Every year, in Lombardy, about 7,800 new cases of lung cancer are recorded (5,000 in men and 2,800 in women). Numbers that could rise due to the indirect effects of Covid-19. In Lombardy, in the crucial months of the pandemic, in fact, there was a reduction in hospital admissions due to the fear of contagion by all cancer patients, including those with lung cancer, with the risk of serious consequences on the treatment front. Despite the difficult period, however, a positive signal arrives: in the Region there is an increase in the diagnosis of lung cancer at an early stage.
The role of screening
“The timely recognition of the disease – he says Sabrina Rossi, Medical Oncology Operating Unit of the IRCCS Humanitas Clinical Institute of Rozzano (MI) – is a key aspect in a cancer in which immediate patient care is essential and can significantly improve the chances of survival and quality of life”. The role determined by oncological screening is fundamental for a timely diagnosis of cancer. Even in this area, however, the Covid pandemic has weighed significantly, forcing a forced stop throughout the country. Despite this generalized condition, at Humanitas – whose Cancer Center has never stopped its activities in support of patients – important results have been observed thanks to the measures implemented to monitor the virus. “For lung cancer, unlike other neoplasms, there is no screening program that allows identifying the disease in the very early stages – explains Dr. Rossi -. On the other hand, however, the increase in chest CT scans to monitor Covid pneumonia has made it possible to arrive at early diagnoses of lung cancer, with significant therapeutic results “.
Computed tomography
On the other hand, the use of computed tomography, an indispensable part for planning radiation treatment, has been extended to the thoracic district to all patients, candidates for radiotherapy, precisely for the identification of early signs from Covid. “In this way – explains Dr. Franceschini Department of Radiotherapy and Radiosurgery of the IRCCS Istituto Clinico Humanitas – we were able to intercept coronavirus positive patients who did not yet show symptoms, for which suitable interventions were adopted and the risk of infection was avoided in the wards of the most fragile ” . In a condition of extreme urgency and novelty such as that envisaged by the pandemic, it was thus possible to observe the potential of a single tool for the benefit of different categories of patients, with important benefits on both sides.
A team effort
“After the identification of lung cancer, our clinical practice includes a multidisciplinary discussion of all experts to identify the most valid therapeutic strategy – explains Dr. Rossi -. On the treatment front, we use immunotherapy after chemo-radiotherapy, in cases where it is required, with important benefits “. The validity of this approach, in unresectable third stage patients, was confirmed by the 5-year update of the results of the PACIFIC study presented last June at the congress of the American Society of Medical Oncology (ASCO).
The Pacific studio
PACIFIC results demonstrated the great benefits of immunotherapy in patients with unresectable stage III non-small cell lung cancer (NSCLC) who did not progress after chemo-radiotherapy. One in three patients with NSCLC has stage III disease at diagnosis, a setting where most of the time the tumor cannot be surgically removed. In the study, there was a five-year overall survival rate of 42.9% for patients treated with an immunocologic molecule, durvalumab, compared with 33.4% for placebo after chemo-radiotherapy. After immunotherapy treatment lasting up to one year, one in three patients treated with durvalumab did not progress five years after enrollment compared with 19% for placebo.
“The important results of the PACIFIC study are also confirmed by the ‘real life’ data, that is to say from daily clinical practice – concludes dr. Franceschini -. Several studies, including Italian ones, have shown that at 2-3 years the data found in hospitals are absolutely superimposable to those of the registration study. The observations will continue over the next few years and it will be possible to verify whether the 5-year results will also be validated, with the strong benefit of durvalumab ”.
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