The presence of a multidisciplinary team of professionals who evaluates and analyzes individual cancer cases by characterizing them from a molecular and clinical point of view increases the probability that patients will obtain target therapies and improves the cost-effectiveness of therapies. These groups are called Molecular tumor board (Mtb) and the National Cancer Institute has just formally formed one made up of 26 professionals including oncologists, pathologists, molecular biologists, pharmacists, geneticists, to which are added new profiles, such as bioinformatics and case managers, who help in the management and interpretation of the large amount of information collected in the prospective database constantly populated with complete molecular and clinical-pathological data. The creation of this database made it possible to carry out the MTB2 research project, carried out by the IRCCS National Cancer Institute Foundation in collaboration with the consulting company BIP (Business Integration Partners), and supported by an unconditional grant from Roche, which analyzed various organizational and economic aspects of MTB and which will soon be the subject of scientific publication.
Precision oncology, an opportunity to be seized immediately
Data from 471 patients with non-small cell lung cancer (NSCLC), 86 patients with cholangiocarcinoma, 79 patients with stomach cancer and 77 patients with pancreatic cancer were analyzed. One of the objectives of the research was to measure the advantage obtained by patients in accessing personalized therapies through the use of Next Generation Sequencing (NGS) techniques, which allow the complete genomic profiling of the molecular alterations of tumors. “The NGS technique allows you to maximize the search for biological information in a single sample carried out on very small quantities of tissue, with great advantages in terms of rapidity of analysis, in order to quickly direct patients with advanced or metastatic disease towards treatment more adequate. – stated Giancarlo Pruneri, Full Professor of Pathological Anatomy at the University of Milan and Director of the Department of Pathology and Laboratory Medicine of the IRCCS National Cancer Institute of Milan Foundation. – Our research has shown how the use of “large” panels in some specific tumor settings significantly improves the ability to capture the molecular alterations useful for including patients in clinical trials and allowing access to target therapies “.
Precision medicine: handbook for the cancer patient
by Simone Valesini
From the analysis carried out in the Institute on Mtb data, it appears that, in the case of cholangiocarcinoma, the percentage of patients eligible for target therapy (on label, off label or trial) rises from 17% with an analysis based on NGS panels ” small “(usually containing about 50 genes frequently altered in cancer) to 44% when molecular characterization is performed with” large “NGS panels (comprising several hundred genes). Even higher is the increase in the accessibility data to personalized therapies for patients with pancreatic cancer (from 2% to 35%) and stomach cancer (from 0% to 40%), while no significant changes were observed. in the case of the NSCLC.
This important result determined the decision of the INT, under the guidance of the Scientific Director Giovanni Apolone, to start the new project “Precision oncology for everyone”, which aims to sequence 2,500 patients with advanced and metastatic disease every year using large panels. . The project will maximize the ability to capture molecular alterations even for pathologies currently not considered eligible by the guidelines of the European and Italian society of oncology (ESMO and AIOM), with the main aim of implementing the recruitment of patients in experimental clinical studies.
The research also demonstrated the economic sustainability of the introduction of MTB in the Institute in terms of cost-benefit ratio: it emerged that MTB has a marginal impact on the cost of the entire path of the cancer patient, which averages around the 4%. These results confirm the sustainability of the use of the NGS method compared to the “single gene” model. Previous studies carried out in INT have already shown that NGS generates incremental economic savings compared to the volume of patients analyzed and the complexity of the molecular panels applied.
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