Breast cancer mortality has decreased by 6.8% from 2015 to today: thanks to early diagnosis and “precision” therapies. In fact, before the pandemic, survival 5 years after diagnosis had reached 88%: one of the highest figures in Europe. Today, however, 8 out of 10 patients fear delays in the availability of innovative treatments potentially able to improve this figure, and for 72% the health emergency caused by Covid has diverted the attention of institutions from the needs of people affected by cancer. Furthermore, 93% positively evaluate the possible reinforcement and extension of adjuvant therapy, that is the therapy taken after surgery, which aims to reduce the risk of relapse. The data emerge from an online survey on post-Covid health care, which involved 130 women with breast cancer, part of an adjuvant therapy awareness project carried out with the unconditional support of Pierre Fabre.
Breast cancer, a figure who welcomes you to the hospital is like a drug
by Tiziana Moriconi
Adjuvant therapy for breast cancer
“Every year, in Italy, almost 55,000 women are diagnosed with breast cancer, the most frequent neoplasm in the entire population and constantly growing”, says Francesco Cognetti, oncologist and president of the Together Against Cancer Foundation: ” Most of the patients, about 46,200 (84%), have the disease in the initial stage (I-II-III) and 7,000 (15% of these) are characterized by overexpression of the HER2 protein (HER2 +) ”. Adjuvant treatments for these patients are of three types – chemotherapy, hormone therapy and biological therapy – and are offered to patients based on the characteristics of the tumor and the condition of the woman.
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The risk of relapse
“In a very general way, hormone therapies for hormone-dependent cancers reduce the risk of relapse by 60%; chemotherapy and targeted anti-HER2 therapies, for those with this type of cancer, reduce it by about 80%; finally, in the case of triple negative cancer, in which we only have chemotherapy for now, the risk is reduced by half “, explains Pierfranco Conte, president of the Periplo Foundation, which deals with clinical research and assistance in oncology:” Before ‘arrival of biological drugs, the Her2 positive tumor was among the most difficult to cure, while today this situation has been reversed. A very positive result, but that is not enough, because – underlines the expert a percentage of patients between 15 and 20% have relapses with a peak incidence 18-24 months after surgery, although some patients present late relapses, even after 10 years “. This indicates two things: that there is a need for new therapies and new tools to identify the 20% of patients at greatest risk, in order to personalize treatments even more. “Most relapses have an inevitable course towards metastatic disease”, underlines Cognetti: “This is why the enhancement of adjuvant therapies is the only way to reduce the chances of relapse. 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 recurrences after 5 years, with a positive impact also on costs for the national health system “.
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How Her2 positive cancer is treated today
For Her2 positive tumors larger than 2 cm or with involved axillary lymph nodes, the standard treatment is preoperative (neoadjuvant) chemotherapy associated with trastuzumab followed by surgery: if no more tumor exists after surgery, one year is completed. of trastuzumab; if, on the other hand, breast or lymph node cancer persists, patients are treated with TDM1, an anti-HER2 antibody that delivers a powerful chemotherapy to cancer cells. Smaller tumors are operated immediately and then treated with postoperative chemotherapy plus trastuzumab if the lymph nodes are negative, or with chemotherapy plus trastuzumab and pertuzumab if the lymph nodes are positive. To these treatments hormone therapy is added when the tumor also expresses hormone receptors.
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It is essential to respect the times and be treated in a Breast Unit
Shortening the time between diagnosis and the start of treatment and always referring to a Breast Unit also helps to increase the survival rate. Thanks to the Re.Mi projects, supported by the Periplo Foundation, the minimum requirements for the diagnostic therapeutic and assistance pathway (PDTA) of breast and lung carcinomas have been defined. For the breast cancer patient undergoing surgery, the surgery must be performed within 30 days of the first diagnosis. And adjuvant medical therapy should be started within 8 weeks of surgery. Scientific evidence has shown that delays can compromise the effectiveness of treatments. “However, there are cases in which neoadjuvant therapy is indicated before surgery”, recalls Conte: “Patients often run to the first available surgeon to remove the tumor as soon as possible, but not in all cases, as we have seen, the intervention is the first thing to do. For this – he concludes – it is essential to contact a Breast Unit, where each case is discussed by a multidisciplinary team that evaluates the best strategy for each individual patient “.
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