The question may also be brutal. But today it is more urgent than ever. In the era of precision medicine, of the powerful prospect of treating tumors by hitting them at the root, in a precise way, almost making us think of therapies as molecular scalpels that deal with the genes responsible for our, precisely our, killer mutation, and no longer with the flamethrower of chemotherapy, the gap seems more and more to open up between the patients who have access to it and those who, on the other hand, do not.
And it is so urgent that Asco (the American Society of Clinical Oncology), the largest and most powerful army against cancer in the world, is once again rallying in attendance – in Chicago from 3 to 7 June – the oncology community international aims precisely at that, with an unequivocal title given to the 2022 assembly: Advancing Equitable Cancer Care Through Innovation. By presenting a series of research that shows just how a huge chunk of the population does not have the best and most up-to-date treatments available, the ones that make oncology so sparkling and exciting today. And wondering how and how much the most advanced technologies can help in this enterprise.
With a precise mandate from President Joe Biden: halve cancer mortality over the next 25 years. And there will be no shortage of money to do so, Biden promised by relaunching the Moonshot Inititive, which he himself had launched at Asco in 2016, before the two scourges, Trump and Covid.
And in Italy? We have a universal health service available to fulfill the mandate of the Constitution which “guarantees free care to the indigent”. And that it does. But in the face of the surge in genetic technologies, we are obliged to ask ourselves: treatments yes, but which ones? Let’s start from the beginning.
Tumors, here is the first atlas of all mutations
by Dario Rubino
April 19, 2022
What hospitals need
As readers of Salute know, thanks to our Oncoline channel, in recent years at least twenty new drugs have arrived in the hospital that are called “molecular targeting” because they are directed precisely and only against a specific and guilty mutation of a specific tumor. . They are very powerful, and very expensive. But without that molecular target they are almost useless. Therefore, the strength of this new oncology is played out entirely on two terms: “biomarkers” and “appropriateness of treatment”. That is: the possibility of knowing if our tumor has a genetic characterization that can be attacked (therefore the availability of tests to ascertain it); and the ability to use the drugs available (therefore the good reading of the test results and the design of a therapy in concert). Are all Italian hospitals capable of doing this?
Precision medicine: handbook for the cancer patient
by Simone Valesini
November 18, 2021
Franco Perrone, director of the complex Clinical Trials structure of the Pascale Cancer Institute of Naples and Aiom president-elect, replies: “In many cases, the technologies needed are relatively simple. In others they are more complex and require genomic tests capable of exploring a large number of alterations, performed only in a few centers, which often act as a support for many treatment centers. The interpretation of genomic tests also requires a multi-professional competence that is being tried to formalize in the so-called Molecular Tumor Boards which have the objective of integrating technologies and skills to facilitate the best paths and choices for patients “.
Precision medicine: handbook for the cancer patient
by Simone Valesini
November 18, 2021
The differences from region to region
The so-called Molecular Tumor Boards are the key wheel of this game, because they are multiscipnary teams that bring together the clinical and genetic skills necessary for precision oncology. But, according to a survey by Cittadinanzattiva, only eight regions have activated them. Moreover, from the same survey we learn that only 15% of the interviewees declare that genomic tests are reimbursed in their region. Perrone is therefore right when he states: “One of the main causes of inequality is inherent in the federal structure of our healthcare system which does not guarantee all Italian citizens to have the same rights in terms of diagnostics and treatment. An attempt has been made to overcome inequities. in 2021 with a central state rule for breast cancer genomic testing (facilitating the decision on whether or not to do chemotherapy in a subset of patients); in this case, the Ministry allocated the funds and distributed them to the regions taking into account the presumed number of patients who could benefit from it “.
Genetic screening: how to make them sustainable for the NHS
Technology saves money
In short, genetics would make it possible to better treat cancers, as well as avoid treating people who would not benefit from the treatments. This translates into a saving of money, but also, and above all, of fatigue of the patients. Not only that: the technologies available in this sense are constantly advancing, the real challenge is to transform this revolution into an efficiency of the system from which everyone will benefit.
Yet, a survey carried out by three European patient associations informs us, for example, that in Italy only 2% of genetic investigations are conducted with Ngs, the best technology available to identify mutations. Obviously, in order to spread it more, it would be necessary to modernize the instruments. And it has been calculated that 24 million euros would be needed to add to those already allocated in 2020 for molecular diagnostics.
But perhaps, rather than putting money on the plate, it would be necessary, however, to integrate the most up-to-date sequencing technologies into the Lea, or in the performances that must be guaranteed to citizens. At least, explains Perrone: “In cases where doing them allows savings for the NHS compared to the sum of traditional genetic tests, however necessary to guarantee patients the best therapies. As, for example, for lung tumors. But the cases will increase. over time, as the number of drugs for which the diagnosis of a biomarker is required will increase, and as the cost of the tests will decrease; which in any case remains marginal compared to that of the latest generation drugs “.
Tumors, hospital oncologists: “Insert NGS sequencing in Lea”
by Mara Magistroni
23 Maggio 2022
How to make cancer weaker
In short, the question on the plate is: technology makes anticancer therapies more and more effective and could also be a great help to optimize the system in order to make it even more equitable. But both the costs and the objective complexity of making and taking “precision” decisions therefore require an organization of oncology, with adequate funds for tests and drugs, but also, and perhaps above all, with networks that connect the principals hospitals close to the patient’s residence with highly specialized centers (large hospitals, Irccs) where complex and expensive technologies are present, and skills capable of using them to the fullest.
Insiders call them “cancer networks” and have been talking about them for years. But for the most part they remain a vain hope, and very few regions have activated them. “The networks take off where politics wants them to take off”, says Perrone. But it remains that they are the only way to make the new oncology “fair”, and to ensure the best treatment for everyone. In the awareness, of course, you need money to do it. “Supporting the useful expenses (I mean all the useful ones) for patients should be considered an obligation of a health system like the Italian one. If the money is not enough, more must be found, and for many years this has not been done, on the contrary”, concludes the specialist. To ensure, however, that the word “useful” is the beacon, therapies need to be appropriate. Give to the right people (who can actually benefit from it) in the right way. The scientific community today is focused on this, and on how technology can help, starting with Chicago.