms of prevention and care tools, the increasing size of ESMO, which has become the second largest organization in the field, after the American Society of Clinical Oncology (ASCO), has allowed it to directly engage with political actors worldwide.