The European Congress of Clinical Oncology (Esmo) has just ended in Paris and Italian oncology is already looking beyond. In fact, today the study project was presented in Rome, at the Istituto Superiore di Sanità Beyond the Rome Trial, an extension of the research illustrated in Paris that demonstrated how extended profiling can change the fight against cancer. Based on the results achieved in the Rome Trial – the possibility that is for over 40% of the patients involved to obtain additional therapeutic opportunities from extended genomic profiling compared to the evaluation of only mutations known for the possible association with molecular target drugs, and to identify also mutations within their families – we now want to expand the study to include, in addition to the 41 Centers of Excellence already participating in the first study, also 11 molecular tumor boards, interdisciplinary discussion groups, which will use the same platform for discussion and data collection, created from CINECA together with La Sapienza University.
“We want to develop a mutational oncology project in Italy with all its innumerable potentials – says Paolo Marchetti, Scientific Director of IDI in Rome, Professor of Oncology at the La Sapienza University of Rome and President of the Foundation for Personalized Medicine.” The extended profiling it is, in fact, much ‘bigger’ than the traditional one linked to the histological model. The latter is based on the search for a single mutation to associate a drug with. In these cases the pathologist, to help the oncologist select the therapy, for example, in lung cancer, must carry out ten individual tests. On the other hand, it is much cheaper and more efficient to perform a single test able to search and study all the genes together through the use of small panels of NGS. However, alongside this traditional model defined as “histological”, today the great opportunities offered by Next Generation Sequencing (NGS) or parallel sequencing in the application of the ‘mutational’ model are known “.
In extended profiling, small NGS panels are not used to see eight or ten mutations, but more extensive research is carried out and up to 340 or over 500 significant mutations in the evolution of the neoplasm can be analyzed. Extended profiling can now be carried out in various Italian centers and is carried out in metastatic cancer patients who have undergone no more than two lines of treatment.
The study that was proposed today to drug companies and to those involved in genomic profiling represents a response to the need to regulate access to molecularly targeted therapies, of which no information is yet available in individual types of cancer. “It is not enough to carry out a genomic test to think about treating patients outside of a controlled and shared path. Avoiding improvised treatments and promoting knowledge in this sector of mutational oncology represents the challenge we are carrying out together with prestigious institutions”, he goes forward Marchetti.
“In precision oncology the mutation / drug axiom must be overcome. It is necessary to study as a whole as many alterations as possible to understand not only the possible target, but also its interaction pathways. With our previous study we have analyzed further 780 patients from different centers of the Peninsula. We have shown that a broad genomic profiling within a specific Molecular Tumor Board (MTB), that is a multidisciplinary group, determines important advantages for those patients who can resort to drugs with molecular target or ‘immunotherapy, regardless of the initial site of the tumor and the availability of preliminary activity studies “.