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Integrated oncology, increasingly based on science

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“THE FIRST question to ask cancer patients during the first visit is this: ‘what are your priorities and what is important to you?'”. To speak is Deng Gary, medical director of the Integrative Medicine department of the Memorial Sloan Kettering Cancer Center in New York, who just a few days ago was in Rome for the X International Congress of the Association for the Research of Integrated Cancer Therapies (Artoi): an event that saw the participation of 12 countries, gathered with the aim of drawing up shared guidelines on which are the best complementary treatments and on when and how to use them in order to enhance the effectiveness of standard therapies and mitigate their side effects, based on scientific evidence more solid. “Certainly we need to reduce the tumor mass – explains Gary from the consensus round table – but considering health from a higher perspective we can start not only from what we doctors consider most useful, but from what the patient considers most useful. Only in this way can care be centered on the patient and we can make the most of our experience “.

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The results of integrated oncology in glioblastoma and lung cancer

This is the premise. in fact, when it comes to integrated oncology. Which is conquering an ever greater space in the world of “classical” oncology also in Italy. As shown by the research presented at the congress: “We are conducting two studies on over 70 patients with glioblastoma and on almost 60 patients with lung cancer, followed for 5 and 3 years, respectively,” he explains. Massimo Bonucci, president of Artoi: “Everyone received an integrated treatment: classic therapies, such as chemo and radiotherapy, were accompanied by treatments such as acupuncture, hyperthermia, supplementation of natural substances that we know we can safely associate with drugs antiblastics. We must be careful not to trivialize: we are talking about substances of which we know well the pros and cons and the possible positive and negative interferences, depending on the drugs taken. Additionally, we used nutrition as a support. In these two series – not randomized, but controlled – we observed an improvement in both quality of life and survival compared to the data reported in the literature. There are now many similar studies at an international level, and the consensus document that emerged from the comparison between the various specialists will be a starting point for building the culture of integrated oncology, not only in Italy “.

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The challenge of the coming years

By integrated treatment we do not mean the use of this or that single substance, but – indeed – the synergy of several complementary strategies. This approach is still little practiced here, but slowly something is changing. It is no coincidence, in fact, that the first master in integrated oncology is about to start within the Department of Medicine and Psychology of the Sapienza University of Rome, in collaboration with Artoi. “The field is extremely large,” he said Paolo Marchetti, Professor of Medical Oncology at the Capitoline University, Scientific Director of the IDI-Irccs in Rome and President of the Foundation for Personalized Medicine, who gave the opening lecture of the congress: “It goes from acupuncture to supplementation of any kind and this can create a lot of confusion in some academic and clinical world. But the goal is clear: the control of symptoms and, more generally, the restoration of the conditions of well-being of the cancer patient. Whether this happens with a drug from a multinational or through the improvement of physical activity or with an infusion, it does not matter, what matters is that it is supported by scientific evidence. Some approaches already have very strong evidence, for others they are weak and need further study, for still others they are totally absent. Still other initiatives cannot be supported by evidence because they are linked to the doctor’s intuition ”.

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In acupuncture, for example, it is easy to standardize interventions and conduct studies with control groups, but when a “dynamic” and personalized package of interventions is administered, it is difficult to establish what produced an effect. The effort for the next 10 years, according to Gary, will be to better define reproducible treatments. This is why we need a shared consensus and training. In the US, already in 2014 a part of the American congress of clinical oncology concerned integrated therapies, to demonstrate how it had entered fully into medical science.

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Making the two worlds communicate

The collaboration between Sapienza and Artoi will not be limited to the academic course, but will also extend to the path of patient care, through daily discussions with integrated oncology specialists. But how can the two worlds – sometimes seemingly distant – collaborate in clinical practice? “At Memorial Sloan Kettering – explains Deng Gary – when we take care of a patient, we generally write an email to our oncologist colleagues who are always very busy: we explain to them how we intervened and we provide links to studies published and indexed on Pubmed to give an reference with respect to our approach. This, over time, creates trust and facilitates our work. Patients who feel better and solve their problems, however, remain the strongest evidence “.

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The study of interference and precision medicine

From a research perspective, an integrated approach could provide useful information for precision oncology as well. For example: let’s take 10 patients, all with the same type of tumor, all with the same mutation, all in some way “similar”. And all, obviously different: in some the therapy is very effective, in others a little less, in others not at all. Some have the “x” side effect, others the “y” effect, and there may be those who, despite having a regression of the disease, are forced to stop drugs because the undesirable effect has too great an impact on quality of life. The data show a confused picture, apparently without logic, that genomics can only partially explain. Why is it so difficult to understand the reasons for these enormous differences? One of the reasons is that they can be the result of unknown interference or are not taken into account. Interference, for example, with substances found in the house we live in, with food, with pollution, with the behavior we have.

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To understand the world of interference – what Marchetti and other researchers call the exposome – we need to focus on failures. To ask oneself, for example, why the female gender (and not only the female sex) does not respond to immunotherapy like the male one, or why the same happens in those who have been treated for a long time with antibiotics. And when a group of patients responds differently to the same treatment, we must think that we are probably not really observing a homogeneous whole and ask ourselves what the differences are in common. The message – truly shared – that is brought home from the 12 nations present at the congress indicates a change of perspective: to consider the patient no longer at the center, but as a partner.

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