OVER twenty years of pioneering research dedicated to improving the care of older people with lung cancer. Research that has changed clinical practice and, above all, has improved the quality of life of many fragile patients. It is for this work, and for having opened a new path of geriatric oncology, that Cesare Gridelli will be awarded in two days at the American Society of Clinical Oncology (Asco) annual meeting. Recognition is the B.J. Kennedy Award and Lecture for Scientific Excellence in Geriatric Oncology, established in 2007: that same year it was given to another Italian, Lodovico Balducci, and in 2015 to Silvio Monfardini.
Tumors: new therapies, more healed. And a mountain of money
by Daniela Minerva
The “soft” chemo study
“Until 20 years ago, elderly patients with advanced lung cancer were not treated”, says Gridelli, Neapolitan by birth and today head of the Medical Oncology of the Moscati Hospital of Avellino: “Chemotherapy was very toxic and all that was offered to patients over 70 was palliative therapy to relieve coughs ”. His first study was, in 1997, that tested the tolerability and efficacy of a lighter chemotherapy, with a single drug (vinorelbine) and without platinum, in elderly patients. The results showed that this chemotherapy was tolerated and that it led to an improvement in the quality of life, thanks to the reduction of pain and breathlessness. “This was the primary objective of the study – recalls Gridelli – even before the increase in survival. The results were presented precisely at the Asco congress and gave way to a series of important studies in collaboration with the Pascale Hospital of Naples and, later, with the Hospital of Avellino “.
Cancer, what it means to cure the elderly
by TIZIANA MORICONI
Drugs are becoming less and less toxic. Now let’s improve territorial assistance
Over the years other increasingly less toxic combinations of drugs have been tested. And the landscape has changed again with the arrival of oral biological therapies, well tolerated by the over 70s, and immunotherapies, which have allowed important progress for the treatment of the most fragile patients. “Survival has improved a lot – continues the oncologist – today we are able to administer chemotherapy even to the most fragile patients and to make combinations of chemo and immunotherapy. New molecularly targeted drugs and immunotherapies will increasingly have to gain ground over chemotherapies in this population. But the change must clearly also concern the type of assistance: these are patients who must be taken care of at the local level, with an integration of hospital and local services ”. This does not occur everywhere in Italy today: the organization is closely linked to the development of oncological networks and multidisciplinary groups.
Cancer and the elderly, the geriatrician makes a difference
Tiziana Moriconi
Elderly does not mean fragile
Gridelli deliberately uses the term “fragile” instead of “elderly” because even the conception of an elderly person has changed over time. “Biological age matters much more than chronological age,” he explains: “People of the same chronological age can have very different health conditions. But assessing the biological age is complex: we are beginning to have a series of tools available, which, however, are not yet standardized. Being able to establish criteria on the basis of biological age is one of the challenges of the near future ”.
In addition to the research activity, Asco’s recognition also goes to the tireless educational activity carried out by the Campania oncologist: together with the leading experts in geriatrics and oncology worldwide, he contributed to defining the international recommendations on the treatment of cancer. of the lung in frail people. If the path appears well traced, however, much remains to be done at a cultural level, starting with the criteria for access to clinical trials. “Until recently – concludes Gridelli – the limit for participating in a clinical study was 70 years. This is no longer the case, but elderly and frail patients continue to be underrepresented ”.
.