Almost 3,500 new cases of breast cancer are recorded every year in Sicily. And about 800 patients on the island are candidates for genomic tests, which make it possible to predict the risk of relapse and, therefore, to exclude chemotherapy in addition to hormone therapy, avoiding unnecessary toxicity and saving resources. In our country, however, these analyzes, recommended by the most important international guidelines and used in the main European countries, are free only in Lombardy, Tuscany and in the Autonomous Province of Bolzano, which have approved their reimbursement. For this reason, within the Sicilian Oncological Network, a Commission has been established that brings together all the breast cancer centers of the island with the aim of preparing a dossier to be sent to the Regional Health Department, so that genomic profiling is also reimbursable. in Sicily. This is what emerged during a webinar organized by the Italian Association of Medical Oncology (AIOM), which took place recently. The event is the fourth stage of the virtual tour which includes 8 regional meetings, to raise awareness among oncologists on the role of genomic tests in breast cancer. The project is carried out with the unconditional support of Exact Sciences.
“The tests are indicated for a particular subtype of patients, those with luminal-type breast cancer, which expresses estrogen receptors but not the HER2 protein, at intermediate risk – he says. Antonio Russo, National Treasurer of AIOM and Ordinary of Medical Oncology, DICHIRONS – University of Palermo -. About 800 patients are included in this population every year in Sicily. Genomic tests represent a useful tool for the clinician to select the best treatment for the patient in intermediate risk cases. They are molecular analyzes that analyze a number of different genes within cancer cells to predict the risk of recurrence. The results are useful for evaluating the prognosis and the likelihood of benefiting from the addition of adjuvant chemotherapy, i.e. after surgery, in women with operated breast cancer, at an early stage, with positive hormone receptors and without expression of the HER2 protein. to hormone therapy. AIOM is working with the institutions to make access to tests uniform throughout the national territory “.
“Most women with breast cancer, about 65%, have luminal disease – he explains Vincenzo Adamo, Director of Medical Oncology Papardo Hospital of Messina, Professor of Medical Oncology at the University of Messina and coordinator of the Sicilian Oncological Network -. Today, several tests are available in clinical practice that analyze gene expression profiles. The importance of genomic profiling is increasingly evident, thanks to scientific evidence. And the distinction between patients with low, intermediate and high risk of relapse is fundamental. The tests help to define the best therapy for women who are in the ‘gray zone’, constituted by the intermediate risk, avoiding unnecessary chemotherapies “. “A 21-gene test has shown in clinical studies to accurately identify the patients for whom adjuvant chemotherapy is a lifesaver and those who can avoid it – continues Prof. Adamo -. Another test, profiled on 70 genes, showed that, in cases with low clinical profile and low genomic profile, 8-year metastasis-free survival reaches 94.7% without chemotherapy. Therefore, in these cases, hormone therapy alone is able to protect patients. There is also a test on 50 genes which, in addition to being able to identify the intermediate risk profile among the three profiles, has proved to be important as a predictive test of response to endocrine therapy at 10 years and to be able to identify the subtypes of luminal tumors. The Commission established within the Sicilian Oncology Network is processing data to identify patients who can benefit from genomic tests. We hope that, also in Sicily, their reimbursement will be established as soon as possible “.
“The sharp decrease in the improper use of chemotherapy – he concludes Massimiliano Spada, Coordinator AIOM Sicily – can translate, on the one hand, into a clinical benefit for patients who are no longer exposed to over-treatment and the relative risk of immediate and late toxicity, and on the other hand in a favorable impact on healthcare costs, which represents a fundamental element that clinicians also have to deal with. In Sicily, 200,000 citizens live after cancer and about 40% have had breast cancer. Genomic testing should be considered an investment, not an expense “.
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