For days, media and public attention has been focused on Kate Middleton’s tumor and everyone is wondering what it could be. The only clue is that it is abdominal cancer which leads to the possibility that it could be one of the female tumors including ovarian cancer, one of the so-called ‘big killers’. In fact, it represents approximately 30% of gynecological neoplasms and occupies tenth place among all female tumors. This is why the Ovarian Cancer Commitment (Occ) was born, a European initiative promoted by AstraZeneca together with the European Society of Gynecological Oncology (Esgo) and the European Network of Gynecological Cancer Advocacy Groups (ENGAGe). It aims to improve the quality of life and survival of patients, but also to promote and speed up access to tests for predictive biomarkers and innovative treatments for ovarian cancer, the gynecological neoplasm which has the highest rate of mortality.
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The urgency of screening programs
In Italy up to 80% of ovarian cancer cases are diagnosed late. In fact, over 4,800 new diagnoses per year are identified with the disease already in an advanced stage. It is therefore necessary to increase awareness among women, through appropriate information campaigns, on a pathology that is still little talked about. “The pathology causes more than 3,200 deaths every year – he underlines Nicoletta Colombo, director of Medical Oncology Gynecology at the European Institute of Oncology and associate professor of Obstetrics and Gynecology at the University of Milan-Bicocca. This is due to non-specific and late symptoms, and the total lack of screening programs. Despite the difficulties in obtaining early diagnoses, there has been no lack of important therapeutic innovations in recent years. In particular, precision oncology is bringing great benefits in terms of survival.”
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The importance of diagnostic tests
Ovarian cancer is characterized by significant genetic deficits that alter the mechanisms for repairing DNA damage. “The HRD test capable of detecting when the mechanism of homologous recombination or Homologus Recombination Deficiency does not work has existed for some years,” he continues. Sandro Pignata, director of the Medical Oncology Division, Department of Uro-Gynaecology – National Cancer Institute Irccs Fondazione G. Pascale, Naples. It is a ‘correction system’ which, if it stops working, causes the DNA to generate new errors. These are, in fact, the main biological characteristics of ovarian cancer.”
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Precise diagnoses for personalized therapies
Performing the HRD test therefore allows treatments to be adapted to each individual patient and allows clinicians to propose surveillance or risk reduction strategies. “It represents an evolution of the BRCA test and is relevant in the choice of therapy with Parp inhibitors, the new class of drugs capable of combating tumors that present a defect in the homologous recombination process,” continues Pignata. The execution of the HRD test requires technological and software platforms currently present only in a few highly specialized centers. Furthermore, at the moment, the pricing and reimbursement process for the test is not always clear and homogeneous for all Regions.
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Reference centers throughout the territory
Another fundamental issue that the members of the Ovarian Cancer Commitment have focused on is the right of all patients with ovarian cancer to be assisted in oncology centers specialized in the treatment of this very complex disease. “In a short time – he underlines Anna Fagotti, full professor of Obstetrics and Gynecology at the Catholic University of the Sacred Heart, director of the Complex Operational Unit at the Fondazione Policlinico Universitario A. Gemelli Irccs and president of the European Society of Gynecological Oncology – it is necessary to adopt the selection criteria and standards of the reference centers within regional oncology networks. Throughout the national territory, homogeneous guidelines are needed that respect some essential criteria and standards, 10 in total, which were recently established by the European Society of Gynecological Oncology and provide, among others, the presence of a specialized surgeon, a volume threshold of at least 20 interventions per year, the presence of multidisciplinary teams and access to clinical trials”.
The role of patient associations and institutions
As always happens when it comes to rather serious diseases, there are still many unsatisfied needs of patients: “Therapeutic innovation is improving the prospects of women affected by ovarian cancer but greater attention must be paid to the level of social and healthcare assistance and quality of life during and after therapies,” he comments Nicoletta Cerana, president Acto Italia – Alliance against Ovarian Cancer ETS. “Ovarian cancer still causes too many victims in Italy as well as in many other Western countries – comments the Honorable Annarita Patriarca, member of the Social Affairs Commission of the Chamber of Deputies. However, it is still a poorly understood oncological disease and it is necessary to inform the public more. On the institutional side, a joint commitment from the Government and Parliament is necessary to guarantee access to all women to the most innovative and effective treatments. A priority that cannot be postponed, which must be included in the political agenda.”
‘Do you have two minutes?’
During the round table for the presentation of the Ovarian Cancer Commitment, the new communication campaign “Do you have two minutes?” which aims to raise awareness on the topic of prevention. “Our company is proud to support a valuable project like this which aims to inform the female population about a neoplasm that still has a complex diagnosis”, concludes Alessandra Dorigo, Head of Oncology of AstraZeneca Italy. At the same time, with Ovarian Cancer Commitment we have started a collaboration with the various players in the health system with the aim of improving the diagnosis and treatment of ovarian cancer. Advances in scientific research and clinical practice in recent years have produced great results. The common commitment must be to make these innovations more accessible so that they do not remain the prerogative of a few patients.”