Advances in the treatment of metastatic colorectal cancer, a disease that in 2022 has affected beyond 48 thousand Italians. Two specific monoclonal antibodies, targeted against key targets for tumor growth, can improve the effectiveness of standard therapy against this form of cancer, doubling the “progression-free survival” of the disease: this is the period of time, usually calculated from the of the diagnosis or from the beginning of a therapy, during which the pathology from which a patient suffers does not progress.
The two drugs bevacizumab e panitimumab, have shown that they can significantly lengthen the survival of the most complex patients, already treated with multiple lines of therapy without results. This is confirmed by the results of two different experiments. «An important and inexpensive therapeutic novelty», underlined the oncologists gathered in Naples for The Naples Conference on colorectal cancer, from today to 17 March. Spotlight on one of the most widespread cancers: in 2022 over 48 thousand new cases were estimated in Italy.
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The therapy
In the international multicenter phase III study Sunlight, standard trifluridine/tipiracil treatment of refractory metastatic colorectal cancer was supplemented with bevacizumab, an antibody directed against the vascular growth factor Vegf, which can block the growth of new blood vessels.
“The patients, about 500, were complex cases, already treated with one or two lines of therapy – explains Fortunato Ciardiello, full professor of the “Luigi Vanvitelli” Department of Precision Medicine of the University of Campania, scientific coordinator of the conference and co-author of the study – Median survival increased to 10.8 months with combination therapy compared to 7.5 with standard treatment. Clinical benefit emerged in all patient subgroups regardless of age, gender, location of the primary tumor, number of metastases, or the presence or absence of mutations that may affect therapy.
Therefore, according to Ciardiello, the strategy works: «Continuing to inhibit the formation of new blood vessels that feed the tumor can have a significant clinical significance even during the progression of the disease. The disease control rate increased by 30% to 77%. A remarkable result and in the absence of an increase in toxicity. All of this points to the combination of bevacizumab with trifluridine/tipiracil as a possible new standard of care for these patients, for whom we had few treatment options until now.”
Post-pandemic cases boom: “They will increase again in 2023”
In Italy colorectal cancer is the second most frequent after breast cancer, with 48,100 cases in 2022, or +4,400 in 2 years. Yet, according to the Italian Association of Medical Oncology (Aiom), seven out of ten people do not adhere to the screening and do not perform the test for the search for occult blood in the faeces, which the Italian health system offers free of charge, every two years, to everyone and 50-69 years.
In 70% of cases the invitation was not accepted, due to laziness, fear or fatalism. «We will have an epidemic of colorectal cancers in the coming years, identified in a more advanced form, due to the effects of the pandemic that blew up screenings, but also
due to the low propensity of citizens to make them,” said Ciardello, sounding the alarm.
It has also been shown that the occult blood test is able to reduce mortality by about 30%. Ironically, this pre-pandemic neoplasm was a prime example of the effectiveness of prevention programs: in 2020, incidence rates were down 20% from the 2013 peak. nullified the results obtained.
According to Aiom president Saverio Cinieri, «Today we are witnessing an epidemic of new diagnoses. In the North 45% of citizens take the occult blood test, in the Center 31%, in the South only 10%. Furthermore, only 5 Regions exceed the target of 50% participation: Veneto (almost 70%), Trentino, Valle d’Aosta, Emilia-Romagna and Friuli Venezia Giulia».
The bad news doesn’t end there. «In 2023 they will increase again – he continues
Ciardiello – and we are starting to see more and more cases under the age of 50″. Also for this tumor the age of onset is lowered and younger patients are increasing. «Among the causes – the expert always explains – poor diet, alcohol abuse among young people and smoking. We want to reiterate that prevention passes through correct lifestyles and that discovering a tumor at an early stage makes the difference in terms of recovery”. The fecal occult blood test, for example, is able to reduce mortality by about 30%, oncologists recall. “You need to get screened and not be afraid of colonoscopy,” Ciardiello recommends.