Tabernero Finds New Paths in Gastrointestinal Treatment Landscape

Josep Tabernero, MD, PHD, MSc

When Josep Tabernero, MD, PHD, MSc, first climbed Mont Blanc in the summer of 2015, the journey to the “roof” of Europe tested his strength and endurance. Dressed warmly in winter hiking clothes, with snow crampons on his feet and a safety rope around his waist, Tabernero slogged for 2 days through a long and strenuous climb up snow-covered peaks and craggy rock. Pictures from the trip revealed intimidating sharp-angled crevasses of granite that he had to traverse. But when he finally reached the summit, his hard work was rewarded. Up in the cold, biting air, he and other hikers could see a commanding, majestic view: the rest of the Alps, clear blue sky, and clouds below their feet!

“The view is amazing. You feel that you and your fellow hikers have won,” Tabernero said.

“When you hike, you have to do a strong job. You have to have lots of energy. At times, you think you are going to fail. You are not able to succeed. But you put [in] more energy, and then at the end, you succeed,” he added.

As in hiking, Tabernero’s work as a groundbreaking cancer investigator and physician focused on gastrointestinal tumors has had its own twists and turns. But just as mountains are conquered step by step, each patient, each clinical trial, each paper, and all the other developments happening in his research laboratory have revealed new insights into this often-deadly disease, leading to creative ways to target it. And as director of Vall d’Hebron Institute of Oncology (VHIO) in Barcelona, Spain, Tabernero has had a major hand in helping to shape a purely multidisciplinary and translational research environment that has established VHIO as one of the premier cancer research centers in Europe.

“Besides treating patients, who are at the center of everything we do, we also have great opportunities here to advance clinical science and research,” he said. “Every day, I wake up determined and motivated in equal measure. Not a lot of people can say that, but I can.”

Colorectal Cancer: Often Deadly and Always Wily

Tabernero is best known for applying translational research against gastrointestinal tumors, with particular focus on colorectal cancer. This work spans preclinical and clinical research, studying the molecular makeup of tumors, and assessing novel anticancer medicines, including molecular targeted therapies, in order to improve outcomes for patients. Colorectal cancer is often deadly and wily—it can respond differently from one treatment to another. That’s why Tabernero and his team are also engaged in identifying and better defining the different subtypes of colorectal cancers.

The current scientific consensus is that there are 4 major subtypes of colorectal cancer, each with its own molecular characteristics. To better classify colorectal cancer, Tabernero and his team were members of an international consortium that used largescale data sharing and analytics across expert groups to study the cancer. A 2015 Nature Medicine paper, “The Consensus Molecular Subtypes of Colorectal Cancer,” with Tabernero as one of the coauthors, laid down the different subsets.

“We consider the [consensus molecular subtypes] groups the most robust classification system currently available for [colorectal cancer]—with clear biological interpretability— and the basis for future clinical stratification and subtype-based targeted interventions,” reads the study abstract.

In his laboratory, Tabernero has been hard at work poking at the vulnerabilities of colorectal cancer by studying biomarkers that may yield a response to specific treatments. This has involved examining sequential circulating-free DNA, collecting sequential tumor biopsies, and implanting tumors from patients into mice to track tumor growth.

To more precisely treat these tumors, Tabernero and his team have been developing targeted molecular therapies using existing drugs and those under development that focus on certain proteins, such as ERK and PI3K signaling pathways that regulate a cell’s function. Mutations or faulty regulation in these proteins can result in cancer. Using stem cells has also been important in pioneering studies.

“Many times, we go back to the bench with questions that we have to solve to treat patients’ diseases,” he said.

Early Years

Born and raised in Barcelona, Tabernero studied medicine from 1981 to 1987 at the Universitat Autònoma de Barcelona. After obtaining his medical license in 1987 and completing a mandatory year stint as a physician in the Spanish army, Tabernero decided to do a residency in oncology.

“It was quite a new specialty,” he said, explaining that while doctors at the time didn’t have genomic sequencing and other advanced tools, but the enabling technology for such complex and cutting-edge analyses were tantalizingly on the horizon.

“We could anticipate things were going to change because survival with cancer was very low. It was clear that with the incidence of the disease, there would be a huge investment in cancer science,” he said.

He had a 4-year residency at Sant Pau University Hospital in Barcelona. Afterward, he was appointed as a clinical assistant physician in genitourinary and gastrointestinal tumors at the same hospital where he spent his residency. He then joined the Vall d’Hebron Univesity Hospital (HUVH) in 1997 as a senior clinical assistant physician, specializing in gastrointestinal tumors. In 2010, Tabernero became head of the Department of Medical Oncology HUVH, and director of clinical research at VHIO, and in 2012 he took the reins of the Institute as director.

If he had not gone into medicine, Tabernero said, his interest in science and problem solving could have led him into a career in chemical engineering. But a fascination with how the body works was an early defining interest for him.

“A Very Good Doctor”

In addition to his Giants of Cancer Care^® award, Tabernero has an impressive list of other honors, such as earning the Josep Trueta Medal for Health Merits. During a long career, Tabernero has also coauthored an impressive number of research papers, over 440, on topics ranging from sequencing cell-free circulating tumor DNA from cerebrospinal fluid to looking at the prognostic value of BRAF and KRAS mutations in different types of colon cancer. Even with his heavy administrative workload, Tabernero has managed to coauthor more than 30 research papers in 2019. Indeed, his long career has touched every aspect of gastrointestinal cancer care, and with each study and paper, Tabernero has done much to advance the understanding of these types of cancer.

“We have to leave the world a better place than how we found it. That’s our mandate. It is very rewarding that our work has made a contribution in this research area,” he said. “Without the close connectivity and crosstalk between my amazing clinical colleagues and research teams, our devoted efforts aimed at advancing translational research and delivering increasingly personalized treatments and care would be in vain.”

During a usual week, when he’s not traveling, Tabernero spends 20% of his time seeing patients, another 20% for multidisciplinary meetings with colleagues and fellows about clinical trials, 20% focused on bench research, and 20% managing VHIO.

He also devotes time to the European Society for Medical Oncology, where he served as president for the 2018-2019 term and is currently a member of the executive board. In addition, he sits on several editorial boards, including those for Annals of Oncology, Cancer Discovery, and Clinical Cancer Research.

Under his leadership, investigators at VHIO share a competitive drive for excellence but are collaborative, too, said Elena Garralda, MD, principal investigator of VHIO’s Early Clinical Drug Development Group and executive director of VHIO’s Phase I Unit: Research Unit for Molecular Therapy of Cancer — “la Caixa,” under Tabernero’s leadership.

“Not only is Josep an excellent person, an incredible doctor and outstanding boss, he is extremely fair with his colleagues,” said Garralda. “Two of his guiding principles are collaboration and teamwork. With patients, his kindness and generosity know no bounds, and he always take the necessary time to explain and discuss their treatment options with heart and compassion.”

As a manager, Tabernero strives to empower his colleagues and mentees so they can prosper in their careers and make a real, lasting contribution to ultimately improving outcomes for patients. “When you see people and they are more autonomous and doing well in their research and responsibilities, you feel happy,” he said.

Off Hours

Despite his busy schedule, Tabernero said, spending time with his wife, a doctor in internal medicine for the regional health system in Catalonia, and 3 children is still very important. “The limited time I spend with my family, I try to instill good values in them through which to live their lives. I am also committed to giving them my all when I am with them,” he said.

The one thing that hasn’t been transferred is a desire to follow in his footsteps. “When I decided to be a doctor, there were no doctors in the family,” he said. “I am the first and the last because none of my children want to study medicine,” he added, laughing with mirth.

Tabernero loves to travel around the world with his wife and participates in outdoor activities in the mountains with his children. Besides hiking, he enjoys skiing and biking. He has traveled to the Pyrenees in Spain and the Alps several times. His second summit of Mont Blanc was in 2017, and it was with friends. At the time of the writing of this profile, Tabernero was planning a trip to Japan to test his endurance again for a climb up Mount Fuji.

For Tabernero, the journey to find a cure for cancer is just as rewarding as summiting a mountain.

“On the way up, the view is nice,” he said about mountain hiking and climbing. “You see different landscapes, and it’s always beautiful. On a personal level, [hiking mountains] also gives you resistance to adversity.”