Dr. Emiliano Calvo doesn't remember the exact moment he decided to dedicate his life to early-phase oncology trials. "When I was a little kid, I was always looking forward to becoming a physician that treated patients with cancer as well as a researcher in cancer," he recalls during a conversation at START Madrid, where he serves as Director of Clinical Research and President of START Europe. "The best way to fulfill both things in the same role? Becoming a 'phase one-ologist', as I like to call it."
It's an apt term for someone who has spent two decades at the bleeding edge of cancer drug development, where scientific rigor meets desperate hope, and where every patient enrolled represents both a life in the balance and a potential breakthrough for thousands more.
A conversation with Dr. Emiliano Calvo reveals what it takes to run a world-class early-phase oncology program—and why the right partnerships matter more than ever.
The START Center for Cancer Research—the world's largest early-phase oncology network—operates 15+ clinical trial sites across the US and Europe, with 30+ principal investigators overseeing more than 700 active early-phase trials. Since its founding, START has contributed directly to the development and regulatory approval of over 45 groundbreaking cancer therapies. But behind these impressive statistics lies something more fundamental: a philosophy about how early-phase research should be conducted, and who should have access to it.
An Orchestra of Clinical Trial Complexity
When Dr. Calvo describes a typical day at START Madrid, he reaches for an unexpected metaphor. "It's like an orchestra with different musicians, with different roles, everybody coordinated and perfectly synchronized."
The comparison is both poetic and precise. At START Madrid alone, approximately 80 people work across 10 to 12 different roles, from clinical coordinators to pharmacists to data managers. Each must perform their part flawlessly because the score they're playing is constantly being rewritten.
"In our day-to-day life, what we do is deal with complexity—a lot of complexity that's changing in a dynamic way because the studies and the drugs are also changing," Dr. Calvo explains. Protocol amendments arrive. New side effects emerge. Trial designs evolve mid-study. Through it all, the team must maintain what Dr. Calvo calls "excellence," because that's what patients with life-threatening cancers deserve.
The drugs themselves present unique challenges. Many are first-in-human compounds with unknown toxicity profiles. Some have predictable side effects; others surprise even experienced investigators. "We need to conduct these studies under sophisticated, very changing and challenging study designs with drugs that sometimes are difficult to manage with different side effects, new side effects, and unpredictable side effects," he says.
Managing this complexity requires more than clinical expertise. It demands what Dr. Calvo emphasizes as the essential ingredient for any successful Phase 1 program: "Communication, communication, communication."
It's a lesson he repeats often to younger members of his team, knowing that in early-phase trials, a missed detail or delayed conversation can have consequences far beyond the immediate study.
The CRO Partnership Equation
Given the high stakes and operational complexity of early-phase trials, site selection becomes critical for pharmaceutical companies and CROs. Dr. Calvo has seen countless partnerships over his career, and he's developed a clear sense of what separates productive collaborations from frustrating ones.
"What we look for in a CRO is to be able to work as one, only team in the conduction of the study, in the treatment of our patient, and in the development of the drug," he explains. It's not about outsourcing work, but about genuine integration.
START favors CROs that demonstrate deep expertise in early-phase trials, beyond general clinical research capabilities. They want partners who bring exciting drugs with genuine therapeutic potential. But technical competence is just the starting point.
"From a CRO, we always like to see upper management, operations, the feasibility area, the startup area—all types of expertise that are really required for the excellent conduction of a phase one trial," Dr. Calvo notes. When these elements align, something changes. "All these characteristics make the work and the conduction of a clinical trial something that is excellent, productive, fruitful, and also enjoyable."
That final word—enjoyable—might seem surprising in the context of next-generation cancer research. But Dr. Calvo understands that sustainable excellence requires more than grinding determination. It requires relationships where collaboration feels natural, where problems get solved through partnership rather than finger-pointing, and where shared mission creates shared satisfaction in the work.
"With the CROs that have these characteristics, we always love to partner for a more profound level of collaboration," he says.
Beyond Transactional: The Precision Site Network Advantage
This philosophy of deep collaboration is precisely what drew START into the Precision Site Network. While START had worked successfully with Precision for Medicine on individual studies, joining the formal network structure offered something qualitatively different.
"All that I said before about the characteristics of a good CRO is happening with Precision for Medicine," Dr. Calvo emphasizes. "Becoming part of the network is very important because we can go deeper into our collaboration to favor more studies and better studies for our patients."
The network model addresses one of early-phase research's most persistent friction points: startup timelines. In traditional site relationships, each new study triggers a cascade of administrative processes—contract negotiations, confidentiality agreements, feasibility assessments, site qualification visits. These necessary steps can consume months before the first patient even hears about a trial.
The Precision Site Network streamlines this through pre-established frameworks. Master confidentiality agreements remain active for years rather than requiring renewal for each study. Pre-negotiated contract terms and payment structures eliminate lengthy back-and-forth. Sites visited within the past year may qualify for PSV waiver or for remote PSV, avoiding redundant on-site assessments.
"We really need to be faster with the contracts and all the processes of getting the site ready for treating patients," Dr. Calvo explains. "For that, it is really needed a multidisciplinary approach of both teams—the CRO and our team together. That is happening with Precision for Medicine."
But efficiency gains, while valuable, aren't the primary motivation. What matters most is what faster startup enables: earlier patient access to potentially life-changing therapies.
Redefining Patient Access in Early-Phase Oncology Clinical Trials
For decades, early-phase oncology trials have been geographically concentrated in major academic medical centers, primarily in the United States and a handful of European cities. This created a profound inequity, where patients in smaller cities or rural areas had little chance of accessing cutting-edge investigational therapies unless they could travel, often repeatedly, to distant specialized centers.
START's community-based model challenges this paradigm. By building sophisticated early-phase capacity in Madrid, Barcelona, La Rioja, and beyond, START brings novel therapies to patients in their own communities. The Precision Site Network amplifies this approach by connecting high-performing community and academic sites worldwide, creating multiple access points for patients who might otherwise have no options.
"We are here to try to bring drugs to our patients instead of bringing patients to our drugs," Dr. Calvo explains. It's more than logistics—it's a fundamental reimagining of how clinical research should be structured. "Our mission is hope through access, and we are perfectly aligned in achieving this goal."
The numbers bear out this alignment. Data from recent Precision Site Network (PSN) performance shows PSN sites consistently outperform non-network sites across key metrics:
- 94% feasibility response rate (faster engagement in study planning)
- 74% site selection rate (sponsors choose PSN sites nearly 3X more often)
- 26% faster IRB approval (quicker path to first patient)
- 9% faster site activation (earlier study launch)
- 74% of all enrolled patients came from PSN sites
These improvements compound. Faster startup means earlier patient access. Higher feasibility response rates mean better study planning. Greater sponsor selection means more trials available to patients at these sites.
But perhaps most significantly, the network creates bidirectional value. Sponsors gain access to proven sites with streamlined processes. Sites gain access to more trials and operational support. And patients gain access to innovations that might otherwise remain geographically out of reach.
The Invisible Infrastructure
What makes a site network function effectively isn't always visible in the data. Behind START Madrid's 80-person team and Precision's global operations network lies something harder to quantify but essential to success: trust built through repeated positive experiences.
"We like to have that formal collaboration regarding timelines, expectancies," Dr. Calvo notes. In early-phase trials, where unexpected challenges are essentially guaranteed, having pre-established communication channels and mutual understanding of how problems will be addressed makes the difference between studies that succeed despite obstacles and studies that founder because of them.
The Precision Site Network facilitates this through multiple engagement channels: recurring meetings to discuss site updates and new trial opportunities, conference-based investigator engagement at major scientific meetings like ASCO and ESMO, ad hoc operational support for issue resolution, and regular newsletters acknowledging site contributions and introducing new blinded study information.
This ongoing dialogue means that when a complex trial launches, the foundation of partnership is already in place. The first conversation about a new study isn't the first conversation between the parties—it's another step in a continuous collaboration.
Tomorrow's Research Infrastructure
As our conversation winds down, Dr. Calvo reflects on what this partnership means for the broader landscape of cancer research. "We are perfectly aligned in a synergistic way in achieving what is our shared goal: to bring more drugs, better drugs, sooner, in a more accessible way to our patients with cancer," Dr. Calvo says.
In the context of early-phase oncology trials, this collaboration acknowledges that a patient facing a life-threatening cancer shouldn't have to be wealthy enough or mobile enough to travel repeatedly to a distant medical center to access cutting-edge care.
Hope should not require a passport or a plane ticket. Access should not depend on proximity to a major academic institution.
Through partnerships like the one between START and the Precision Site Network, that vision of equitable access moves closer to reality—one trial, one patient, one breakthrough at a time.
How does the Precision Site Network work?
The Precision Site Network connects sponsors with over 100 high-performing investigative sites across 15 countries, delivering faster startup, higher enrollment, and proven operational excellence in oncology and rare disease trials.
Key advantages for sponsors:
- Pre-qualified sites with established track records
- Streamlined contracting and feasibility processes
- Central governance supporting operational delivery
- No additional fees for sponsors contracting with Precision for Medicine
About the START Center for Cancer Research
START represents the world's largest global network of fully dedicated, community-based, early-phase oncology clinical trial sites. With over 700 active early-phase trials and contributions to 45+ FDA/EMA-approved therapies, START is committed to its mission of "Hope Through Access"—bringing breakthrough cancer treatments to patients in their communities.
