We don’t like to admit it, but AI can do better than us when it comes to diagnosis. Of course, under the guidance and careful planning of health professionals, but there is no competition. An example above all: in the identification of breast cancers, studies conducted in the United States have shown that, thanks to the deep learning algorithms on which Artificial Intelligence is based, it is possible to obtain an absolute reduction of 5.7% of false positives and 9.4% of the negative ones. Not only. In comparison with the work of 6 radiologists, an 11.5% increase in sensitivity was demonstrated. The seventh edition of the International Meeting on New Drugs and New Insights in Breast Cancer, taking place in Rome at the Agostino Gemelli IRCCS University Hospital, is dedicated to the new strategies in the treatment of breast cancer, with the participation of about 200 experts from all over the world. .
Telemedicine: after Covid, 8 out of 10 patients want to use it also in the future
by Irma D’Aria
Towards ever more ‘tailor-made’ treatments
There are over 20 thousand variables in clinical practice to make breast cancer diagnoses more precise and thus be able to make ‘tailor-made’ decisions on precision treatment. All objectives that are not achievable by healthcare professionals with traditional tools. The numerous applications of Artificial Intelligence in the diagnosis and therapy of breast cancer are already a reality in the main centers of reference in our country. “Today, in Italy, more than 834 thousand women live after the diagnosis of breast cancer, with a 5-year survival that reaches 88% – he explains Francesco Cognetti, president of Foce (Federation of Oncologists, Cardiologists and Hematologists) and of the Together Against Cancer Foundation. From 2015 to 2021, a reduction in deaths of almost 7% has been estimated “. A very important result, obtained thanks to the screening programs, which allow to identify the disease at an early stage, and to increasingly effective therapies.
Artificial intelligence against breast cancer
What can be done thanks to Artificial Intelligence
In diagnosis and treatment, Artificial Intelligence is opening up a new world that can accelerate improvements for patients even more. “Artificial Intelligence is the tool with which we can study an enormous mass of data and transfer it into clinical practice for the benefit of patients – specifies Cognetti – but we need guidelines and a governance structure at an institutional level to make it operational throughout the territory these systems, which today are a reality in centers of reference such as Gemini ”. But what is it possible to do with AI? “Through radiomics, the images obtained from radiological examinations, such as CT, MRI or PET, are converted into a huge amount of numerical data”, he says Luca Boldrini, radiotherapist oncologist and director of the radiomics research faculty of the Agostino Gemelli Irccs University Hospital Foundation in Rome. Their analysis requires the use of very advanced techniques, represented by machine learning methods, which are also used in the management of big data. We are faced with a large patrimony of numerical data, which would not be able to be elaborated and exploited properly with the simple visual observation by the human being “.
Artificial Intelligence at the service of precision oncology
Practical examples help to understand better. Some studies of artificial intelligence, applied to the reading of mammograms, have shown an increase in the average sensitivity of about 10% in the diagnosis of mammary tumors. “Artificial intelligence can also represent a tool at the service of precision oncology – continues Luca Boldrini. Breast neoplasms are characterized by specific molecular alterations, target of targeted therapies, which represent the basis of the decision-making mechanism of therapies. It is possible to combine this information with the thousands of other clinical data available (such as age, stage of disease or haematological values) and insert it into the algorithms on which the Artificial Intelligence models are based to identify, for example, new biomarkers or make comparisons between specific variables and patient survival, the stage of disease or the response to therapies, creating real predictive models “.
The timing of access to treatment
Artificial Intelligence can also be useful for defining the access times to oncological treatments. The Gemelli researchers have developed a model that indicates, for example, how long a patient waits before starting radiotherapy after surgery, also in relation to the availability of care at the place of residence.
Advances in treatment
Beyond the enormous potential of Artificial Intelligence, today patients can already benefit from the great progress already made or underway in the most difficult cancers to treat such as triple negative ones, which represent about 15% of all cancers of the breast. In these cases, until now, chemotherapy has been the only usable weapon. “Immunotherapy, in association with chemotherapy, changes the therapeutic landscape in this patient population, even in local or locally advanced disease”, continues Cognetti who adds: “Even in histotypes that already have numerous therapeutic options, such as those with overexpression of the Her2 protein, today we are witnessing the development of further weapons, especially in the most advanced forms and in the presence of brain metastases. It is possible to prolong survival even in these most difficult patients to treat “.
The use of molecularly targeted therapies
Then there are the prospects of using a new class of molecularly targeted therapies, CDK4 / 6 inhibitors, after surgery, with better results than hormone therapy alone. In the most advanced stages of the disease, in patients already treated with the association of traditional hormone therapy with anti-cyclins, the new Serd, that is selective drugs on estrogen receptors, can be used, with further possibilities of response and control of the disease. And surgery is less and less aggressive even in patients with lymph node metastases “.
Advances in advanced disease
Progress in the treatment of advanced disease is remarkable. “More than 37 thousand people with metastatic breast cancer live in our country, a figure that is constantly increasing thanks to new treatments – he explains Giovanni Swaps, scientific director of the Agostino Gemelli Irccs University Hospital Foundation. In fact, 30% of these patients are alive 5 years after diagnosis. In diffuse metastatic disease we are able to obtain prolonged remissions, so for many women we can speak of chronicization with a good quality of life. It is not uncommon to find patients alive even over 10 years after diagnosis. These results can be improved by overcoming the obstacles still present in care. It is essential that all patients are treated in the Breast Units, that is, in Breast Centers, where the adherence to the guidelines is higher, the experience of the specialists is better and the adoption of a multidisciplinary approach is guaranteed “.
Choose therapy based on molecular alterations
There are several subtypes of breast cancer, defined in relation to the molecular alterations. “This allows us to choose the treatment in a highly selective way in relation to the characteristics of each subgroup”, he emphasizes Giampaolo Tortora, Full Professor of Medical Oncology at the Catholic University of the Sacred Heart, Director of the Comprehensive Cancer Center and of the Medical Oncology Unit of the Agostino Gemelli Irccs University Hospital Foundation. In some types of breast cancer, approximately 20% of the total, a protein, Her2, is present in excessive quantities, thus causing rapid and uncontrolled growth of diseased cells. From a biological point of view, it is one of the most aggressive forms and, in the past, as there were no weapons available, these patients had the worst prognosis. Today, however, thanks to targeted therapies that block the Her2 receptor, used both in the initial non-metastatic and in the metastatic forms, the clinical course has radically changed “.
Adjuvant therapy
Adjuvant therapy, ie after surgery, can be considered one of the greatest successes in oncology in the last thirty years. “In patients with early stage disease and Her2 overexpression – continues Tortora – adjuvant systemic treatment with chemotherapy, hormone therapy and one year of biological therapy with an anti-Her2 antibody today represents the standard of care and is able to reduce the risk of recurrence and death. A percentage of patients between 15 and 20% continue to relapse with a peak incidence 18-24 months after surgery, although some patients have late relapses even after 10 years of follow-up. New possibilities are now available because recent studies have shown that innovative drugs, added to standard therapies for the 15-20% of patients not yet cured, are able to further reduce relapses after 5 years ”.
Neoadjuvant therapies
In the neoadjuvant phase, i.e. before surgery, in the Her2 positive forms, combinations of different anti-Her2 drugs and hormone therapy are also available, thus avoiding the use of chemotherapy and obtaining the same results in terms of efficacy. “Other advances have been made in metastatic disease that expresses hormone receptors and Her2 negative, in postmenopausal patients – he explains Alessandra Fabi, Head of Precision Medicine Breast Cancer at the A. Gemelli Irccs University Hospital. Combining CDK4 / 6 inhibitors with hormone therapy has been shown to be better than standard hormone therapy alone. Thanks to this regimen, half of the patients are alive at 5 years. It is the longest survival achieved so far in advanced breast cancer and this allows us to speak of the real chronicization of the disease, delaying the use of chemotherapy “.
Making up for delays in screening
There is no doubt that mammography screenings and the increased awareness of women in adhering to these secondary prevention programs have led to an increase in the diagnosis of early-stage cancer in recent years. “The delays accumulated during the pandemic, amounting to almost 5 months, must be recovered as soon as possible. Screening exams performed between January 2020 and May 2021 fell by 28.5% for breast cancer compared to 2019. And there are over 3,558 missed diagnoses, ”he says Riccardo MasettiDirector of Breast Surgery at the A. Gemelli Irccs University Polyclinic and President Susan G. Komen Italy.
The comparison between experts at an international level
What took place at Gemelli is the seventh edition of the International Meeting on New Drugs and New Insights in Breast Cancer in which internationally renowned clinicians and researchers take part. “It is important to stimulate interactions between scientists from different countries and provide them with the necessary means to carry out research activities – he concludes Ahmad Awada |, director of the Department of Medical Oncology at the Jules Bordet Cancer Institute in Brussels (Belgium). Today we have many weapons available to combat this big killer: prevention, early diagnosis, conservative surgery, combined chemotherapies, hormonal therapies and biological drugs that allow the majority of affected women to heal. The results presented at the conference confirm that the winning strategy is that of calibrating the therapy on the specific characteristics of the patients “.