How a Never-Wavering Enthusiasm Changed Lung Cancer Care for the Better

Solange Peters, MD, PhD

For Solange Peters, MD, PhD, hyperactivity activity runs in the family. This has served her well in her never-ending quest to improve the lives of patients with lung cancer, though her mother may have seen its first manifestations a little differently growing up, always trying to get Peters to sit still during dinner. However, Peters acknowledged that she first identified those same qualities that made routine more difficult growing up in her parents, equipping her with the tools to stay devoted to her work without growing fatigued.

“My family was always extremely involved in politics and in society, so I was born participating in public street protests, mainly for greater social justice and the defense of the less fortunate, so the commitment [piece] is something that is probably acquired but through the family history,” Peters said.

Having grown up in an environment that encouraged Peters to face rather than shy away from the world also helped her cultivate a strong character, which helped her earn respect as a woman in a competitive and male-dominated field. But you would be mistaken to think that she operates in a silo. Although not inherent to her personality, Peters explained that she does see a collaborative spirit in herself, often encouraging those she works with to embrace the same.

“If you are in a minority, it’s going to be you or somebody else; it’s not going to be you and somebody else, so collaboration was not always intuitive [for me]. I had to learn that, and that’s what I say to young doctors. Even if being collaborative means you lose the priority or the most important piece of visibility, middle-term or long-term, you still will be largely

rewarded,” Peters said. “You will get back way more than you had been giving by being collaborative...the whole environment will be modified around you in a positive manner. It was a learning process because, as women and in the world of oncology, the competition is the first thing you see.”

EARLY LIFE AND FORMATIVE EXPERIENCES

Peters grew up as the youngest of 5 children in the small town of Lausanne, Switzerland, where her children now walk to and from school, enjoying swimming in the lake and hiking in the mountains. Her father was born in 1920 in eastern Germany and stood strongly committed against Nazism, moving to Turkey to simultaneously study medicine in Istanbul and organize resistance alongside forces in Italy. He later found the same sense of commitment in his wife, Peters’ mother, who had been born in Switzerland and shared the same sense of political activism. They also shared a love of medicine, both being pharmacologists.

“The whole family is [involved in] politics,” Peters said. “If I hadn’t done medicine, I would do politics or would have become a lawyer, but I think medicine may be more practical.” Peters acknowledged that she did give a law career a try, following lots of trials in the media across the region and nationally throughout high school; however, when she found herself consistently on the other side of the final judgment, she knew it was not her calling.

Peters added that she came to love medicine on her own accord, stating that there was never any pressure to become a doctor. “The pressure was about

education,” Peters said. “They really wanted me to speak many languages [and] go to university, but whatever choice I had made, they would be happy.” Now she is fluent in several languages, including English, German, Italian, and French, also possessing an ability to understand Spanish and Portuguese. “It was very useful in building community and trying to be part of something bigger,” she said.

As a student of medicine, Peters went on to pursue a PhD—while swimming competitively—in both biology and HIV, a malady that was responsible for the deaths of millions at the time. “My friends were dying of HIV because of abuse of drugs but also sexual transmission.” Her thesis centered around HIV treatment, for which there was only 1 drug available at the time. It was during this time that she identified an interest in studying HIV resistance mechanisms, a thread that has woven its way through her present work with immunotherapy in lung cancer.

“I remember we had to go in a P3 laboratory, which was highly protected, [to] try to grow these viruses and understand why they had become resistant to the treatment. I remember some people telling me I would be punished one day, [having] grown millions of copies of resistant viruses. [This work] built a sense of urgency, and I developed a need to try to make it longer,” Peters said.

By the time she had finished her thesis, HIV had gone from being a death sentence to being a controllable disease, one in which women who had been diagnosed with the disease could have children—an impossibility at the outset. Feeling a sense of relief, Peters turned her focus to the next urgency: cancer.

STEPPING INTO A LUNG CANCER CAREER BY CHANCE

With her doctorate in hand, Peters prepared to tackle the injustices of oncology under the guidance of her first mentor Roger Stupp, MD, now at Northwestern University Feinberg School of Medicine in Chicago, Illinois. “What moves me now and what moved me then is the sense of unfairness when things happen to people without them having chosen or having a way to control them,” Peters said.

“Roger taught me everything from how to write an article to how to [read] a CT scan,” she continued, noting that for the first article she ever wrote with Stupp, he corrected each sentence she wrote, demonstrating a patience and willingness that Peters values in her own teachings. “You cannot expect that somebody can be on the scene or be responsible for something if you don’t help and teach,” she said.

Stupp’s specialties included brain cancer and lung cancer, having published the first study showing the efficacy of temozolomide (Temodar) in glioblastoma. However, she has Stupp to thank for her decision to specialize in lung cancer.

“He told me the most captivating field of oncology was brain cancer and that lung cancer was not interesting. [He said], ‘Nothing is ever happening in lung cancer. [There are] no changes [and] no innovation, so you take the lung cancer, I’ll keep the brain tumor.’ Now he maybe regrets it a little bit,” she said.

At that time, of course, he was right, Peters explained, adding that patient survival 20 years ago was less than 1 year. When asked whether the poor outlook regarding lung cancer prognosis ever wore

her down, she explained that the opportunity for innovation, later manifesting in the form of targeted therapy and immunotherapy, was too great.

Now with no end in sight, Peters feels more committed than ever to continuing to drive the disease into oblivion, acquiescing that although extending survival remains a top priority for the field, her own encounters have also taught her to value life through the patient’s eyes.

“Now we have some hope to give. Hope is not only about thinking everything’s going to be OK; hope is about having a plan, and now we have lots of plans in lung cancer,” Peters said.

She is now chair of Medical Oncology and the Thoracic Malignancies Program in the Department of Oncology at the University Hospital of Lausanne, overseeing some 300 individuals with a staff of 70 physicians and working to develop proof-of-concept clinical trials grounded in translational work developed in the laboratory. Whether good or bad, Peters states that her team can always count on her to be fully transparent with them, having cultivated a sense of trust. This results in loyalty that has led to no more than a handful of her team members having left for none other than family reasons.

CARVING OUT A ROLE FOR HERSELF

As an academician, Peters noted that hard work is far from a distinguishing characteristic, but it was her work ethic that she accredited for her establishment at the national level in Switzerland. “[I remember] going to the Swiss collaborative group trying to make people know who I was,” Peters said. By this time, Stupp had moved to the United States, so Peters worked under the mentorship of Rolf A. Stahel, MD, president of the ETOP IBCSG Partners Foundation and vice president of the International Cancer Foundation, who was developing the European Thoracic Oncology Platform, much like the Alliance Group in the United States.

“He brought me [in] initially to build databases, to be a kind of an organizer. But by doing that, I suddenly met the whole European landscape by doing very practical things like database management, trial designs, and things like that. I got to know a lot of things, a lot of people, and entered the whole network,” Peters said. Stahel’s generosity continued, Peters recalled, noting that throughout his career, he took it upon himself to elevate his mentee.

“At some point in his career, he said, ‘I’m not going to speak about it at ESMO [European Society for Medical Oncology] or [the American Society of Clinical Oncology meeting]; it’s going to be Solange.’ [He was not] just proposing my name but imposing...the fact that, at some point, your mentee will be replacing you. I somehow owe him my career,” Peters said.

Subsequently, Peters was elected to be the president of ESMO, an honor she says gave her international recognition but also awareness. The responsibilities were not taken lightly, either, operating as the youngest-ever president and the second of only 2 women in the organization’s almost now 50-year history.

As an ESMO board member, prior to her presidential position, Peters had created the society’s first oncology committee for women. As president, she took her responsibility even further, remaining steadfast in her commitment to raise the platforms of women in oncology, much like Stahel did for her years prior.

“When I started in ESMO, women speakers at meetings were 15%, now they are 50%. [The female] board members were me and myself. Now, [women represent] half of the [ESMO] board members, and we have installed quotas for women, so we really moved it the right way,” Peters said.

Despite her success in moving the needle for women, Peters recalls feeling challenged about not having “the usual reproach of the stereotypes [people] put on women about how we react, how we speak, how we express ourselves, and how we are considered less knowledgeable about things.”

Having the support of her friends and colleagues in the community helped her push through these fears, allowing Peters to demonstrate her aptitude for the job so much so that she was elected to continue her work for 1 more year during the beginnings of the COVID-19 pandemic, rounding out her ESMO trifecta as the longest-ever president.

Although Peters has since completed her term as president, she will continue to voice the importance of gender equality in oncology—until it is just as instinctual to name a female expert in an oncologic specialty as it is a man.

“[My hope for] the future of such a committee is to maintain a very strong requirement in terms of representation of women and never forget about it,” Peters said, adding that her championship of professional women in oncology is what she views as her most important accomplishment. “Of course, you can quote all the trials, all The New England [Journal of Medicine] publications, but we all have [those accolades]. Otherwise, we wouldn’t be a full professor.”

THE LIFE OF A POLITICAL ACTIVIST

As the daughter of political activists, Peters cultivated a sense of right and wrong early on, carrying her sense of justice into her career in medicine. “[I liked] the idea of fighting against unfairness, [improving] equity, [and] trying to avoid imbalances and discriminations. [I was always interested in] trying to make this world a little more balanced and equal for everyone,” Peters said.

Following her service as ESMO president, Peters created the International Cancer Foundation (ICF), which works to establish self-sustainable health care in underdeveloped countries in Africa, South America, Central America, and some areas of Asia.

“We don’t want to play the colonizers of modern times. The idea is not to get there and leave. The idea is to create something [that] makes sense on-site and will remain after you leave,” Peters said, adding that the ICF was able to demonstrate the feasibility of setting up a sustainable structure for pathological diagnosis of breast cancer in Botswana. This will now reduce the number of women subject to overtreatment with mastectomy and chemotherapy.

But her work has also reached the inner workings of the Swiss government. As one of the preeminent lung cancer specialists in Switzerland, Peters is often consulted for answers to questions that some may choose to shy away from. “[I’m] outspoken, but the idea is to have strong statements,” she said. As a result, Peters had amassed a following that allowed her to work with other officials at the helm of national policymaking.

“I remember having been extremely vocal in telling people that [their] job as a physician is to prescribe the best drug to [their] patients—whatever the price— [because] we have an insurance system. If you really believe the price is too high, you have to [commit] to politics, but you cannot mix both. You cannot decide not to prescribe [an agent] because it’s too expensive. You prescribe because you’re a physician. If you find it too expensive, you go to the parliament and start to rebuild the pricing system,” Peters said.

After circulating that message, politicians started lining up at her door, asking her to become involved in the political arena. And that’s exactly what she did, working alongside the parliament to develop more affordable drug pricing regulations, and recently being elected as the President of the largest Swiss umbrella cancer organization, Oncosuisse. However, it is among her own constituents that she sometimes faces the most challenges.

“The most difficult paradigm to maintain in our societies is this consideration about solidarity in health,” Peters said, explaining that some still view universal health care as a privilege, not a right, especially for an individual with a history of smoking.

FAMILY LIFE AND NEXT CHAPTERS

As for what’s next, Peters hopes that societies do not lose sight of the solidarity principle, working together to lessen the burden rather than isolate in the face of adversity. “It’s not intuitive, but what builds societies is sharing,” Peters said.

She’s also far from handing over the reins to the next generation, stating that she has another 15 years before retirement. But recognizing the inevitable, Peters plans to follow in her mentors’ footsteps by sponsoring the individuals devoted to carrying the torch forward. “It’s probably more of a success to have a young person achieving [new feats] than for you to have 2 new manuscripts, right?” She also plans to throw herself more into her work with the ICF, bringing her network and expertise to new borders.

The strong sense of community that Peters has worked to instill among her colleagues, she has also cultivated within her own family. A resident of Lausanne, which has a population of approximately 100,000 people, Peters has 2 biological children, Eliott and Lucies, who are aged 20 and 17 years, respectively. Eliott is a mathematics lover and is studying to become a physicist, whereas Lucies is interested in pursuing medicine. However, her family dynamic is anything but traditional. “My partner [and I have a] big family—4 kids around and 10 people,” Peters said. Her other 2 “god children,” Letitia, 20, and Zofia, 19, are planning to pursue art school and law school, respectively, rounding out the family’s joint ventures.

Although she works long hours, often sustaining herself with sweets and chocolates until dinner, her commitment to her family—much like her work—has never wavered. She finds pockets of time for honest exchanges, the latest of which has become an evening gathering at the lake in town; every year up until last, this includes an annual week-long skiing trip. They’ve also been to Dubai, Corsica, Paris, Copenhagen, Munich, Athens, and New York. This year, the family is traveling to Paros, an island off the coast of Greece, as well as Prague for Christmas.

“I travel a lot, so every time I’m here, we try to [get together]. It can be stupid things, [like] watching a movie when there’s bad weather, going for dinner, or meeting just for coffee,” Peters said, adding that when that’s not possible, they can always rely on their daily texts through WhatsApp. “They’re the motivation in everything.”

And if you’re wondering how Peters finds time for herself, you’re not the only one. She admits, “Routinely, I wake up veryearlysoIcanrunat5am.Ialsofind peace in swimming.”