From sarcomas to systems change, Jean-Yves Blay’s fight for fairness in cancer care
“The best mentorship,” says Professor Jean-Yves Blay, “is giving people the keys, letting them drive—then debriefing the ride.” It’s a line that captures the essence of a career built on trust, rigor, and a fierce belief in what teams can accomplish together.
Jean-Yves Blay – world-renowned oncologist, President of Unicancer, General Director of the Centre Léon Bérard, the Comprehensive Cancer Centre of Lyon, longtime leader in sarcomas – doesn’t stake claims to solitary triumphs. He talks about systems, about people, and about work that compounds over decades.
From Mathematics to Medicine – Then to Oncology
He grew up in a family of physicians and, as a teenager, hesitated between mathematics and medicine. At 16, the choice crystallized: medicine. Oncology came slightly later, sparked by an encounter that shaped everything to come.
“At my first position in a comprehensive cancer center,” he recalls, “I saw the whole ecosystem – clinicians, scientists, care teams – pulling together. Molecular biology was just entering the stage, reshaping our understanding of disease biology and influencing treatment. You could feel the future arriving.” In France, oncology wasn’t yet a formal specialty; it became one while he was a fellow. Jean-Yves stepped into it without looking back.
The Lineage of Mentorship
Jean-Yves Blay’s gratitude for mentors is immediate and specific. In Lyon, Paris, and across Europe – often alongside major cooperative groups – he found guides who shaped his scientific and clinical compass.
He names Michel Clavel, Thierry Philip and Maud Brunat-Mentigny, Pierre Biron among the earliest influences, and highlights Paris-based mentors Michel Marty and Thomas Tursz. A pivotal scientific voice was immunologist Salem Chouaib, “who helped me understand just how central science is.” On the European stage, Allan Van Oosterom (Leuven) and Jaap Verweij (Rotterdam) were “very, very important.” There are many more, he notes, but these figures formed the scaffolding of his early career.
Building the Next Generation
Prof. Blay is just as deliberate about his mentees. There are the close-in collaborators – across specialties but often anchored in rare cancers – such as Mehdi Brahmi and Armelle Dufresne, along with “several young others now moving to the front.” And then there is the broader platform he helped build as head of the French Sarcoma Group for more than a decade: a national network of experts with young leaders in “all regions in France,” providing true country-wide coverage in a notoriously complex field.
How He Mentors: “Keys First, Then the Road Test”
“I give the key of the car and let people run,” he says with a half-smile. “Then we discuss the ride.” The method is simple and demanding: align on the objective, grant real freedom to operate, equip people with the means to execute – and step in only when needed.
There is, however, a non-negotiable: deliverables. “It’s acceptable if a topic takes five years,” he says, “but you must get to the endpoint.” Failure is part of the journey – “you’ll learn more from it than from success” – yet the long-term vision must remain intact.
“Know what you want to achieve, and finish.”
What Fuels Him
Prof. Blay doesn’t separate work from joy. “I work a lot,” he admits, “but I don’t feel like I’m working. It’s a pleasure.” And that pleasure is multiplied by teams, including friends and family, quoting Dr Axel Le Cesne and Isabelle Ray-Coquard.
“Nothing substantial is achieved alone. You must genuinely like people, enjoy working with them – and help them enjoy working with you.” He cites a French saying: When you love what you do, you don’t work a single day of your life. “That is absolutely my case.”
Who Thrives on His Team
Asked which qualities he values most, Jean-Yves Blay answers without theatrics: kindness, relationship intelligence, focus – and an evident enjoyment of the work. Efficiency matters. So does depth. But kindness comes first.
Unicancer: A National Engine
As President of Unicancer – the network of France’s comprehensive cancer centers – Jean-Yves helps steer a uniquely integrated model of care, research, and education. The network today brings together 20 centers, a scale that enables national coherence while rewarding local excellence. It’s the systems-level vantage point he seemed destined for since that first, formative exposure to the comprehensive cancer center model.
Building France’s Clinical-Trials Powerhouse
France’s clinical-trials ecosystem is one of the most active in the world – often underestimated because much of its work isn’t loudly advertised.
“That’s a long history,” Blay says. “In the late 1990s and 2000s, there was a national realization that we were lagging behind in clinical research, and the government decided to support us.”
That support came through multiple mechanisms. A major driver was the creation of academic grant systems such as the PHRC programs – competitive but accessible even to young investigators if proposals were well designed.
“These are what I call low-cost clinical studies,” he explains, “not because the science is cheap, but because they don’t require the extensive data collection of a new-drug trial. They might explore a surgical technique, a radiotherapy question, or a new approach in neuro-oncology. But they strengthen the network’s capacity to deliver clinical research.”
This growing capability intersected perfectly with the emergence of Unicancer, the federation of France’s comprehensive cancer centers – today numbering 20 – that can each act as a sponsor for clinical trials.
“They do a lot,” Jean-Yves says. “And Unicancer itself also sponsors studies – particularly international ones – complementing the work of the centers.”
The result is staggering. “Right now,” he notes, “we have 737 studies open or in follow-up, and we enroll around 6,000 patients per year in trials sponsored by Unicancer alone.”
That volume has created what he calls a virtuous cycle: success brings funding from Europe, partnerships with pharma, and reinvestment into research infrastructure. Even publication incentives help sustain momentum.
“When a French physician publishes in a major journal like The New England Journal of Medicine, the hospital receives about €40,000. So, naturally, directors – who in our centers are all physicians – encourage strong clinical research. It aligns everyone’s motivation toward quality science.”
Doctors Leading Hospitals
That last point – physician leadership – matters deeply to Jean-Yves Blay.
“In France,” he says, “the only hospitals led by doctors are the cancer centers – 18 of them – and the three military hospitals. All others are led by administrators. The difference shows in the results.”
The financial and operational balance of doctor-led hospitals, he explains, is consistently stronger. “It’s published everywhere: these hospitals perform better. Of course, public hospitals have different missions and constraints, but the contrast is striking.”
He’s aware similar analyses have been conducted in other countries, including the United States. “From what I’ve heard, France is not an exception,” he adds carefully. “I haven’t seen all the data myself, but it seems to hold true across systems.”
Confronting Inequalities – From France to the World
Few topics animate him more than inequality in cancer care. As both a national and international leader – former president of the EORTC and current head of ESMO’s policy committee – he’s seen inequity from every angle.
“In France, our comprehensive cancer centers were created by General de Gaulle in 1945,” he says with quiet pride. “Their first mission was equality – equal access to cancer care for every citizen.”
That mission remains, but the challenges have evolved. France’s social security system covers all cancer treatment costs for patients. “The inequality now is not financial,” he explains. “It’s about access. In some regions, there simply aren’t enough doctors, and delays in diagnosis mean patients arrive with advanced disease that could have been caught earlier.”
Across Europe, inequalities take different forms. “Some countries have systems like ours; others don’t. In many, certain treatments are not available unless patients can pay. Europe is trying to change that by identifying and supporting comprehensive cancer centers in every country, spreading multidisciplinarity and excellence. But it’s a long path – we’re only halfway.”
Globally, the picture is starker. “In low- and middle-income countries, inequality starts with the lack of human resources,” he says. “Wealthy nations must be careful: we often attract doctors from these regions to fill our own shortages, worsening the crisis elsewhere. WHO projects that by 2030, the world will be missing over 10 million doctors and health care workers. That’s the real foundation of inequality.”
He pauses. “And it will be even worse by 2040.”
Can Artificial Intelligence Help?
When asked whether AI could compensate for the physician shortfall, Dr. Blay offers cautious optimism.
“Healthcare is one of the areas where AI has already shown success,” he acknowledges. “But like any medical tool, it must be evaluated rigorously – and it often isn’t yet.”
He believes AI can reduce unnecessary workload and improve efficiency, “but to what extent, it’s hard to say.”
Then comes a warning drawn from a recent study. “In endoscopy, they found that after AI was introduced, doctors’ ability to detect abnormalities actually declined – as if we were becoming less sharp because the machine does everything. That worries me.”
He leans forward. “We need humans to train the machine – not the other way around.”
Sarcomas: Progress and Perspective
When I ask him what’s next in sarcoma research, Jean-Yves Blay smiles knowingly. “Some of our most effective ways to improve survival are actually simple and inexpensive.”
He explains that one of the most powerful interventions in sarcoma care has not been a new molecule, but centralization.
“When you centralize management, survival increases – and costs go down,” he says. “We’ve seen this in Scandinavia, the U.K., and in France. At the national level, if patients are referred to accredited expert centers, you reduce mortality by up to 90% – and decrease costs by about the same.”
He brought that data directly to the Ministry of Health. “I told them, ‘It’s cheap to do well.’ When care is centralized, you get fewer relapses, fewer complications, and much better outcomes.”
But what about innovation? Why, I ask, are we still treating many sarcomas as we did decades ago?
He answers without defensiveness. “We’re still classifying. We’re splitting sarcomas into smaller and smaller entities – each rare, each biologically distinct. Soon we’ll have hundreds of micro-entities, and for many of them, traditional randomized trials just won’t be feasible.”
This reality is reshaping how clinical research must be done. “We need new trial models,” he says. “Right now, doxorubicin remains the first-line standard because we haven’t yet finished identifying where it doesn’t work. Once we complete that, we can build the next step – molecularly guided therapies, non-randomized, tumor-by-tumor.”
He gestures as if drawing a map. “We’re entering the sixth classification soon. Last time, we had 150 histotypes. The next will have even more. It’s going to take time – a long time.”
Immunotherapy in Sarcomas: A Measured Hope
On immunotherapy, Prof. Blay is both pragmatic and hopeful.
“In advanced sarcomas, immunotherapy works only in a few histotypes,” he explains. “We’re starting to understand why – likely related to biological factors such as the presence of follicular lymphoid structures in the tumor. They seem to help predict response.”
But his real optimism lies earlier in the disease course. “Even though immunotherapy rarely works in advanced disease, it may be completely different in the neoadjuvant setting,” he says.
Several randomized trials are already exploring combinations of PD-1 or PD-L1 antibodies with chemotherapy or radiotherapy. “Some results are positive, others are still on the way. But I believe the earlier use may be key. In late disease, it’s often too late.”
The Books That Shaped Him
When the conversation turns to books, Blay’s scientific precision gives way to something more lyrical.
“Oh,” he says, laughing, “that’s a dangerous question. I could talk for hours.”
He names three works that have stayed with him since his youth.
“The first is a collection of 15th-century poetry by François Villon – very hard to read for non-French speakers, but beautiful. It captures the essence of human life – its enthusiasm, its tragedy, its humor.”
“The second,” he continues, “is Journey to the End of the Night by Louis-Ferdinand Céline, a doctor himself. I’ve read it countless times. It’s raw, brilliant, deeply human. Of course, Céline later took a dark path politically, but as a writer – remarkable.”
“And the third,” he adds, “would be Bulgakov’s The Master and Margarita. Another doctor. I discovered it recently, and it’s absolutely incredible – wild, philosophical, magical. One of my favorites now.”
Then, as if unwilling to stop, he adds a few more names: “William Burroughs – so wild, so poetic. Charles Bukowski, who actually wrote about Céline. And Jorge Luis Borges – his imagination and simplicity are extraordinary.”
He pauses thoughtfully.
“You know, literature and medicine are not so different. Both search for truth.”
Before we end, I ask the question I always ask my guests: Who should I interview next?
Without hesitation, Blay replies: “Laurence Zitvogel from Gustave Roussy.”
Interview by Gevorg Tamamyan, Editor-in-Chief of OncoDaily