Istituto Nazionale dei Tumori di Milano
The National Tumor Institute of Milan (INT), foundation and government-designated centre for treatment and research (IRCCS), is a leading cancer center in Italy pursuing mainly clinical and translational research, exploring and developing the fields of biomedicine and public health, in order to deliver high quality healthcare services.
The National Tumor Institute in Milan (hereafter, “INT”) was established in 1928 and became a public IRCCS Foundation in 2006. A recognized Comprehensive Cancer Center (CCC) since 2013, INT conducts translational and bidirectional research, moving from basic research, healthcare needs, epidemiology, clinical results and biobanks, and back to basic research. INT counts a total of 2.104 employees, of which 1.372 are healthcare personnel and 363 administrative personnel.
INT has recently been designated a Comprehensive Cancer Centre by the Organization of European Cancer Institute (OECI) in recognition of its excellence both in patient care and the development of new treatments.
INT research aims to improve prevention, early diagnosis and treatment of cancer diseases, and the quality of life of cancer patients. Research activity is based on integration and synergy between: preclinical and basic research, translational research, clinical research and epidemiological research.
INT Research lines for the three-year period 2017-2020:
Primary and secondary prevention and early diagnosis
Primary prevention: identifies the pathogenic role of pollutants and erroneous lifestyles, aims to correct them by means of intervention studies, to reduce the onset risk
Secondary prevention: in a particular condition of risk or pathology in progress, this line studies the altered molecular mechanisms and the host-tumor interactions context and identifies biomarkers useful for early diagnosis, for the reduction of the risk of relapse or toxicity, for the choice of the most effective intervention.
Precision medicine and technological innovation (pharmacological and otherwise)
Multidisciplinary study of the new frontiers of precision medicine and innovative diagnostic-therapeutic technologies, through a reverse translational approach. Starting from relevant clinical questions, translational research leads the lab results to the patient's needs and, in the opposite direction, reports the interventions results to the preclinical research. This line will focus on the interactions between tumor, host (microenvironment) and environment, on the application of technological innovation (clinical trial) and not (diagnostics, imaging, innovative intervention).
Complexity and rare tumors
This line analyzes the pathology complexity, with a multi- and interdisciplinary approach including the genetic, molecular, clinical and social point of view. The study of rare tumors, familiarity and of pediatric tumors is to provide better therapeutic approaches available and innovative. Projects of this line will support the management of complex patients employing clinical, epidemiological and health intervention approaches
Healthcare research and research outcome
Observational, intervention and organizational activities are carried out to obtain evidence of health interventions efficacy, to gather evidence and organize clinical and biological data (big data) in databases. The aim is to evaluate the impact of prevention, diagnosis, treatment and rehabilitation activities, and their value in terms of utility and cost-effectiveness. In this line we find the organization of diagnostic-therapeutic care pathways, assessment of outcomes and organizational impact in the real world, health technology assessment of interventions and innovative technologies, testing of sustainability models, patient-reported outcome.
Each line develops basic and pre-clinical research projects, interventional, epidemiological and healthcare clinical projects that involve different pathologies and multidisciplinary and multi-professional teams.
Clinical research at INT: innovative therapies for patients
Clinical research is a key component of the medical and health research conducted in INT, intended to produce knowledge valuable for understanding human tumors, preventing and treating them, and promoting health. Clinical Research embraces a continuum of studies involving interactions with patients, diagnostic clinical materials and data in any of the following categories: (a) tumor mechanisms (etiopathogenesis); (b) bi-directional integrative (translational) research; (c) clinical knowledge, detection, diagnosis and natural history of tumors; (d) therapeutic interventions including development and clinical trials of drugs, biologics, devices, and instruments; (e) prevention (primary and secondary) and health promotion; (f) health services research, including outcomes, and cost-effectiveness; and (g) epidemiology.
Clinical Research constitutes the "crossroads" between basic and translational research. Thanks to the description of the mechanisms of tumor transformation acquired from basic and translational research, we arrive at the formulation of innovative therapies, whose real effectiveness will have to be demonstrated through clinical trials. These increasingly relate to targeted drugs, reducing the need for conventional chemotherapy. The patient becomes in turn fundamental for his active involvement in the study at all levels, including the personal one through his direct testimony about his quality of life during the therapy, or simply making himself available to clinical and radiological controls over time. Only in this way it will be possible to identify those therapies that in the future will become a new standard capable of prolonging the patient's life or increasing the rate of recovery from the disease.
Clinical Trials Center
The CTC supports Clinical Researchers in managing many aspects of investigational clinical studies, such as study design and statistical validation, submission to the Ethics Committee and regulatory authorities (AIFA for Phase I studies), budget and contract related issues, as well as data management and statistical analysis, thanks to data managers, medical statisticians, and an administrative and specialist. The CTC also provides pharmacovigilance through “ad hoc” trained pharmacist, employs qualified Research Nurses to improve patient care in the various steps of the study (scheduling of treatments, blood sampling, exams, controls, etc.), and laboratory biologists to handle tissue and blood samples for pharmacokinetics and molecular studies. The CTC works through validated and updated SOP and electronic CRF customized for each study; personnel education and training is coordinated by the Scientific Directorate.
The CTC is also improving the organization of sponsored clinical trials, speeding up administrative processes, budget definition, patient recruitment and data management, organizing a centralized record of all radio-diagnostic exams, and assisting Clinical Monitors in their visits. Since June 2016 INT has become a certified center for Phase I clinical trials. Of the 633 clinical studies, 24 were phase I and 29 of phase I/II.
INT Research impact and healthcare outcomes (2017)
Since 2007 INT is online with its own journal, Tumori Journal: www.tumorijournal.com (Frequency: 6 issues per year, Impact Factor: 1.304, Editor in Chief: Ugo Pastorino)
Tumori Journal covers all aspects of cancer science and clinical practice with a strong focus on prevention, translational medicine and clinically relevant reports. We invite the publication of randomized trials and reports on large, consecutive patient series that investigate the real impact of new techniques, drugs and devices in day-to-day clinical practice.
State-of-the-art reviews that summarize and critically analyze the clinical, economic, and social consequences of cancer are also welcome.
The educational Context in INT:
As a comprehensive cancer centre for excellence, INT is deeply committed to quality education and training. Postdoctoral research fellowships, graduate student training, medical residency training, psychology and social work training, as well as many opportunities for continuing medical education are part of the wide ranging academic options available at INT.
To give new impulse to translational research, it is crucial attracting medical doctors working in our Institute, and giving them the opportunity to receive training in cutting-edge research technologies. Our aim is to implement a system that will allow young physicians to gain direct experience in research and help the translation of laboratory discoveries into effective treatments for patients.
Since 1997 INT has partnered with the Open University (Milton Keynes, UK) to offer a PhD Programme for young graduates in scientific disciplines. During the course of their studies students conduct their experimental work under the supervision of experienced researchers, have access to modern laboratories and advanced technologies and benefit from a dedicated program of seminars. (Academic quality of the educational program is annually validated by the Open University.)
INT is a formal partner of the Università Statale degli Studi di Milano and hosts several chairmen: the Department of Oncology and Hematology with medical students and students from the medical biotechnology degree; postgraduate training for the residencies of oncology, hematology, general surgery, radiotherapy, anesthesiology and intensive care are also provided. Nursing degree.
Young people have a natural curiosity towards the scientific rules governing the world. To favour this attitude and increase their scientific knowledge, INT offers the possibility of brief stages to high school students for visiting laboratories, meeting INT researchers, learning importance of new technologies for advance in oncology research.